by Jeff S. Williams, DC
Article: “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials”
Authors: Roberta T. Chow, Mark I. Johnson, Rodrigo A.B. Lopes-Martins, Jan M. Bjordal
Publication Information: The Lancet 2009 Dec 5;374(9705):1897–1908, doi: https://doi.org/10.1016/S0140-6736(09)61522-1
Comment from Dr. Jeff Williams
When searching for low-risk, cost-effective modalities possessing the ability to aid practitioners in the treatment of non-complicated musculoskeletal complaints, research must lead the way. Often, we see the newest and the latest technology or apparatus put forth as the cure for everything we have been waiting for.
Low-level laser (LLLT) has, on the surface, the appearance of the latest and greatest apparatus. But what research is out there backing up claims commonly seen with low-level laser marketing in the healthcare field?
A quote from one 2015 study states, “According to the more than 4,000 studies on pub.med.gov, it can be concluded that the majority of laboratory and clinical studies have demonstrated that LLLT has a positive effect on acute and chronic musculoskeletal pain. Due to the heterogeneity of populations, interventions and comparison groups, this diversity means that every single study has not been positive. Pain is a very complex condition which presents in different forms with an interplay of mechanical, biochemical, psychological and socioeconomic factors. It is extremely challenging to compare LLLT to other treatments, and LLLT regimens are complicated by different lengths of treatment, all without standardization of wavelengths and dosages. Currently, there have been no long-term (greater than two-year follow up) human clinical studies that have evaluated LLLT. The overall positive short-term clinical studies in addition to strong laboratory studies should give the clinical confidence that LLLT may be beneficial for many individuals suffering from musculoskeletal pain, regardless of the cause. Consideration of evidence based treatment studies for LLLT has led to the determination that LLLT is classified as experimental/investigational by insurance companies (BCBSKS 2013), while the American Academy of Orthopedic Surgeons has no recommendations for or against its use. With FDA approval for temporary relief of muscle and joint pain, this underlines the need for further well-designed clinical studies.” (Cotlar H 2015)
Supporting this information is a paper published in The Lancet by Dr. Roberta Chow, et. al., and titled “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.” (Chow R 2009)
Why They Did It
The authors note that neck pain is a common malady and, many times, is expensive to treat. In addition, it is noted by the authors that pharmacological treatment has limited evidence backing it up as an effective treatment for neck pain therefore, other more effective and less expensive means should be explored. Low-level laser treatment for neck pain is the focus of this paper.
How They Did It
- The paper was a systematic review and meta-analysis of randomized controlled trials to assess efficacy of low-level laser for neck pain.
- The authors searched common databases comparing low-level laser using any wavelength with placebo or with active control in acute or chronic neck pain.
- Pain was the main outcome measurement and was a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.
- Sixteen randomized controlled trials were identified and accepted for use in the paper.
- There was a total of 820 subjects within the 16 trials.
What They Found
The authors concluded, “We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.”
It’s clear that one must be realistic when mitigating the real capabilities of low-level laser therapy as a treatment when including it in a clinical protocol. However, research appears to be positive for the use of low-level laser for pain relief and in accelerating healing. In addition, the side effects appear to be few, it is generally cost-effective, and widely tolerated by different types of patients (Cotler H 2015).
Dr. Williams is an actively practicing chiropractor, teacher, speaker, chiropractic advocate, vlogger/blogger, philanthropist, Anatomy & Physiology professor and podcast host. He is the founder and host of “The Chiropractic Forward Podcast,” addressing chiropractic care today through the use of chiropractic research reviews. Contact Dr. Williams at firstname.lastname@example.org.
Chow R (2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials." Lancet 374(9705): 1897-1908.
Cotler H (2015). "The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain." MOJ Orthop Rheumatol 2(15).