Low-level laser therapy found to be effective in the management of neck pain
Citation of the full article:
Chow R.T., ‘Johnson M., B Lopes-Martins R.A.B., Bjordal J.M., 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):1897-908.
Neck pain is a common form of pain among various sections of the population for which pharmacological management has limited evidence of efficacy and oftentimes, side-effects. Thus, an alternative therapy is necessary to combat it and reduce pain and suffering in those suffering from the condition. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for different forms of pain (neck pain inclusive), in which non-thermal laser irradiation is applied to sites of pain. This is a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in treating and managing neck pain. The purpose of the review was to determine, according to available medical evidence, whether LLLT is effective or not in the treatment of neck pain conditions.
The systematic review used a computerised database search to look for evidence and published articles which compared the efficacy of LLLT (using any wavelength) with placebo or with active control in acute or chronic neck pain. This search generated a total of 16 randomised controlled trials in which altogether, 820 patients participated. The size for the primary outcome – pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale.
For acute neck pain, results from two of the 16 trials used in this review showed a relative risk (RR) of 1.69 (95% CI 1.22 – 2.33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4.05 (2.74 – 5.98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19.86 mm (10.04-29.68). Seven trials provided follow-up data for 1 – 22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22.07 mm (17.42 – 26.72). There was no significant difference in the side effects experienced by those who received LLLT and those who received placebo.
Based on the findings from this systematic review, the authors concluded that LLLT reduces pain immediately after treatment in acute neck pain conditions and up to 22 weeks after completion of treatment in patients with chronic neck pain.
Although, LLLT and photomedicine is a growing field of study with overwhelming potentials, physicians should take great caution in dealing with evidence from early researches and studies. While it is understandable that there is a dearth of literature/evidence as far as LLLT is concerned simply because the field is still evolving, conclusion arrived at as a result of review and meta-analysis of just 16 studies with only 820 participants (which is considered too small) should be taken with a pinch of salt. In the study summarised above, the studies were not even screened for quality as not all studies are of good qualities considering the methodologies and designs employed for the study. This alone can faults the findings of a systematic review.
Moreover, the study would have had a more robust base on which to make generalisations if the references and citations in the generated 16 articles had been used to probably increase the number of studies and evidence used for the review but this was not done. Details of randomisation were not explained in the study and the socio – demographic characteristics of the patients, which can affect how they rate or assess pain, were not put into serious consideration.
However, this study is a solid foundation on which other studies can build on in order to increase the number and improve the quality of evidence available on LLLT and since there are no serious side effects associated with LLLT, it is worth trying out for patients suffering from various forms of pain especially those resistant to conventional therapy.