The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review

Fagundes, Marina Gomes; Albuquerque, Jéssica Rodrigues dos Santos; Silva, Emanuelly Juliane Santos; Dantas, Ana Caroline Victor; Lima, Thiago Bezerra Wanderley e

doi:10.5935/2595-0118.20230014-en

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REVIEW ARTICLE • BrJP 6 (1) • Jan-Mar 2023 • https://doi.org/10.5935/2595-0118.20230014-en copy

The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

Low-level laser therapy (LLLT) is one of the most used resources in clinical practice for pain relief. Therefore, it is important to comprehend its real effects in the treatment of this symptom.

LLLT seems to show good results for pain relief, however there is heterogeneity among studies that makes it difficult to really understand these effects.

More robust clinical trials are needed to achieve a better comprehension of the LLLT effectiveness in reducing pain.

ABSTRACT

BACKGROUND AND OBJECTIVES:

Among the approaches inherent to conservative treatment, the low-level laser therapy (LLLT) is one of the most used resources in the treatment of myofascial pain. This research sought to search the literature for the available evidence on the treatment of myofascial pain syndrome with LLLT in order to analyze the reported effects of this intervention.

Medline/PubMed, SCOPUS, Web of Science, Cochrane Central Registry of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) by Ebsco was used to search for articles on randomized clinical trials that related myofascial pain syndrome with LLLT. Studies were systematically selected by two reviewers independently, through title, abstract and, later, full text. Ten articles that met the criteria were included in this integrative review. In six of these articles, the improvement in pain compared to placebo group was presented right after LLLT session, although these results did not remain in the follow-ups of the studies that performed follow ups.

CONCLUSION:

LLLT seems to be a resource that decreases pain in patients with myofascial pain syndrome. Despite the positive results in reducing pain with the use of LLLT in some studies, this review admits the heterogeneity of studies with conficting results related to the effectiveness of LLLT. Research that defines the parameters and adequate therapeutic dosages are necessary for a better understanding of the real effects of LLLT on this clinical condition.

Keywords:
Pain; Trigger-points; Low-level laser therapy

Authors	Population	Laser Type	Wavelength	Parameters	Periodicity	Follow-up
Thorsen et al.¹⁶16 Torsen H, Gam AN, Svensson BH, Jess M, Jensen MK, Piculell I, Schack LK, Skjøtt K. Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study. Scand J Rheumatol. 1992;21(3):139-41	n=41 with myofascial pain and age between 23 and 65 years	GaALAS	830 nm	Continuous and pulse mode Power 30 mWatt Energy/spot 0.9 J (max 9 J/treatment) Probe head area 2.5 mm²	6 times/week 2 weeks 12 sessions
Gur et al.¹⁴14 Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm Gallium Arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med. 2004;35(3):229–35.	n=60 (13 men and 47 women) with myofascial pain Intervention group: 30 Placebo group: 30	GaAs infrared laser	904 nm	Duration 200 ns Frequency 2.8 kHz Average power 11.2 mW Power density/spot: 2 J/cm2 (max 20 J/cm²) Max output 20 W/pulse 1 cm surface Time 3 min on each spot	Daily for 2 weeks, except weekends. 10 sessions	2, 3 and 12 weeks
Ceylan et al.¹⁷17 Ceylan Y, Hizmetli S, Siliğ Y. The effects of infrared laser and medical treatments on pain and serotonin degradation products in patients with myofascial pain syndrome. A controlled trial. Rheumatol Int. 2004;24(5):260-3.	n=39 with myofascial pain Intervention group: 19 Placebo group: 20	Gymna 200 laser	904 nm	Duration 200 ns Frequency 4 kHz Energy/spot 1.44 J Laser probe tip length 5 mm Time 3 min at each spot	1 time a day for 10 consecutive days.
Ilbuldul et al.¹²12 Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):00068.	n=60 subjects with myofascial pain Laser group: 20 Dry needling group: 20 Laser placebo group: 20	HeNe Laser	632.8 nm	Energy/spot 2 J	3 times a week 12 sessions	6 months
Altan et al.¹⁹19 Altan L, Bingöl U, Aykaç M, Yurtkuran M. Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int. 2005;25(1):23-7.	n=53 (18 men and 35 women) with myofascial pain Intervention group: 23 Placebo group: 25	GaAs laser	904 nm	Maximum power 27 W, 50 W or 27 • 4 W Frequency 1 kHz Time 2 min at each spot	1 time/day for 10 weekdays 2 weeks	2, 12 and 14 weeks
Dundar et al.⁵5 Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clin Rheumatol. 2007;26(6):930-4.	n=64 (9 men and 55 women) with myofascial pain Intervention group: 32 Placebo group: 32	GaAsAl laser	830 nm	Power 42 J Frequency 1 kHz Time 2 min in each spot	1 time/day for 15 weekdays 3 weeks	4 weeks
Lee and Han¹⁵15 Lee JH, Han J T. The dose-dependent effect of an 830-nm, 450-mW low-level laser therapy on the myofacial trigger point of the upper trapezius muscle: a randomized, double-blinded, clinical trial. J Phys Ther Sci. 2011;23(6):933-5.	n=24 (10 men and 14 women) with myofascial pain. Intervention group: 12 Placebo group: 12	GaALAs	830 nm	Power 450 mW Energy density 35.71 W/cm² Spot diameter 0.3 cm Spot size 0.07 cm²	Intervals of 1 week for 1 min, 2 min, and 5 min, respectively.
Rayegani et al.²⁰20 Rayegani S, Bahrami M, Samadi B, Sedighipour L, Mokhtarirad M, Eliaspoor D. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med. 2011;47(3):381-9.	n=63 (17 men and 46 women) with myofascial pain Laser Group: 17 Ultrasound group: 16 Laser placebo group: 16		880 nm	Continuous mode 880 nm/pulsed 905 nm Peak power 1100 mW Frequency 700 Hz with variable duty cycle Energy density 39,7 J/cm² Time 2 minutes each spot	5 times/week 2 weeks 10 sessions
Manca et al.²¹21 Manca A, Limonta E, Pilurzi G, Ginatempo F, De Natale ER, Mercante B, Tolu E, Deriu F. Ultrasound and laser as stand-alone therapies for myofascial trigger points: a randomized, double-blind, placebo-controlled study. Physiother Res Int. 2014;19(3):166-75.	n=60 (32 men and 28 women) with myofascial pain Laser group: 11 Laser placebo group: 11 Ultrasound group: 12 Ultrasound placebo group: 12 No therapy group: 11	GaAs	904 nm	Pulse duration 200 ns Pulse frequency 1953 Hz Peak power 90 mw Average output 30 mw Power density 22.5 mw/cm² Energy dose 18 J/session Spot size 4 cm² Laser probe 4 cm² Time 600 seconds	5 times/week 2 weeks 10 sessions	12 weeks
Momenzadeh et al.⁴4 Momenzadeh S, Akhyani V, Razaghi Z. Evaluation of the effects of intravenous and percutaneous low level laser therapy in the management of shoulder myofascial pain syndrome: A controlled randomized clinical trial. J Lasers Med Sci. 2016;7(1):16-20.	n=30 with myofascial pain Laser intervention group: 10 Intravenous laser intervention group: 10 Placebo group: 10	GaALAs	810 nm	Continuous mode Power 60 mw Energy density 20.35 J/cm² Time 300 seconds each point	1 every 2 days except friday 12 sessions	1 and 3 months

Authors	Criteria											Total score
	1	2	3	4	5	6	7	8	9	10	11
Thorsen et al.¹⁶16 Torsen H, Gam AN, Svensson BH, Jess M, Jensen MK, Piculell I, Schack LK, Skjøtt K. Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study. Scand J Rheumatol. 1992;21(3):139-41	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	8
Alltan et al.¹³13 Shiwa SR, Costa LOP, Moser ADL, Aguiar IC, de Oliveira LVF. PEDro: a base de dados de evidências em fisioterapia. Fisioter Mov. 2011;24(3):523-33	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6
Ilbuldu et al.¹²12 Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol. 2015;2(5):00068.	Yes	Yes	No	Yes	No	No	Yes	Yes	Yes	Yes	Yes	7
Rayegani et al.²⁰20 Rayegani S, Bahrami M, Samadi B, Sedighipour L, Mokhtarirad M, Eliaspoor D. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med. 2011;47(3):381-9.	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	8
Ceylan et al.¹⁷17 Ceylan Y, Hizmetli S, Siliğ Y. The effects of infrared laser and medical treatments on pain and serotonin degradation products in patients with myofascial pain syndrome. A controlled trial. Rheumatol Int. 2004;24(5):260-3.	Yes	Yes	No	No	No	No	No	Yes	Yes	Yes	Yes	5
Lee and Han¹⁵15 Lee JH, Han J T. The dose-dependent effect of an 830-nm, 450-mW low-level laser therapy on the myofacial trigger point of the upper trapezius muscle: a randomized, double-blinded, clinical trial. J Phys Ther Sci. 2011;23(6):933-5.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9
Dundar et al.⁵5 Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clin Rheumatol. 2007;26(6):930-4.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9
Momenzadeh et al.⁴4 Momenzadeh S, Akhyani V, Razaghi Z. Evaluation of the effects of intravenous and percutaneous low level laser therapy in the management of shoulder myofascial pain syndrome: A controlled randomized clinical trial. J Lasers Med Sci. 2016;7(1):16-20.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9
Gur et al.¹⁴14 Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm Gallium Arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med. 2004;35(3):229–35.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9
Manca et al. ²¹21 Manca A, Limonta E, Pilurzi G, Ginatempo F, De Natale ER, Mercante B, Tolu E, Deriu F. Ultrasound and laser as stand-alone therapies for myofascial trigger points: a randomized, double-blind, placebo-controlled study. Physiother Res Int. 2014;19(3):166-75.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9

Autores	Pain assessment tools	Main findings
Thorsen et al.¹⁶16 Torsen H, Gam AN, Svensson BH, Jess M, Jensen MK, Piculell I, Schack LK, Skjøtt K. Low level laser therapy for myofascial pain in the neck and shoulder girdle. A double-blind, cross-over study. Scand J Rheumatol. 1992;21(3):139-41	Visual Analog Scale (VAS)	No difference was found between laser group and placebo group with regard to pain reduction.
Gur et al.¹⁴14 Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm Gallium Arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med. 2004;35(3):229–35.	VAS	There was a significant decrease in pain in active laser group compared to placebo group at the end of treatment, and at 1 and 10 weeks after completion of treatment.
Ceylan et al.¹⁷17 Ceylan Y, Hizmetli S, Siliğ Y. The effects of infrared laser and medical treatments on pain and serotonin degradation products in patients with myofascial pain syndrome. A controlled trial. Rheumatol Int. 2004;24(5):260-3.	VAS	There was a significant decrease in pain in active laser group compared to placebo group at the end of treatment.
Ilbuldul et al.²⁰20 Rayegani S, Bahrami M, Samadi B, Sedighipour L, Mokhtarirad M, Eliaspoor D. Comparison of the effects of low energy laser and ultrasound in treatment of shoulder myofascial pain syndrome: a randomized single-blinded clinical trial. Eur J Phys Rehabil Med. 2011;47(3):381-9.	VAS and algometer	There was a significant decrease in pain at rest and pain on activity in laser group compared to placebo. However, there was no difference in any of the parameters between the groups at the 6-month follow-up.
Altan et al.¹⁹19 Altan L, Bingöl U, Aykaç M, Yurtkuran M. Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int. 2005;25(1):23-7.	VAS and algometer	There was no difference between the intervention and control group regarding the pain outcome.
Dundar et al.⁵5 Dundar U, Evcik D, Samli F, Pusak H, Kavuncu V. The effect of gallium arsenide aluminum laser therapy in the management of cervical myofascial pain syndrome: a double blind, placebo-controlled study. Clin Rheumatol. 2007;26(6):930-4.	VAS	There was no difference between the intervention and control group regarding the pain outcome.
Lee e Han⁹9 Tomazoni SS, Almeida MO, Bjordal JM, Stausholm MB, Machado CDSM, Leal-Junior ECP, Costa LOP. Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review. J Physiother. 2020;66(3):155-65	Algometer	There was a significant decrease in pain in active laser group compared to placebo group after 5 minutes of application.
Rayegani et al.¹⁴14 Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm Gallium Arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomize-controlled trial. Lasers Surg Med. 2004;35(3):229–35.	Algometer	There was a significant decrease in pain at rest and pain on activity in laser group compared to placebo.
Manca et al.²¹21 Manca A, Limonta E, Pilurzi G, Ginatempo F, De Natale ER, Mercante B, Tolu E, Deriu F. Ultrasound and laser as stand-alone therapies for myofascial trigger points: a randomized, double-blind, placebo-controlled study. Physiother Res Int. 2014;19(3):166-75.	VAS and algometer	No difference was found between laser group and placebo group with regard to pain reduction.
Momenzadeh et al.⁴4 Momenzadeh S, Akhyani V, Razaghi Z. Evaluation of the effects of intravenous and percutaneous low level laser therapy in the management of shoulder myofascial pain syndrome: A controlled randomized clinical trial. J Lasers Med Sci. 2016;7(1):16-20.	Pain Disability Index (PDI) and VAS	There was a significant decrease in pain in active laser group compared to placebo group at the end of treatment.

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[1] Correspondence to: Thiago Bezerra Wanderley e Lima E-mailthiagowandrle 13@htmail.com

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The effects of low-level laser in the treatment of myofascial pain syndrome: systematic review

HIGHLIGHTS

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: