Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials

Abstract

Objective: The efficacy of low-level laser treatment (LLLT) for chronic back pain remains controversial due to insufficient trial data. We aimed to conduct an updated review to determine if LLLT (including laser acupuncture) has specific benefits in chronic non-specific low back pain (CNLBP).

Methods: Electronic databases were searched for randomised trials using sham controls and blinded assessment examining the intervention of LLLT in adults with CNLBP. Primary outcomes were pain and global assessment of improvement with up to short-term follow-up. Secondary outcomes were disability, range of back movement, and adverse effects. A random effects meta-analysis was conducted. Subgroup analyses were based on laser dose, duration of baseline pain, and whether or not laser therapy used an acupuncture approach.

Results: 15 studies were selected involving 1039 participants. At immediate and short-term follow-up there was significant pain reduction of up to WMD (weighted mean difference) -1.40 cm (95% CI -1.91 to -0.88 cm) in favour of laser treatment, occurring in trials using at least 3 Joules (J) per point, with baseline pain <30 months and in non-acupuncture LLLT trials. Global assessment showed a risk ratio of 2.16 (95% CI 1.61 to 2.90) in favour of laser treatment in the same groups only at immediate follow-up.

Conclusions: We demonstrated moderate quality of evidence (GRADE) to support a clinically important benefit in LLLT for CNLBP in the short term, which was only seen following higher laser dose interventions and in participants with a shorter duration of back pain. Rigorously blinded trials using appropriate laser dosage would provide greater certainty around this conclusion.

Keywords: LASER THERAPY, LOW LEVEL; PAIN MANAGEMENT; SYSTEMATIC REVIEWS.

Figure 1

Flow chart: study selection. *Excluded study (Toya⁴¹). LBP, low back pain.

Figure 2

Risk of bias summary: review authors’ judgements on risk of bias items for each included study. Proportion of low risk studies: Random sequence generation (53%), Allocation concealment (47%), Blinding participants (67%), Blinding therapists (60%), Blinding outcome assessors (67%), Incomplete outcome data (60%), Selective reporting (80%), Group baseline similarity (67%), Co-interventions (80%), Compliance (100%), Intention to treat (40%), Timing outcome assessment (87%). Note: Glazov 2013a and 2013b represent different groups of same study.

Figure 3

Forest plots: subgroup analysis of pain at immediate follow-up. LA, laser acupuncture.

Figure 4

Forest plots: subgroup analysis of global assessment at immediate follow-up. LA, laser acupuncture.