Efficacy of low-level laser therapy on myofascial trigger point: a systematic review and meta-analysis of randomized clinical trials

Davide, Corbetta and Stefano, Agazzi and Roberto, Gatti and Barbero, Marco (2015) Efficacy of low-level laser therapy on myofascial trigger point: a systematic review and meta-analysis of randomized clinical trials. In: World Confederation for Physical Therapy Congress 2015 , 1-4 May, Singapore.

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BACKGROUND: A myofascial trigger point (MTrP) is defined as a hyperirritable spot in a palpable taut band of skeletal muscle fibers. It can produce referred pain, either on digital compression or spontaneously. Various approaches for MTrP treatment are available, such as massage, stretching, ischemic compression, dry needling and application of physical agents. . Among the latter, low-level laser therapy (LLLT), defined as non-invasive light source treatment that generates a single wavelength of light, might be considered as an option for treating patients with MTrPs. PURPOSE: To explore the evidence regarding the efficacy of LLLT to reduce pain in patients with MTrPs in the upper quarter muscles. METHODS: Pubmed, Scopus and PEDro electronic databases were consulted for articles published up to July 2014. Search strategy used the following keywords: ‘laser therapy, low-level’ ‘trigger points’ and ‘Pain Measurement’. Identified studies were screened against the following inclusion criteria: randomized controlled trial (RCT), at least one MTrP in the upper quarter muscles, and LLLT treatment for trigger point-related pain. RCTs that met these criteria were assessed for internal validity using the Cochrane Collaboration's tool for assessing risk of bias. RESULTS: Eleven studies were included in the review. The methodological quality was generally moderate-to-low, in particular the monitoring of pharmacological co-interventions in studies was lacking. A meta-analysis including ten trials was performed for estimate the efficacy of LLLT on pain rated with VAS. The estimated effect in standardized mean difference (SMD) was 1.01 (95%CI, 0.56 to 1.47) favouring laser therapy. Performing a subgroup analysis, according to the presence of uncontrolled pharmacological co-interventions, the meta-analysis revealed that in three studies in which co-interventions were absent, the estimated effect of laser was not statistically significant in reducing pain with a SMD of 0.16 (95% CI, -0.35 to 0.68) against those in which pharmacological co-intervention were not monitored with SMD of 1.34 (95% CI, 1.06 to 1.62). The test for subgroup differences resulted: Chi² = 15.56, df = 1 (P < 0.0001), I² = 93.6%. CONCLUSION: LLLT seems to be effective for reducing MTrP pain. However its effect is minimal when used as unique treatment. Due to the lacking of monitoring pharmacological co-interventions it is not possible to drew firm conclusion on the efficacy of the LLLT in reducing myofascial pain. Well-designed studies with an accurate monitoring of co-interventions that could interfere with the effect of the laser therapy are needed to support its use as approach for MTrP treatment. IMPLICATIONS: The effect of the laser therapy should not be widespread recommended as unique treatment of MTrP pain

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