High-intensity laser therapy in low back pain management: a systematic review with meta-analysis.

Low back pain (LBP) is a widespread health issue affecting people globally and is the second leading cause of missed workdays. High-intensity laser therapy (HILT) promises to decrease pain intensity in LBP patients. The aim of this work was to evaluate the effect of HILT in adult LBP patients. We searched for randomized controlled studies (RCTs) published before January of 2023. Our primary outcome was pain intensity, while our secondary outcomes included disability and flexibility scores. We synthesized the evidence using RevMan v.5.4 and assessed methodological quality with the Oxford/Jadad scale and the Cochrane collaboration's risk of bias tool 1. The model favors the HILT group over the control group in terms of pain intensity after treatment (MD with 95% CI is -1.65 [-2.22, -1.09], p-value < 0.00001, I2=67%), Oswestry disability index (MD with 95% CI is -0.67 [-1.22, -0.12], p-value = 0.02, I2=73%), and Roland disability index (MD with 95% CI is -1.36 [-1.76, -0.96], p-value <0.00001, I2=0%). The patients in the high-intensity laser therapy had statistically significantly lower (low back) pain intensity compared to the patients in the control group. Based on three RCTs, our model also showed the positive effect of the HILT on LBP in terms of the Oswestry disability index and Roland disability index.

Effects of photobiomodulation and deep water running in patients with chronic non-specific low back pain: a randomized controlled trial.

Photobiomodulation therapy (PBM) is often used to treat musculoskeletal disorders such as chronic non-specific low back pain (NSCLBP) as it can have positive effects on biomarkers-creatine kinase (CK) and serum cortisol levels-related to stress caused by physical exercise, such as deep water running (DWR) or by pain. The aim of this study was to evaluate the effects of the combination of PBM and aquatic exercise (DWR) on the intensity of pain, disability, 6-min walk test adapted (6WTA), and on cortisol and creatine kinase (CK) levels in a population with NSCLBP. The participants were allocated into three groups: TGPBM (Photobiomodulation and Training Group), TGPLA (Placebo Photobiomodulation and Training Group), and the GPBM (Photobiomodulation Group). Information regarding anthropometric data, blood pressure, and heart rate were collected, and the questionnaires were applied: IPAQ-Short Form, Oswestry Disability Index, and the Visual Analog Scale for Pain. The submaximal exercise test (6WTA) was performed. Blood was collected for analysis of cortisol and CK levels. The training sessions were performed twice a week, for 4 weeks. In the intragroup comparisons, there were statistically significant changes in the TGPBM and GPBM groups in the outcomes pain intensity, disability (reductions in both groups), and in cortisol (increased in the TGPBM and reduced in the GPBM); in the TGPLA group, there was a statistically significant reduction only in the outcome of pain intensity. In the intergroup comparison, in the comparison between TGPBM and TGPLA, there was a statistically significant difference in the level of cortisol, as well as in the comparison between TGPBM and GPBM, in which there was a statistically significant difference for this same outcome (cortisol) and for the 6WTA outcome. The effects of the combination of PBM and aquatic exercise have positive effects on reducing pain intensity, disability, and cortisol levels, but its effects on other variables (6WTA and CK) are too small to be considered significant. Trial registration number: NCT03465228-April 3, 2019; retrospectively registered (ClinicalTrials.gov).

Biological non-ablative repair of lumbar discs by transforaminal intradiscal laser irradiation: MRI quantitative analysis of the effects-preliminary report.

Degenerative disc disease is a significant reason for low back pain. Low-level laser irradiation (LLLI) of cartilage results in its reshaping and combines with regenerative reaction. A certain pattern of lumbar disc irradiation induces healing reaction and formation of new cartilage. Quantitative MRI analysis of regenerative response of the cartilage is the subject of this investigation. Fifty-one lumbar discs of 28 patients with discogenic low back pain underwent irradiation with 1.56-µm Er fiber laser (1.2 W). Quantitative MRI analysis is performed in STIR regime within 0.93-14.80 months. Signal intensity is estimated from irradiated discs and control measured from adjacent non-irradiated discs and vertebral bones. T2 WI follow-up is performed within a long period (up to 5 years) in selected cases. The mean value of MRI signal intensity from the irradiated discs increased by 14% (p <<< 0.001). The control bone measurement revealed no difference in signal intensity (p = 0.83). The adjacent non-irradiated discs slightly increased their signal (p < 0.05). T2 WI follow-up within 5 years revealed a steady increase of the signal and the irradiated discs healing. LLLI of degenerated intervertebral discs by 1.56-µm Er fiber laser produces increase of MRI disc signal within the first year after treatment that confirms regenerative response of the disc and could lay in the basis of clinical improvement. Further assessment on the effect is mandatory.

Laser photobiomodulation is more effective than ultrasound therapy in patients with chronic nonspecific low back pain: a comparative study.

The purpose of this study was to compare the effects of laser photobiomodulation therapy (lPBMt) and ultrasound therapy (UST) in patients with chronic non-specific low back pain (CNLBP). Forty-five patients with CNLBP aged 30-40 years were divided randomly into three groups of 15 subjects each. The lPBMt group received 8 weeks of lPBMt with an exercise program, while the UST group received 8 weeks of UST with the same exercise program; the control group received only the exercise program for 8 weeks. Pain, disability, functional performance, and lumbar range of motion were assessed at the beginning of the study and after 8 weeks. There were no significant differences in demographic and clinical characteristics among the three groups at baseline (p > 0.05). At the end of the study, there were significant improvements in pain, disability, and functional performance in the two experimental groups (p < 0.05), but changes in the control group were non-significant. However, lumbar range of motion was significantly improved only in the lPBMt group (p < 0.05). When the three groups were compared in terms of a change in clinical variables, there was a significant difference among the three groups in all measures in favor of lPBMt group. Based on our results, both lPBMt or UST combined with an 8-week exercise program seemed to be effective methods for decreasing pain, reducing disability, and increasing functional performance in patients with CNLBP, although lPBMt is more effective than UST.

Photobiomodulation of the dorsal root ganglion for the treatment of low back pain: A pilot study.

BACKGROUND AND OBJECTIVE: Chronic low back pain is a worldwide public health issue with high socioeconomic impact. The aim of this study was to determine the efficacy of laser irradiation of the dorsal root ganglion of the second lumbar spinal nerve for chronic axial low back pain compared to lidocaine injection and radiofrequency treatment. STUDY DESIGN/MATERIALS AND METHODS: Twenty-eight patients were randomly divided into three treatment groups: lidocaine injection, radiofrequency, or laser. The second intervertebral foramen between the second and third lumbar vertebrae was accessed by percutaneous needle puncture bilaterally, guided by fluoroscopy. In the local anesthetic group, injection of 1 ml lidocaine without epinephrine was applied through a 20-gauge (G20) Quincke tip spinal needle inserted in the second lumbar intervertebral foramen. In the radiofrequency group, the probe (150 mm long with a 5 mm active tip) was directed through a G20 needle placed in the second lumbar intervertebral foramen and neuromodulation was done with a radiofrequency of Cosman G4® in pulses of 20 ms with wash-out period of 480 ms, for 300 seconds at 42°C. A single treatment was used. In the laser treatment group, a continuous wave, 808 nm wavelength diode laser (Photon Lase III® DCM, Brazil), with an output power of 100 mW was used for a single treatment. An 18 gauge needle was placed in the second lumbar intervertebral foramen guided by fluoroscopy. Light was delivered through a 600 µm optical fiber placed in the G18 needle. The tip of the fiber extended 5 mm beyond the tip of the needle in the second lumbar intervertebral foramen. The beam spot size was 0.003 cm(2) , irradiance = 35W/cm(2) , exposure time = 84 seconds, energy density = 2800J/cm(2) , total energy was 8.4 J. The low back pain score was assessed by the visual analog scale (VAS) and Pain Relief Scale (PRS) pre, post procedure and in 1 month follow up. Temperature was measured using a digital thermometer. RESULTS: All patients in the local anesthetic and laser treatment groups reported a pain reduction of at least 50% immediately post-procedure and 10 out of 11 patients in the radiofrequency group reported a pain reduction of at least 50%. At 1 month post-treatment, the laser treatment group had the greatest number of patients who reported more than 50% pain relief based on PRS (7 out of 10 patients) while only 2 out of 7 patients and 3 out of 11 patients in the lidocaine and radiofrequency treatment groups respectively reported more than a 50% pain relief. CONCLUSION: Laser irradiation caused an immediate decrease in low back pain post-procedure similar to pain reduction caused by lidocaine injection. Both lidocaine injection and laser irradiation were more effective than radiofrequency treatment for immediate and longer term (1 month post-treatment) chronic back pain. Lasers Surg. Med. 48:653-659, 2016. © 2016 Wiley Periodicals, Inc.

Effectiveness of Low-Level Laser Therapy in Patients with Discogenic Lumbar Radiculopathy: A Double-Blind Randomized Controlled Trial.

Purpose: To determine the effectiveness of low-level laser therapy (LLLT) in patients with discogenic lumbar radiculopathy and correlation among pain intensity, functional disability, and lumbar range of motion (LROM). Study Design/Setting. A double-blind RCT was conducted at physical therapy departments of different hospitals of Islamabad, Pakistan. The study period was March 2020 to August 2021. Patient Sample. The study comprised 110 patients with acute LBP and unilateral discogenic lumbar radiculopathy. Outcome Measures. The outcomes of the treatment were measured on the first day and then after 18 sessions from each patient's pain intensity, functional disability, L-ROM, and straight leg raise by using visual analogue scale, Oswestry disability index, dual inclinometer, and straight leg raise test. Methods: A total of 110 participants with a mean age of 38 ± 7.4 years were randomly assigned into two groups of 55 each. The experimental group of 55 patients was treated with LLLT and conventional physical therapy. The control group of 55 patients was treated with conventional physical therapy alone. Both groups had received 18 treatment sessions. The data were analyzed through SPSS-21.0. Results: The results of the Wilcoxon signed-rank test score as well as Mann-Whitney U test indicated a statistically significant difference in values (p < 0.05 in all instances) within the groups and between the groups, respectively. Conclusions: The LLLT is proved as an efficient adjunct therapy to conventional physical therapy for discogenic lumbar radiculopathy.

Short-term clinical efficacy of the pulsed Nd: YAG laser therapy on chronic nonspecific low back pain: A randomized controlled study.

BACKGROUND: Chronic non-specific low back pain (LBP) is gradually increasing among populations worldwide and affects their activities. Recently, the Nd:YAG laser has been presented in the rehabilitation field. OBJECTIVES: This study aims to explore the short-term effects of the Nd:YAG laser on chronic non-specific LBP individuals. METHODS: Thirty-five individuals with chronic nonspecific LBP were included in the study from December 2019 to March 2020. Randomly, they were categorized to Nd:YAG group (n = 18) and sham laser as a control (n = 17) thrice weekly for a 6-week intervention. Modified Oswestry disability index (MODI), pain disability index (PDI), visual analogue scale (VAS), and lumbar flexion range of motion (ROM) have been assessed pre and post-6 weeks of the intervention. RESULTS: Significant improvements were observed in the Nd:YAG group (MODI, P < .001; PDI, P = .007; VAS, P < .001; lumbar ROM, P = .002), whereas the sham group showed no significant changes (MODI, P = .451; PDI, P = .339; VAS, P = .107; lumbar ROM, P = .296) after 6-week intervention. Between-group comparisons showed significant differences in tending toward the Nd:YAG group (MODI, P < .001; PDI, P = .046; VAS, P < .001; lumbar ROM, P = .003). CONCLUSIONS: Regarding the present study outcomes, short-term pulsed Nd:YAG laser (6 weeks) may reduce functional disabilities and pain intensity, and improve the lumbar flexion ROM in patients with chronic nonspecific LBP. Further well-designed randomized controlled studies with large sample sizes should be conducted regarding laser treatment.

A pilot cohort study of lumbar facet joint denervation in patients with chronic low-back pain.

INTRODUCTION: Radio-frequency (RF) denervation of the facet joints is a procedure aimed at the nociceptive median branch nerves of the lumbar dorsal rami. Pain signals from the facet joints are carried through these fibres; by ablating these fibres, central signalling can be prevented. This pilot study investigated the clinical effect and feasibility of the procedure at our institution, the Spine Centre of Southern Denmark. METHODS: Patients with at least 50% pain relief after initial medial branch diagnostic blocks were candidates for RF denervation. Patients were divided into two groups: 1) patients with at least 80% pain relief and 2) patients with between 50% and 79% pain relief after diagnostic blocks. Denervation was performed bilaterally on the three lowest facet joints in the lumbar spine. The primary outcome parameter was visual analogue scale (VAS). Follow-up questionnaires were answered after one week and after three, six and 12 months. RESULTS: For the whole sample, we found a mean reduction of 43 VAS points after one week. At three months, we found a mean reduction of 25 points. Six-month data showed a mean 19-point reduction. Twelve-month data showed a mean reduction of 17 points. Group 1 showed superior improvements at all follow-up points and after 12 months, we found a mean VAS reduction of 22 points for this group. CONCLUSIONS: This pilot cohort study found RF denervation of the facet joint to be a promising alternative for patients with chronic low-back pain. The effect persisted at the one-year follow-up; however, the effect diminished over time. FUNDING: The Danish Rheumatism Association, The A.P. Møller Foundation for the Advancement of Medical Science. TRIAL REGISTRATION: The study protocol was approved by the ethical committee of Southern Denmark with registration number S-20160070.

Effect of laser treatment on postural control parameters in patients with chronic nonspecific low back pain: a randomized placebo-controlled trial.

The management of nonspecific lumbar pain (NSLP) using laser irradiation remains controversial. A systematic review of recently published studies indicates that the effects of laser therapy are commonly assessed using only imperfect methods in terms of measurement error. The main objective of this study was to assess static postural stability using an objective tool in patients with chronic NSLP after laser irradiation at different doses and wavelengths. In total, 68 patients were included in the laser sessions and were randomly assigned into four groups: high-intensity laser therapy at 1064 nm and 60 J/cm2 for 10 min (HILT), sham (HILT placebo), low-level laser therapy at 785 nm and 8 J/cm2 for 8 min (LLLT), and sham (LLLT placebo). In addition, all patients were supplemented with physical exercises (standard stabilization training). To assess postural stability, a double-plate stabilometric platform was used. All measurements were performed pre- and post-laser sessions (three weeks) and at follow-up time points (one and three months). Laser procedures led to more balanced posture stability in patients, although these positive changes were significant mainly for short-term observation (after 4-week therapy). In the follow-up analysis, the parameters were gradually impaired. Kruskal-Wallis analysis of variance (ANOVA) for independent variables did not show any difference between the studied groups. Low- and high-intensity laser therapy does not lead to a significant improvement in postural sway in patients with NSLP compared with standard stabilization training based on short- and long-term observations.

Radiofrequency denervation of the lumbar zygapophysial joints--targeting the best practice.

OBJECTIVE: Radiofrequency denervation of the zygapophysial (facet) joint is a frequently performed procedure for chronic low back pain. Several studies have shown considerable efficacy of the procedure, but none of the randomized controlled trials performed to date has used anatomically correct placement of radiofrequency cannula parallel to the target nerve. Three main techniques have been utilized for many years: North American, European, and Australian. Each has conceptual and technical limitations. This review analyzes these techniques and proposes a standardized technique of radiofrequency denervation of lumbar zygapophysial joints. DESIGN: Current techniques of radiofrequency neurotomy were analyzed with respect to anatomic and technical accuracy. Step by step guidelines were developed using a combination of previously described techniques along with newly elaborated technical hints and details. CONCLUSION: We believe that the technique using "tunnel vision" with anatomically appropriate cannula placement and use of a large-bore, curved needle with a 10-mm active tip may improve the results of radiofrequency denervation of lumbar zygapophysial joints. Providing a detailed description of an anatomically accurate technique should be of value to those seeking to perform this procedure in a valid manner.

Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain.

OBJECTIVE: In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP). DESIGN & SETTING: Data, comprising 161 patients (29 eventually lost to follow-up), were obtained from two randomized controlled trials on efficacy of radiofrequency treatment for back pain and sciatica. Subsequently patients were additionally treated in an open prospective follow-up period. Although all groups presented a significant visual analog scale reduction after 3 and 12 months, no additional pain relief after radiofrequency compared with injection treatment was found. Both trial populations showed sufficient similarities. A principal component (factor) analysis was performed on baseline psychometric tests, SF-36, and physical activity variables. We constructed five clinically relevant psychological profiles: "psychologically negative,""adaptive manager,""rigid qualities,""supporting partner," and "strong ego." These were examined as possible predictors of significant pain relief using logistic regression analysis. RESULTS: The "psychologically negative" dimension showed a negative and the "adaptive manager" dimension a positive prognostic effect on outcome. CONCLUSIONS: Minimally invasive treatment for CLBP leads to significant pain reduction, including potential placebo effects. However, psychologically vulnerable patients, characterized by, among others, reduced life control, disturbed mood, negative self-efficacy, catastrophizing, high anxiety levels, inadequacy, and poor mental health, tend not to respond to this treatment. Patients characterized by a.o. reduced pain and interference levels, positive expectations, and reasonable physical and social functioning, react more favorably. From both a clinical and a financial perspective, psychosocial evaluation and selection of patients seems appropriate, before applying minimally invasive procedures for CLBP.

Low level laser therapy for nonspecific low-back pain.

BACKGROUND: Low-back pain (LBP) is a major health problem and a major cause of medical expenses and disablement. Low level laser therapy (LLLT) can be used to treat musculoskeletal disorders such as back pain. OBJECTIVES: To assess the effects of LLLT in patients with non-specific LBP. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE, CINAHL, EMBASE, AMED and PEDro from their start to November 2007 with no language restrictions. We screened references in the included studies and in reviews and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts. SELECTION CRITERIA: Randomised controlled clinical trials (RCTs) investigating LLLT to treat non-specific low-back pain were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Studies were qualitatively and quantitatively analysed according to Cochrane Back Review Group guideline. MAIN RESULTS: Seven heterogeneous English language RCTs with reasonable quality were included. Three small studies (168 people) separately showed statistically significant but clinically unimportant pain relief for LLLT versus sham therapy for sub-acute and chronic low-back pain at short-term and intermediate-term follow-up (up to six months). One study (56 people) showed that LLLT was more effective than sham at reducing disability in the short term. Three studies (102 people) reported that LLLT plus exercise were not better than exercise, with or without sham in the short-term in reducing pain or disability. Two studies (90 people) reported that LLLT was not more effective than exercise, with or without sham in reducing pain or disability in the short term. Two small trials (151 people) independently found that the relapse rate in the LLLT group was significantly lower than in the control group at the six-month follow-up. No side effects were reported. AUTHORS' CONCLUSIONS: Based on the heterogeneity of the populations, interventions and comparison groups, we conclude that there are insufficient data to draw firm conclusions on the clinical effect of LLLT for low-back pain. There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, wavelengths and dosages.

Lumbar zygapophysial (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis.

BACKGROUND CONTEXT: The publication of several recent studies showing minimal benefit for radiofrequency (RF) lumbar zygapophysial (l-z) joint denervation have led many investigators to reevaluate selection criteria. One controversial explanation for these findings is that the most commonly used cutoff value for selecting patients for l-z (facet) joint RF denervation, greater than 50% pain relief after diagnostic blocks, is too low and hence responsible for the high failure rate. PURPOSE: To compare l-z joint RF denervation success rates between the conventional greater than or equal to 50% pain relief threshold and the more stringently proposed greater than or equal to 80% cutoff for diagnostic medial branch blocks (MBB). STUDY DESIGN/SETTING: Multicenter, retrospective clinical data analysis. PATIENT SAMPLE: Two hundred and sixty-two patients with chronic low back pain who underwent l-z RF denervation at three pain clinics. OUTCOME MEASURES: Outcome measures were greater than 50% pain relief based on visual analog scale or numerical pain rating score after RF denervation persisting at least 6 months postprocedure, and global perceived effect (GPE), which considered pain relief, satisfaction and functional improvement. METHODS: Data were garnered at three centers on 262 patients who underwent l-z RF denervation after obtaining greater than or equal to 50% pain relief after diagnostic MBB. Subjects were separated into those who received partial (greater than or equal to 50% but less than 80%) and near-complete (greater than or equal to 80%) pain relief from the MBB. Outcomes between groups were compared with multivariate analysis after controlling for 14 demographic and clinical variables. RESULTS: One hundred and forty-five patients obtained greater than or equal to 50% but less than 80% pain relief after diagnostic MBB, and 117 patients obtained greater than or equal to 80% relief. In the greater than or equal to 50% group, success rates were 52% and 67% based on pain relief and GPE, respectively. Among patients who experienced greater than 80% relief from diagnostic blocks, 56% obtained greater than or equal to 50% relief from RF denervation and 66% had a positive GPE. CONCLUSIONS: Using more stringent pain relief criteria when selecting patients for l-z joint RF denervation is unlikely to improve success rates, and may lead to misdiagnosis and withholding a potentially valuable treatment from good candidates.

Photobiomodulation using high- or low-level laser irradiations in patients with lumbar disc degenerative changes: disappointing outcomes and remarks.

BACKGROUND: Laser therapy seems to be a beneficial physical agent for chronic low back pain (LBP), and it is commonly used in the clinical rehabilitation practice. However, there are still no indisputable and clearly defined protocols and practical guidelines, and further, the methodology of the previous reports leaves many unsatisfied and raises some reservations. OBJECTIVE: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) in patients with lumbar disc degenerative changes based on the analysis of the short- and long-term results and in comparison with the placebo effect. DESIGN: This study was a prospective and placebo-controlled clinical trial. MATERIALS AND METHODS: A group of 68 participants were qualified for the therapy and were assigned to four comparative groups in the order they volunteered: HILT of 1,064 nm, 60 J/cm2, 10 minutes (HILT); sham (HILT placebo); LLLT of 785 nm, 8 J/cm2, 8 minutes; and sham (LLLT placebo). The following tests were used to assess the effectiveness of treatment: 1) the visual analogue scale; 2) the Laitinen Questionnaire Indicators of Pain; 3) the Oswestry Disability Index; 4) the Roland-Morris Disability Questionnaire; 5) Lasegue test; and 6) Schober's test. All measurements were carried out before and after irradiations (3 weeks) and in follow-ups (1 and 3 months). RESULTS: After applying verum or placebo laser irradiation, therapeutic progress was observed in all comparative groups; however, no statistically significant differences were observed among the procedures. CONCLUSION: The high- and low-energy laser therapy methods used in the present article are ineffective in relation to patients with lumbar disc degenerative changes in both the short- and long-term perspectives and do not show a significant advantage over the placebo effect.

Clinical predictors of success and failure for lumbar facet radiofrequency denervation.

OBJECTIVE: To determine the clinical factors associated with the success and failure of radiofrequency denervation of the lumbar facet joints. METHODS: Clinical data were garnered from 3 academic medical centers on 192 patients with low back pain who underwent radiofrequency denervation after a positive response to diagnostic blocks. Success was defined as >/=50% pain relief lasting at least 6 months. Factors evaluated for their association with outcome included duration of pain, opioid use, symptom location, paraspinal tenderness, pain exacerbated by extension/rotation (ie, facet loading), MRI abnormalities, diabetes, smoking, scoliosis, obesity, prior surgery and levels treated. RESULTS: The only factor associated with a successful outcome was paraspinal tenderness. Variables that correlated with treatment failure were 'facet loading,' long duration of pain, and previous back surgery. CONCLUSIONS: It is counterproductive to use 'facet loading' as the sole basis for choosing patients for facet interventions. In patients at high risk for treatment failure, taking additional steps to reduce the rate of false-positive screening blocks may improve outcomes.

WITHDRAWN: Low level laser therapy for nonspecific low-back pain.

BACKGROUND: Low-back pain (LBP) and related disabilities are major public health problems and a major cause of medical expenses, absenteeism and disablement. Low level laser therapy (LLLT) can be used as a therapeutic intervention for musculoskeletal disorders such as back pain. OBJECTIVES: To assess the effects of LLLT in patients with non-specific low-back pain and to explore the most effective method of administering LLLT for this disorder. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE and CINAHL from their start to January 2007 and EMBASE, AMED and PEDro from their start to 2005 with no language restrictions. We screened references in the included studies and in reviews of the literature and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts. SELECTION CRITERIA: Only randomised controlled clinical trials (RCTs) investigating low level laser therapy as a light source treatment for non-specific low-back pain were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Consensus was used to resolve disagreements. Clinically and statistically homogeneous studies were pooled using the fixed-effect model; clinically homogeneous and statistically heterogeneous studies were pooled using the random-effects model. MAIN RESULTS: Six RCTs with reasonable quality were included in the review. All of them were published in English. Because of clinical heterogeneity in study populations, interventions used and reported outcomes, meta-analysis was not possible to determine an overall effect for pain, disability and range of motion. Three studies (n=168) separately showed a significant pain relief effect of LLLT compared to sham therapy for sub-acute and chronic low-back pain. These effects were only observed at short-term and intermediate-term follow-ups. Long-term follow-ups were not reported. There was insufficient evidence to investigate the difference between LLLT and comparison groups for pain-related disability. There is insufficient evidence to determine the effectiveness of LLLT on anterior-posterior lumbar range of motion compared to control group in short-term follow-up. The relapse rate in the LLLT group was significantly lower than in the control group at six months follow-up period according to the findings of two trials. One study (n=50) reported a significant improvement in pain in LLLT group versus exercise therapy. AUTHORS' CONCLUSIONS: No side effects were reported. However, we conclude that there are insufficient data to draw firm conclusions. There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, different wavelengths and different dosages. Comparison of different LLLT treatments will be more reasonable if dose calculation methods are harmonized.

Low level laser therapy for nonspecific low-back pain.

BACKGROUND: Low-back pain (LBP) and related disabilities are major public health problems and a major cause of medical expenses, absenteeism and disablement. Low level laser therapy (LLLT) can be used as a therapeutic intervention for musculoskeletal disorders such as back pain. OBJECTIVES: To assess the effects of LLLT in patients with non-specific low-back pain and to explore the most effective method of administering LLLT for this disorder. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2005, Issue 2), MEDLINE and CINAHL from their start to January 2007 and EMBASE, AMED and PEDro from their start to 2005 with no language restrictions. We screened references in the included studies and in reviews of the literature and conducted citation tracking of identified RCTs and reviews using Science Citation Index. We also contacted content experts. SELECTION CRITERIA: Only randomised controlled clinical trials (RCTs) investigating low level laser therapy as a light source treatment for non-specific low-back pain were included. DATA COLLECTION AND ANALYSIS: Two authors independently assessed methodological quality using the criteria recommended by the Cochrane Back Review Group and extracted data. Consensus was used to resolve disagreements. Clinically and statistically homogeneous studies were pooled using the fixed-effect model; clinically homogeneous and statistically heterogeneous studies were pooled using the random-effects model. MAIN RESULTS: Six RCTs with reasonable quality were included in the review. All of them were published in English. There is some evidence of pain relief with LLLT, compared to sham therapy for subacute and chronic low-back pain. These effects were only observed at short-term and intermediate-term follow-ups. Long-term follow-ups were not reported. There was no difference between LLLT and comparison groups for pain-related disability. There is insufficient evidence to determine the effectiveness of LLLT on antero-posterior lumbar range of motion compared to control group in short-term follow-up. The relapse rate in the LLLT group was significantly lower than in the control group at six months follow-up period according to the findings of two trials. AUTHORS' CONCLUSIONS: No side effects were reported. However, we conclude that there are insufficient data to draw firm conclusions. There is a need for further methodologically rigorous RCTs to evaluate the effects of LLLT compared to other treatments, different lengths of treatment, different wavelengths and different dosages. Comparison of different LLLT treatments will be more reasonable if dose calculation methods are harmonized.

In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial.

QUESTION: Is low level laser therapy an effective adjuvant intervention for chronic low back pain? DESIGN: Randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: Sixty-one patients who had low back pain for at least 12 weeks. INTERVENTION: One group received laser therapy alone, one received laser therapy and exercise, and the third group received placebo laser therapy and exercise. Laser therapy was performed twice a week for 6 weeks. OUTCOME MEASURES: Outcomes were pain severity measured using a 10-cm visual analogue scale, lumbar range of motion measured by the Schober Test and maximum active flexion, extension and lateral flexion, and disability measured with the Oswestry Disability Index on admission to the study, after 6 weeks of intervention, and after another 6 weeks of no intervention. RESULTS: There was no greater effect of laser therapy compared with exercise for any outcome, at either 6 or 12 weeks. There was also no greater effect of laser therapy plus exercise compared with exercise for any outcome at 6 weeks. However, in the laser therapy plus exercise group pain had reduced by 1.8 cm (95% CI 0.1 to 3.3, p = 0.03), lumbar range of movement increased by 0.9 cm (95% CI 0.2 to 1.8, p < 0.01) on the Schober Test and by 15 deg (95% CI 5 to 25, p < 0.01) of active flexion, and disability reduced by 9.4 points (95% CI 2.7 to 16.0, p = 0.03) more than in the exercise group at 12 weeks. CONCLUSION: In chronic low back pain low level laser therapy combined with exercise is more beneficial than exercise alone in the long term.

Use of pulsed radiofrequency in failed back surgery syndrome.

Failed back surgery syndrome (FBSS) is a well-recognized complication of spinal surgery. Pulse radiofrequency of dorsal root ganglion has been recently described for such patients. In this report, pulsed radiofrequency was applied in 3 patients with failed back surgery syndrome, presenting with severe pain. Reasonable to good pain relief was achieved in 2 patients in 6 months follow-up, however, one patient got short-term pain relief. Based on this limited experience in FBSS where conventional and non-conventional treatments are not effective, pulsed radiofrequency may be considered a logical choice.

[Percutaneous discectomy and intradiscal radiofrequency thermocoagulation for low back pain: evaluation according to the best available evidence].

Within the framework of evidence-based medicine, high quality randomized trials and systematic reviews are needed for new medical treatment. Clinicians should conscientiously, explicitly and judiciously use the best current evidence in making decisions about the care of individual patients. This paper summarizes the best available evidence from systematic reviews and randomized controlled trials concerning two minimally invasive procedures: percutaneous discectomy and percutaneous intradiscal radiofrequency thermocoagulation. Percutaneous discectomy is a minimally invasive surgical procedure that treats contained, herniated discs. Specific procedures within the class include: manual percutaneous lumbar discectomy, Automated percutaneous lumbar discectomy (APLD) laser discectomy and nucleoplasty percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil. Results of systematic reviews were retrieved from four leading evidence-based databases: the National Institute for Clinical Excellence--NICE, which is an independent organization responsible for providing national guidance on treatments, the Cochrane Library, which is the largest library world-wide for systematic reviews and randomized controlled trials, the Center for Review and Dissemination (CRD) at the University of York, which undertakes reviews of research about the effects of interventions in health and social care and finally, a search via Medline. The results from those systematic reviews and randomized trials shows that, at present, unless or until better scientific evidence is available, automated percutaneous discectomy and laser discectomy should be regarded as research techniques. Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain.