TheBeneficialEffectsofHigh-IntensityLaserTherapyandCo-InterventionsonMusculoskeletalPainManagement:ASystematicReview

High-intensity laser therapy (HILT) is an emerging treatment for musculoskeletal pain that delivers powerful laser beams (>500 mW) to penetrate deeper into tissues compared to traditional low-level laser therapy. While low-level laser therapy has been studied extensively, HILT represents a newer generation of laser therapy that can deliver higher amounts of energy to deep tissues in shorter treatment times. Clinicians often combine laser therapy with other interventions like exercise, manual therapy, or electrical stimulation, but the effectiveness of HILT alone versus HILT with co-interventions for musculoskeletal pain management needed systematic evaluation.

Researchers searched multiple medical databases through August 2018 for studies examining HILT in musculoskeletal pain conditions. They included only high-quality randomized controlled trials (scoring ≥7 on the PEDro quality scale) that reported pain scores using visual analogue scales and compared HILT to other treatments or placebo. Two reviewers independently assessed study quality and extracted data on pain outcomes, treatment parameters, and study characteristics. They calculated effect sizes to compare the magnitude of pain reduction between different treatments and analyzed studies in two groups: HILT alone or with exercise, and HILT combined with other interventions.

Of 52 initially identified studies, 19 high-quality trials met inclusion criteria, involving various conditions including spinal pain, knee osteoarthritis, shoulder pain, plantar fasciitis, and other musculoskeletal disorders. Approximately 94% of studies (18 out of 19) showed positive effects of HILT on pain reduction. Effect sizes varied widely, ranging from 0.9 to 9.11 for HILT groups and 0.21 to 11.22 for comparison groups. The most effective HILT applications were for osteopenia/osteoporosis, plantar fasciitis, and knee osteoarthritis, while the least effective were for lateral epicondylitis and some spinal conditions.

Studies with better outcomes typically used higher energy doses (average power 3-25 W), longer treatment periods (up to 3 months), pulsed laser delivery for at least 10 sessions, and often did not include anti-inflammatory medications that might interfere with laser effects.

While HILT shows promise for treating various musculoskeletal pain conditions, the evidence is still emerging and more research is needed before definitive recommendations can be made. The wide variation in treatment parameters, conditions studied, and outcome measures makes it difficult to establish optimal protocols. Adding complementary treatments like exercise or other physical therapy interventions may enhance HILT effectiveness, though this requires further investigation. For patients with chronic musculoskeletal pain, HILT represents a non-invasive treatment option that may provide significant pain relief, particularly for conditions like plantar fasciitis, knee problems, and certain spinal disorders.

However, treatment success likely depends on using appropriate laser parameters, sufficient treatment duration, and possibly avoiding concurrent anti-inflammatory medications that might interfere with the biological effects of laser therapy.