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

摘要

QuestionIn 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?DesignSystematic review of randomised trials with meta-analysis.ParticipantsPeople with acute/subacute or chronic non-specific LBP.InterventionsAny 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 measuresPain intensity, disability, overall improvement, quality of life, work absence and adverse effects.ResultsTwelve 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.ConclusionCurrent evidence does not support the use of PBMT to decrease pain and disability in people with non-specific LBP.RegistrationCRD42018088242.