Besides increasing blood perfusion and collagen proliferation along with peripheral nerve stimulation, laser therapy has direct analgesic and anti-inflammatory effects [12-14]. This is because the laser reduces the level of PGE2, which decreases the release of the substance P, a neuropeptide playing a significant role in inflammation and pain. 

In the case of a high-level nerve sensitization, the pain level could already be too high for the patient to accept a dose-efficient shockwave treatment. Given that high power laser therapy before a shock wave treatment increases the pain threshold, it will be possible to deliver more energy during shock wave therapy,  making it more effective.