Low-Level therapy (also known as cold laser therapy) is another treatment that has been promoted to patients with chronic pain conditions who are desperately seeking relief. This treatment is recommended for a diverse conditions such as back and neck pain, musculoskeletal pain, arthritis, fibromyalgia, tendonitis, bursitis, neuropathy, migraine headaches, sprains and strains, carpal tunnel syndrome and temporomandibular disorders.
Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review.
Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, Tong V, Korporaal C.
J Manipulative Physiol Ther. 2013 Mar-Apr;36(3):143-201. doi: 10.1016/j.jmpt.2013.04.001.
OBJECTIVE: The purpose of this study was to complete a systematic review of manual and manipulative therapy (MMT) for common upper extremity pain and disorders including the temporomandibular joint (TMJ). METHODS: A literature search was conducted using the Cumulative Index of Nursing Allied Health Literature, PubMed, Manual, Alternative, and Natural Therapy Index System (MANTIS), Physiotherapy Evidence Database (PEDro), Index to Chiropractic Literature, Google Scholar, and hand search inclusive of literature from January 1983 to March 5, 2012. Search limits included the English language and human studies along with MeSH terms such as manipulation, chiropractic, osteopathic, orthopedic, and physical therapies. Inclusion criteria required an extremity peripheral diagnosis (for upper extremity problems including the elbow, wrist, hand, finger and the (upper quadrant) temporomandibular joint) and MMT with or without multimodal therapy. Studies were assessed using the PEDro scale in conjunction with modified guidelines and systems. After synthesis and considered judgment scoring was complete, evidence grades of "A, B, C and I" were applied. RESULTS: Out of 764 citations reviewed, 129 studies were deemed possibly to probably useful and/or relevant to develop expert consensus. Out of 81 randomized controlled or clinical trials, 35 were included. Five controlled or clinical trials were located and 4 were included. Fifty case series, reports and/or single-group pre-test post-test prospective case series were located with 32 included. There is Fair (B) level of evidence for MMT to specific joints and the full kinetic chain combined generally with exercise and/or multimodal therapy for lateral epicondylopathy, carpal tunnel syndrome, and temporomandibular joint disorders, in the short term. CONCLUSION: The information from this study will help guide practitioners in the use of MMT, soft tissue technique, exercise, and/or multimodal therapy for the treatment of a variety of upper extremity complaints in the context of the hierarchy of published and available evidence.
Low-level laser therapy for temporomandibular disorders: A systematic review with meta-analysis.
Xu GZ, Jia J, Jin L, Li JH, Wang ZY, Cao DY.
Pain Res Manag. 2018 May 10;2018:4230583. doi: 10.1155/2018/4230583. eCollection 2018.
OBJECTIVES: We systematically reviewed randomized controlled trials (RCTs) of the effect of low-level laser therapy (LLLT) versus placebo in patients with temporomandibular disorder (TMD). METHODS: A systematic search of multiple online sources electronic databases was undertaken. The methodological quality of each included study was assessed using the modified Jadad scale, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS: A total of 31 RCTs were included. Total modified Jadad scale scores showed that the methodological quality was high in 30 studies and low in 1 study. Combining data from all clinically heterogeneous studies revealed positive effects of LLLT on pain relief, regardless of the visual analogue scale (VAS) score or the change of VAS score between the baseline and the final follow-up time point, while dosage analyses showed discrepant results about the effects of high or low doses for patients with TMD. Follow-up analyses showed that LLLT significantly reduced pain at the short-term follow-up. Temporomandibular joint function outcomes indicated that the overall effect favored LLLT over placebo. CONCLUSION: This systematic review suggests that LLLT effectively relieves pain and improves functional outcomes in patients with TMD.
Efficacy of low-level laser therapy in the treatment of temporomandibular myofascial pain: A systematic review and meta-analysis.
Munguia FM, Jang J, Salem M, Clark GT, Enciso R.
J Oral Facial Pain Headache. Summer 2018;32(3):287–297. doi: 10.11607/ofph.2032.
AIMS: To conduct a systematic review and meta-analysis to determine the efficacy of low-level laser therapy (LLLT) in treating temporomandibular myofascial pain in adults compared to laser placebo. METHODS: Randomized, placebo-controlled studies were identified by a search on March 2, 2016 and updated on February 9, 2017 in the PubMed, Web of Science, and Cochrane Library databases. Three of the authors assessed the studies for risk of bias. Outcomes included pain reduction on a visual analog scale (VAS) and interincisal opening. RESULTS: The initial search strategy yielded 142 unduplicated references assessed independently by three review authors. After evaluation, this number was reduced to eight relevant studies for inclusion in this review. Of these eight studies, four were at unclear risk of bias and four were at high risk. In a meta-analysis, pain intensity was significantly reduced after treatment in the group that received LLLT as compared to laser placebo (an average of 2.2 units on a scale of 0 to 10) (P = .005) and an average of 2.4 units 3 to 4 weeks later (P = .022). Pooled results showed a significant increase in interincisal opening at 1 month after treatment (P = .012), but not when the treatment was completed (P = .079). CONCLUSION: The findings from this systematic review showed that LLLT seems to be effective in reducing pain in patients with temporomandibular myofascial pain with moderate-quality evidence. However, due to the high heterogeneity, small number, and high risk of bias of the included studies, the results are not definitive, and further well-designed studies are needed.
Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review.
Shukla D, Muthusekhar MR.
Natl J Maxillofac Surg. 2016 Jan-Jun;7(1):62-66. doi: 10.4103/0975-5950.196127.
PURPOSE: The aim of this systematic review was to assess the efficacy of low-level laser therapy (LLLT) in patients with temporomandibular disorders (TMDs). METHODS: Medline search was done from 1997 to 2011 using search terms appropriate to establishing a relation between LLLT and TMD. Only randomized controlled trials were included in this study. Outcome variables related to pain, muscle tenderness, mandibular movements, and Electromyographic (EMG) activity were considered. Of the 242 articles examined, 13 were finally included in the critical analysis conducted as a part of the present systematic review. RESULTS: Of the 242 titles reviewed, only 13 articles were considered eligible. 7 articles showed significant improvement in the study group, whereas 5 showed no significant improvement between the study and control groups. The primary outcome of most of the studies was pain. Other variables considered were muscle tenderness, mandibular movements; EMG activity was considered. CONCLUSION: Our results have shown that LLLT seems to be effective in reducing pain in TMD's. It may be a treatment option for patients with an interest in a noninvasive, complementary therapy.
Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature.
Herpich CM, Amaral AP, Leal-Junio EC, Tosato Jde P, Gomes CA, Arruda EE, Gloria IP, Garcia MB, Barbosa BR, Rodrigues MS, Silva KL, El Hage Y, Politti F, Gonzalez Tde O, Bussadori SK, Biasotto-Gonzalez DA.
J Phys Ther Sci. 2015 Jan;27(1):295-301. doi: 10.1589/jpts.27.295.
The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment tools. [Subjects and Methods] Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: “temporomandibular joint laser therapy" and "TMJ laser treatment". [Results] Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. [Conclusion] Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD.
Efficacy of low-level laser therapy in the treatment of TMDs: a meta-analysis of 14 randomised controlled trials.
Chen J, Huang Z, Ge M, Gao M.
J Oral Rehabil. 2015 Apr;42(4):291-9. doi: 10.1111/joor.12258.
This study was designed to evaluate the efficacy of low-level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta-analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = -19·39; 95% confidence interval = -40·80-2·03; P < 0·00001; I(2) = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73-7·63; P = 0·006; I(2) = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34-12·13; P = 0·06; I(2) = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79-2·83; P = 0·59; I(2) = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27-4·45; P = 0·01; I(2) = 73%). The results of our meta-analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.
Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature.
Melis M, Di Giosia M, Zawawi KH.
Cranio. 2012 Oct;30(4):304-12.
The authors performed a review of the literature to evaluate the efficacy of low level laser therapy (LLLT) for the treatment of temporomandibular disorders (TMD). Selection criteria included: 1) human subjects, 2) articles written in English, and 3) randomized placebo-controlled trials. Evaluation was performed according to the CONSORT 2010 criteria. A total of 14 articles were included in the review. Studies varied considerably in terms of methodological design, particularly regarding the site of application of the laser beam, the number of applications performed, their duration, the laser beam features (wavelength, frequency, output, dosage), and outcome measures. The outcome of the trials was controversial and not particularly related to any features of the laser beam, to the number of laser applications, and their duration. Based on the results of this review no definitive conclusions can be drawn on the efficacy of LLLT for the treatment of TMD. Many methodological differences among the studies, especially regarding the number and duration of laser applications and characteristics of the laser beam (wavelength, frequency, output), do not allow for standardized guidelines for effective treatment with LLLT. The only indication seems to be that LLLT is probably more effective for the treatment of TMJ disorders, and less effective for the treatment of masticatory muscle disorders.
Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review.
Maia ML, Bonjardim LR, Quintas Jde S, Ribeiro MA, Maia LG, Conti PC.
J Appl Oral Sci. 2012 Nov-Dec;20(6):594-602.
Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected. OBJECTIVE: To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD. MATERIAL AND METHODS: The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events. RESULTS: After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm², while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies
reporting pain relief for both the experimental group and for the placebo. CONCLUSION: Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.
Is low level laser effective for the treatment of orofacial pain?: A systematic review.
Tengrungsun T, Mitriattanakul S, Buranaprasertsuk P, Suddhasthir T.
Cranio. 2012 Oct;30(4):280-5.
The aim of this study was to assess the effectiveness of low level laser therapy (LLLT) as a treatment for orofacial pain considering the methodology of the studies. PubMed (1983-2009) and one conference proceeding were searched. Studying quality was assessed using a validated instrument. A high-quality score was defined as high or low. Outcomes were defined as either positive (+), neutral (0), or negative (-). Thirty-three studies met inclusion criteria. The best evidence synthesis method was used to formulate outcome of LLLT for each type of control group. LLLT vs. placebo pooling revealed high-quality trials in three of eight positive studies. In LLLT vs. other active treatment pooling, two high-quality studies out of nine neutral trials were found. Quality of the trial was not significantly associated with neutral results (p=0.05). Only limited evidence indicated that LLLT is more effective than placebo, sham laser, and other active treatments.
Effectiveness of low-level laser therapy in temporomandibular disorders: a systematic review and meta-analysis.
Petrucci A, Sgolastra F, Gatto R, Mattei A, Monaco A.
J Orofac Pain. 2011 Fall;25(4):298-307.
AIM: To assess the scientific evidence on the efficacy of low-level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMD). METHODS: The databases of PubMed, Science Direct, Cochrane Clinical Trials Register, and PEDro were manually and electronically searched up to February 2010. Two independent reviewers screened, extracted, and assessed the quality of the publications. A meta-analysis- was performed to quantify the pooled effect of LLLT on pain and function in patients with chronic TMD. RESULTS: The literature search identified 323 papers without overlap between selected databases, but after the two-phase study selection, only six randomized clinical trials (RCT) were included in the systematic review. The primary outcome of interest was the change in pain from baseline to endpoint. The pooled effect of LLLT on pain, measured through a visual analog scale with a mean difference of 7.77 mm (95% confidence interval [CI]: -2.49 to 18.02), was not statistically significant from placebo. Change from baseline to endpoint of secondary outcomes was 4.04 mm (95% CI 3.06 to 5.02) for mandibular maximum vertical opening; 1.64 mm (95% CI 0.10 to 3.17) for right lateral excursion and 1.90 mm (95% CI: -4.08 to 7.88) for left lateral excursion. CONCLUSION: Currently, there is no evidence to support the effectiveness of LLLT in the treatment of TMD. CONCLUSION: Although limited in extent, the available data support the efficacy of EMG biofeedback treatments for TMD.