title: Low-level laser therapy for chronic non-specific low back pain: a meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  The efficacy of low-level laser treatment (LLLT) for chronic back pain remains controversial due to insufficient trial data. We aimed to conduct an updated review to determine if LLLT (including laser acupuncture) has specific benefits in chronic non-specific low back pain (CNLBP).
  
  
  METHODS
  Electronic databases were searched for randomised trials using sham controls and blinded assessment examining the intervention of LLLT in adults with CNLBP. Primary outcomes were pain and global assessment of improvement with up to short-term follow-up. Secondary outcomes were disability, range of back movement, and adverse effects. A random effects meta-analysis was conducted. Subgroup analyses were based on laser dose, duration of baseline pain, and whether or not laser therapy used an acupuncture approach.
  
  
  RESULTS
  15 studies were selected involving 1039 participants. At immediate and short-term follow-up there was significant pain reduction of up to WMD (weighted mean difference) -1.40 cm (95% CI -1.91 to -0.88 cm) in favour of laser treatment, occurring in trials using at least 3 Joules (J) per point, with baseline pain <30 months and in non-acupuncture LLLT trials. Global assessment showed a risk ratio of 2.16 (95% CI 1.61 to 2.90) in favour of laser treatment in the same groups only at immediate follow-up.
  
  
  CONCLUSIONS
  We demonstrated moderate quality of evidence (GRADE) to support a clinically important benefit in LLLT for CNLBP in the short term, which was only seen following higher laser dose interventions and in participants with a shorter duration of back pain. Rigorously blinded trials using appropriate laser dosage would provide greater certainty around this conclusion.
authors.affiliation: Hillarys Medical Centre, Hillarys, Western Australia, Australia School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Glazov
authors.affiliation: Primary Health Care, School of Medicine, Griffith University, Meadowbank, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Yelland
authors.affiliation: General Practice and Primary Care Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: LASER THERAPY, LOW LEVEL; PAIN MANAGEMENT; SYSTEMATIC REVIEWS