DISCUSSION: Laser Therapy does NOT work for low back pain... or does it?
Aug 9, 2021
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In this podcast, the effectiveness of laser therapy for low back pain is discussed. The lack of evidence supporting its use is highlighted, while also acknowledging the need for further research on alternative treatments. The debate between class three and class four lasers is explored, along with the challenges of conducting robust trials. The importance of evidence-based treatments and the need for checking sources are also emphasized.
Laser therapy for low back pain lacks sufficient evidence and should be carefully evaluated before use.
Providers should critically evaluate treatments lacking adequate research to ensure patient safety and efficacy.
Deep dives
Insufficient evidence for laser therapy in low back pain
A systematic literature review found insufficient evidence to support the use of laser therapy for reducing pain and disability in people with nonspecific low back pain. Despite the recommendation by the American College of Physicians, the review concluded that laser therapy did not provide significant benefits based on three randomized controlled trials. Several previous systematic reviews were excluded from this review, as they included different types of laser therapy not considered as photobiomodulation therapy. The review's conclusion was based on the exclusion of class IV lasers and the limited evidence supporting the use of laser therapy for low back pain.
Controversial commentary on laser therapy for chronic low back pain
A commentary published in a high-impact journal called into question the efficacy of photobiomodulation therapy for chronic low back pain. The commentary highlighted a recent study that also concluded laser therapy was ineffective for reducing pain and disability in patients. The study adhered to high-quality research standards, including blinding and intention-to-treat analysis. However, the study deviated from the recommended dosing guidelines by using different wavelengths of LEDs and a laser, resulting in lower dosages than the minimums recommended by the World Association for Laser Therapy. The commentary urged clinicians to abandon laser therapy and use alternative, evidence-based treatments.
The need for more robust trials and careful evaluation of treatments
The podcast episode emphasized the importance of conducting more robust trials and carefully evaluating different treatments, particularly those commonly used but lacking adequate research. The host noted examples of treatments, such as opioids, joint fusion, nerve ablation, and spinal cord stimulation, which have been adopted into usual care without sufficient evidence of safety and efficacy. The episode highlighted the need for more research and cautioned against treating patients without a strong evidence base. The host encouraged healthcare providers to critically evaluate the available research and engage with the sources mentioned in the episode for further discussion and insights.
This is Part 1 of a two-part LTI provider discussion, where we look at the latest research and commentaries on laser therapy for low back pain. We will discuss what makes this study great, but also why the conclusion is misleading, and what we can learn from it.