Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review

Shaiane Silva Tomazoni; Matheus Oliveira Almeida; Jan Magnus Bjordal; Martin Bjørn Stausholm; Caroline Dos Santos Monteiro Machado; Ernesto Cesar Pinto Leal-Junior; Leonardo Oliveira Pena Costa

doi:10.1016/j.jphys.2020.06.010

Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review

J Physiother. 2020 Jul;66(3):155-165. doi: 10.1016/j.jphys.2020.06.010. Epub 2020 Jul 14.

Authors

Shaiane Silva Tomazoni¹, Matheus Oliveira Almeida², Jan Magnus Bjordal³, Martin Bjørn Stausholm³, Caroline Dos Santos Monteiro Machado⁴, Ernesto Cesar Pinto Leal-Junior⁴, Leonardo Oliveira Pena Costa²

Affiliations

¹ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. Electronic address: shaiane.tomazoni@gmail.com.
² Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
³ Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁴ Laboratory of Phototherapy and Innovative Technologies in Health, Nove de Julho University, São Paulo, Brazil; Post-graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil.

PMID: 32680739
DOI: 10.1016/j.jphys.2020.06.010

Abstract

Question: In people with non-specific low back pain (LBP), what are the effects of photobiomodulation therapy (PBMT) on pain, disability and other outcomes when compared with no intervention, sham PBMT and other treatments, and when used as an adjunct to other treatments?

Design: Systematic review of randomised trials with meta-analysis.

Participants: People with acute/subacute or chronic non-specific LBP.

Interventions: Any type of PBMT (laser class I, II and III and light-emitting diodes) compared with no treatment, sham PBMT and other types of treatment, or used as an adjunct to another treatment.

Outcome measures: Pain intensity, disability, overall improvement, quality of life, work absence and adverse effects.

Results: Twelve randomised controlled trials were included (pooled n = 1,046). Most trials had low risk of bias. Compared with sham PBMT, the effect of PBMT on pain and disability was clinically unimportant in people with acute/subacute or chronic LBP. In people with chronic LBP, there was no clinically important difference between the effect of PBMT and the effect of exercise on pain or disability. Although benefits were observed on some other outcomes, these estimates were imprecise and/or based on low-quality evidence. PBMT was estimated to reduce pain (MD -11.20, 95% CI -20.92 to -1.48) and disability (MD -11.90, 95% CI -17.37 to -6.43) more than ultrasound, but these confidence intervals showed important uncertainty about whether the differences in effect were worthwhile or trivial. Conversely, PBMT was estimated to reduce pain (MD 19.00, 95% CI 9.49 to 28.51) and disability (MD 17.40, 95% CI 8.60 to 26.20) less than Tecar (Energy Transfer Capacitive and Resistive) therapy, with marginal uncertainty that these differences in effect were worthwhile.

Conclusion: Current evidence does not support the use of PBMT to decrease pain and disability in people with non-specific LBP.

Registration: CRD42018088242.

Keywords: Light emitting diode therapy; Low-level laser therapy; Musculoskeletal disorders; Phototherapy; Rehabilitation.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Disability Evaluation
Humans
Low Back Pain / therapy*
Pain Management / methods*
Pain Measurement
Phototherapy / methods*
Quality of Life
Randomized Controlled Trials as Topic