Photobiomodulation therapy for low back pain

 

This systematic review found that current evidence does not support the use of photobiomodulation therapy to decrease pain and disability in people with non-specific low back pain. Q&A with Shaiane Silva Tomazoni.

There have been several systematic reviews about photobiomodulation therapy (PBMT) for low back pain. Why did you decide that this topic needed to be re-visited?

In fact, there is three systematic reviews in the field of light-based therapy. However, two of them included high-intensity laser therapy and laser acupuncture. Although they are light-based therapies, neither of these is currently considered PMBT.

Therefore, only one systematic review about the effectiveness of PMBT (laser class I, II or III or LED) for low back pain was published in 2008—new trials have been conducted since then.

Therefore an update of this systematic review was necessary in order to provide the best updated evidence to clinicians and patients regarding the effects of PBMT in patients with low back pain.

What comparisons did you consider in the review?

We considered PBMT compared with control conditions such as minimal intervention, placebo and no treatment— compared with other intervention that were used as an adjunct to other treatments.

Did PBMT have a better effect than doing nothing?

Our results showed that there is low-quality evidence that PBMT has no better effect than doing nothing for acute or subacute or chronic low back pain.

What about when PBMT was compared to other interventions?

Low-quality evidence suggested that PBMT plus exercise improved pain and disability more that ultrasound plus exercise.

However, there is an uncertainty about whether this effect is clinically worthwhile. In addition, there is low-quality evidence suggesting that PBMT plus spinal manipulation and exercise is clinically worthwhile and better than exercise alone.

However, it is not possible to distinguish how much (if any) of that benefit is due to PBMT, due to the uncontrolled co-intervention (spinal manipulation).

Finally, there is low-quality evidence that PBMT is not better than energy transfer capacitive and resistive therapy for chronic low back pain in the short term.

Which did you conclude?

We conclude that there is insufficient evidence to support the use of PBMT to decreasing pain intensity and disability in patients with acute or subacute and chronic non-specific low back pain.

What should research in this area focus on now?

The most important aspect to be focused on is the optimisation of PBMT parameters in low back pain. Additionally, it is necessary to have further trials that investigate the long-term follow up as there is a lack of trials with this characteristic.

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