The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials

Abstract

Background Tendinopathy is a common clinical condition that can significantly affect a person’s physical function and quality of life. Despite exercise therapy being the mainstay of tendinopathy management, there are many potential adjunct therapies that remain under investigated, one of which is photobiomodulation (PBM). PBM uses varied wavelengths of light to create a biological effect. While PBM is used frequently in the management of tendinopathy, high quality evidence supporting its utility is lacking. Methods A systematic search of the Pubmed, CINAHL, SCOPUS, Cochrane Database, Web of Science and SPORTSDICUS databases was performed for eligible articles in August 2020. Randomized Control Trials that used red or near-infrared PBM to treat tendinopathy disorders that made comparisons with a sham or ‘other’ intervention were included. Pain and function data were extracted from the included studies. The data were synthesized using a random effects model. The meta-analysis was performed using the mean difference (MD) and standardized mean difference (SMD) statistics. Results A total of 17 trials were included (n = 835). When compared solely to other interventions PBM resulted in similar decreases in pain (MD -0.09; 95% CI − 0.79 to 0.61) and a smaller improvement in function (SMD -0.52; 95% CI − 0.81 to − 0.23). When PBM plus exercise was compared to sham treatment plus exercise, PBM demonstrated greater decreases in pain (MD 1.06; 95% CI 0.57 to 1.55) and improved function (MD 5.65; 95% CI 0.25 to 11.04). When PBM plus exercise was compared to other interventions plus exercise, no differences were noted in pain levels (MD 0.31; 95% CI − 0.07 to 0.70). Most studies were judged as low-risk of bias. The outcome measures were classified as very low to moderate evidence quality according to the Grading of Recommendation, Development and Evaluation tool. Conclusion There is very-low-to-moderate quality evidence demonstrating that PBM has utility as a standalone and/or adjunctive therapy for tendinopathy disorders. Trial registration PROPERO registration number: CRD42020202508.

Short-Term Effects of Whole-Body Photobiomodulation on Pain, Quality of Life and Psychological Factors in a Population Suffering from Fibromyalgia: A Triple-Blinded Randomised Clinical Trial

“…Ghigiarelliet et al showed short-term effects of whole-body PBM in a sports population, without showing any conclusive change [19]. The effects of local PBM on pain are well known and established [39], and its usefulness has been shown in different conditions such as knee osteoarthritis [40], oral mucositis [41], idiopathic burning mouth syndrome [42], neck disability and chronic neck pain [43], pain and function in tendinopathy [44], myofascial temporomandibular disorder [45], fractures [46], central nervous diseases [47] and even in the microbiome [48]. On the other hand, other studies show that PBM does not decrease pain and disability, specifically in people with non-specific low back pain, although those studies analysed the use of local PBM and not whole-body PBM [49].…”

Outcomes of whole-body photobiomodulation on pain, quality of life, leisure physical activity, pain catastrophizing, kinesiophobia, and self-efficacy: a prospective randomized triple-blinded clinical trial with 6 months of follow-up

“…To our knowledge, this is the first study showing long-term results of whole-body PBM in a population suffering from FM, thus comparison with other studies is difficult. Studies showing the effects of PBM on different conditions have been published, as in oral mucositis ( MASCC/ISOO et al, 2020 ), central nervous diseases ( Yang et al, 2021 ), musculoskeletal conditions such as fractures ( Neto et al, 2020 ), knee osteoarthritis ( Vassão et al, 2021 ), neck disability and chronic neck pain ( Gross et al, 2013 ), pain and function in tendinopathy ( Tripodi et al, 2021 ) and myofascial temporomandibular disorder ( Sobral et al, 2021 ; Yang et al, 2021 ). Nevertheless, not all studies have found positive effects when using a PBM approach, as in Tomazoni et al (2020) , who found that local PBM did not improve pain and disability in patients suffering from non-specific low back pain, or Ghigiarelli et al (2020) who did not find significant improvement in a sport population when assessing performance.…”

Roles of Oxidative Stress in Acute Tendon Injury and Degenerative Tendinopathy—A Target for Intervention

“…Moreover, there were no difference in the redox parameters and lysosomal hydrolases between the healthy and injured athletes at baseline prior to HILT, questioning the choices of outcomes in this study [ 88 ]. At present, there is a lack of high-quality evidence of the effect and underlying mechanism of photobiomodulation for the treatment of tendinopathy [ 89 ].…”