Open AccessLow-Level Laser Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis
Author(s) -
Shu Wei Yeh,
Chien Hsiung Hong,
Ming Chieh Shih,
Ka Wai Tam,
Yao Huang,
Yi Chun Kuan
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.241
Subject(s) - medicine , fibromyalgia , meta analysis , physical therapy , strictly standardized mean difference , low level laser therapy , randomized controlled trial , placebo , cochrane library , confidence interval , medline , anxiety , systematic review , laser therapy , alternative medicine , psychiatry , laser , physics , pathology , political science , law , optics
Background: Fibromyalgia is a chronic disorder characterized by widespread pain and tenderness.Low-level laser therapy (LLLT), an emerging nonpharmacological treatment, has been used forrelieving musculoskeletal or neuropathic pain.Objective: The objective of this review and meta-analysis was to determine the efficacy of LLLTon patients with fibromyalgia.Study Design: This study involved systematic review and quantitative meta-analysis of publishedrandomized controlled trials (RCTs).Setting: This study examined all RCTs evaluating the effect of LLLT on fibromyalgia.Methods: We performed a systematic review and meta-analysis of RCTs evaluating the effect ofLLLT on patients with fibromyalgia. PubMed, EMBASE, and the Cochrane Library were searchedfor articles published before August 2018. RCTs meeting our selection criteria were included. Themethodological quality of the RCTs was evaluated according to the Cochrane risk-for-bias method.Review Manager version 5.3 was used to perform the meta-analysis. The primary outcomes werethe total scores on the Fibromyalgia Impact Questionnaire (FIQ), pain severity, and number oftender points. The secondary outcomes were changes in fatigue, stiffness, anxiety, and depression.Standardized mean difference (SMD), 95% confidence intervals (CI), and P values were calculatedfor outcome analysis.Results: We identified 9 RCTs that included 325 fibromyalgia patients undergoing LLLT orplacebo laser treatment with or without an exercise program. The meta-analysis showed thatpatients receiving LLLT demonstrated significantly greater improvement in their FIQ scores (SMD:1.16; 95% CI, 0.64-1.69), pain severity (SMD: 1.18; 95% CI, 0.82-1.54), number of tenderpoints (SMD: 1.01; 95% CI, 0.49-1.52), fatigue (SMD: 1.4; 95% CI, 0.96-1.84), stiffness (SMD:0.92; 95% CI, 0.36-1.48), depression (SMD: 1.46; 95% CI, 0.93-2.00), and anxiety (SMD: 1.46;95% CI, 0.45-2.47) than those receiving placebo laser. Furthermore, when compared with thestandardized exercise program alone, LLLT plus the standardized exercise program provided noextra advantage in the relief of symptoms. On the other hand, the results of the only RCT usingcombined LLLT/LED phototherapy showed significant improvement in most outcomes except fordepression when compared to placebo. When compared with pure exercise therapy, combinedLLLT/LED phototherapy plus exercise therapy had additional benefits in reducing the severity ofpain, number of tender points, and fatigue.Limitations: There were some limitations in this review, mostly because of the low-to-middlemethodological quality of the selected studies; for example, there was no clear allocation processand only patients were blinded in most studies. In addition, one study used per-protocol analysiswith a 20% loss to follow-up. On the other hand, the differences in laser types, energy sources,exposure times, and associated medication status in these studies may have resulted in someheterogeneity.Conclusions: Our results provided the most up-to-date and relevant evidence regardingthe effects of LLLT in fibromyalgia. LLLT is an effective, safe, and well-tolerated treatment forfibromyalgia.Key words: Low-level laser therapy, fibromyalgia, meta-analysis, FIQ, pain, tender points,exercise