Skip to main content

Is low-level laser therapy in relieving neck pain effective? Systematic review and meta-analysis

Rheumatology International volume 33, pages 2493–2501 (2013)Cite this article

Abstract

The aim of this study is to determine the efficacy of low-level laser therapy (LLLT) in reducing acute and chronic neck pain as measured by the visual analog scale (VAS). A systematic search of nine electronic databases was conducted to identify original articles. For study selection, two reviewers independently assessed titles, abstracts, and full text for eligibility. Methodological quality was assessed using the Detsky scale. Data were analyzed using random-effects model in the presence of heterogeneity and fixed-effect model in its absence. Heterogeneity was assessed using Cochran’s Q statistic and quantifying I 2. Risk ratios (RR) with 95 % confidence intervals (CI) were reported. Eight randomized controlled trials involving 443 patients met the strict inclusion criteria. Inter-rater reliability for study selection was 92.8 % (95 % CIs 80.9–100 %) and for methodological quality assessment was 83.9 % (95 % CIs 19.4–96.8 %). Five trials included patients with cervical myofascial pain syndrome (CMPS), and three trials included different patient populations. A meta-analysis of five CMPS trials revealed a mean improvement of VAS score of 10.54 with LLLT (95 % CI 0.37–20.71; Heterogeneity I 2 = 65 %, P = 0.02). This systematic review provides inconclusive evidence because of significant between-study heterogeneity and potential risk of bias. The benefit seen in the use of LLLT, although statistically significant, does not constitute the threshold of minimally important clinical difference.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

CI:

Confidence interval

CID:

Clinical important difference

CMPS:

Cervical myofascial pain syndrome

ICC:

Intraclass correlation coefficient

LLLT:

Low-level laser therapy

RCT:

Randomized controlled trial

RR:

Risk ratio

VAS:

Visual analog scale

References

  1. Hoy DG, Protani M, De R, Buchbinder R (2010) The epidemiology of neck pain. Best Pract Res Clin Rheumatol 24(6):783–792

    Article  PubMed  CAS  Google Scholar 

  2. Loeser JD, Bonica JJ, Technologies Ovid I (2000) Bonica’s management of pain, 3rd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  3. Goroll AH (2000) Evaluation of neck pain. Primary care medicine. Lippincott Williams & Wilkins, Philadelphia, pp 844–847

    Google Scholar 

  4. Guzman J, Haldeman S, Carroll LJ, Carragee EJ, Hurwitz EL, Peloso P et al (2008) Clinical practice implications of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders: from concepts and findings to recommendations. Spine 33(4 Suppl):S199–S213

    Article  PubMed  Google Scholar 

  5. Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K et al (2005) Low level laser therapy (classes I, II and III) for treating rheumatoid arthritis. Cochrane Database Syst Rev 4:CD002049

    PubMed  Google Scholar 

  6. Wesselmann U, Lin SF, Rymer WZ (1991) Selective decrease of small sensory neurons in lumbar dorsal root ganglia labeled with horseradish peroxidase after ND: YAG laser irradiation of the tibial nerve in the rat. Exp Neurol 111(2):251–262

    Article  PubMed  CAS  Google Scholar 

  7. Palma J, Juri H, Campana V et al (1983) Blockade of inflammatory signals by laser radiation. Lasers Surg Med 3(1 Suppl):11

    Google Scholar 

  8. Sattayut S, Hughes F, Bradley P (1999) 820 nm gallium aluminium arsenide laser modulation of a prostaglandin E2 production in interleukin 1 stimulated myoblasts. Laser Ther 11(2):88–95

    Article  Google Scholar 

  9. Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S (2004) Efficacy of 904 nm gallium Arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med 35(3):229–235

    Article  PubMed  Google Scholar 

  10. Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M et al (2008) Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev 2:CD005107

    PubMed  Google Scholar 

  11. Gam AN, Thorsen H, Lonnberg F (1993) The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis. Pain 52(1):63–66

    Article  PubMed  CAS  Google Scholar 

  12. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (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

    Article  PubMed  Google Scholar 

  13. Detsky AS, Naylor CD, O’Rourke K, McGeer AJ, L’Abbe K (1992) Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol 45(3):225–265

    Article  Google Scholar 

  14. Hatala R, Keitz S, Wyer P et al (2005) Evidence-based medicine teaching tips working group. Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results. CMAJ 172:661–665

    Article  PubMed  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  PubMed  CAS  Google Scholar 

  16. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2):149–158

    Article  PubMed  CAS  Google Scholar 

  17. Shiri R, Viikari-Juntura E (2010) Low-level laser therapy for neck pain. Lancet 375(9716):721–722

    Article  PubMed  Google Scholar 

  18. Verhagen AP, Schellingerhout JM (2010) Low-level laser therapy for neck pain. Lancet 375(9716):721

    Article  PubMed  Google Scholar 

  19. Bijur PE, Silver W, Gallagher EJ (2001) Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8(12):1153–1157

    Article  PubMed  CAS  Google Scholar 

  20. Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14(7):798–804

    Article  PubMed  Google Scholar 

  21. Altan L, Bingol U, Aykac M, Yurtkuran M (2005) Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int 25(1):23–27

    Article  PubMed  Google Scholar 

  22. Ceccherelli F, Altafini L, Castro GL, Avila A, Ambrosio F, Giron GP (1989) Diode laser in cervical myofascial pain: a double-blind study versus placebo. Clin J Pain 5(4):301–304

    Article  PubMed  CAS  Google Scholar 

  23. Chow RT, Heller GZ, Barnsley L (2006) The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study. Pain 124(1–2):201–210

    Article  PubMed  Google Scholar 

  24. Chow RT, Barnsley L, Heller GZ, Siddall PJ (2004) A pilot study of low-power laser therapy in the management of chronic neck pain. J Musculoskeletal Pain 12(2):71–81

    Article  Google Scholar 

  25. Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V (2007) The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clin Rheumatol 26(6):930–934

    Article  PubMed  CAS  Google Scholar 

  26. Ilbuldu E, Cakmak A, Disci R, Aydin R (2004) Comparison of laser, dry needling, and placebo laser treatments in myofascial pain syndrome. Photomed Laser Surg 22(4):306–311

    Article  PubMed  Google Scholar 

  27. Ozdemir F, Birtane M, Kokino S (2001) The clinical efficacy of low-power laser therapy on pain and function in cervical osteoarthritis. Clin Rheumatol 20(3):181–184

    Article  PubMed  CAS  Google Scholar 

  28. Konstantinovic LM, Cutovic MR, Milovanovic AN, Jovic SJ, Dragin AS, Letic MD et al (2010) Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized study. Pain Med 11(8):1169–1178

    Article  PubMed  Google Scholar 

  29. Cadeddu M, Farrokhyar F, Levis C, Cornacchi S, Haines T, Thoma A (2012) Evidence-based surgery working group. Users’ guide to the surgical literature. Understanding confidence intervals. Can J Surg 55(3):207–211

    Article  PubMed  Google Scholar 

  30. Jang H, Lee H (2012) Meta-analysis of pain relief effects by laser irradiation on joint areas. Photomed Laser Surg 30(8):p405–p417

    Article  Google Scholar 

Download references

Acknowledgments

We thank Andrea McLellan and Jennifer McKinnell, Health Sciences Librarians, for their guidance in developing a comprehensive search strategy. We also thank Tahrin Mahmood, for masking study results and authors affiliations. We are grateful to Kaelan Moat, Dr. Bingshu Chen, and Dr. Rob Brison for their insightful comments and suggestions.

Conflict of interest

There are no competing interests.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Ottawa, Ottawa, Canada

    Amjed Kadhim-Saleh & Harinad Maganti

  2. Department of Surgery, McMaster University, 39 Charlton Ave. E, Hamilton, ON, L8N 1Y3, Canada

    Michelle Ghert, Sheila Singh & Forough Farrokhyar

  3. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

    Forough Farrokhyar

Authors
  1. Amjed Kadhim-Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Harinad Maganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Ghert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sheila Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Forough Farrokhyar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Forough Farrokhyar.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kadhim-Saleh, A., Maganti, H., Ghert, M. et al. Is low-level laser therapy in relieving neck pain effective? Systematic review and meta-analysis. Rheumatol Int 33, 2493–2501 (2013). https://doi.org/10.1007/s00296-013-2742-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-013-2742-z

Keywords

  • Neck pain
  • Laser therapy, low-level
  • Myofascial pain syndrome
  • Meta-analysis