School of Medicine, Taipei Medical University, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University.
Pain Physician. 2019 May;22(3):241-254.
Fibromyalgia is a chronic disorder characterized by widespread pain and tenderness. Low-level laser therapy (LLLT), an emerging nonpharmacological treatment, has been used for relieving musculoskeletal or neuropathic pain.
The objective of this review and meta-analysis was to determine the efficacy of LLLT on patients with fibromyalgia.
This study involved systematic review and quantitative meta-analysis of published randomized controlled trials (RCTs).
This study examined all RCTs evaluating the effect of LLLT on fibromyalgia.
We performed a systematic review and meta-analysis of RCTs evaluating the effect of LLLT on patients with fibromyalgia. PubMed, EMBASE, and the Cochrane Library were searched for articles published before August 2018. RCTs meeting our selection criteria were included. The methodological quality of the RCTs was evaluated according to the Cochrane risk-for-bias method. Review Manager version 5.3 was used to perform the meta-analysis. The primary outcomes were the total scores on the Fibromyalgia Impact Questionnaire (FIQ), pain severity, and number of tender points. The secondary outcomes were changes in fatigue, stiffness, anxiety, and depression. Standardized mean difference (SMD), 95% confidence intervals (CI), and P values were calculated for outcome analysis.
We identified 9 RCTs that included 325 fibromyalgia patients undergoing LLLT or placebo laser treatment with or without an exercise program. The meta-analysis showed that patients receiving LLLT demonstrated significantly greater improvement in their FIQ scores (SMD: 1.16; 95% CI, 0.64-1.69), pain severity (SMD: 1.18; 95% CI, 0.82-1.54), number of tender points (SMD: 1.01; 95% CI, 0.49-1.52), fatigue (SMD: 1.4; 95% CI, 0.96-1.84), stiffness (SMD: 0.92; 95% CI, 0.36-1.48), depression (SMD: 1.46; 95% CI, 0.93-2.00), and anxiety (SMD: 1.46; 95% CI, 0.45-2.47) than those receiving placebo laser. Furthermore, when compared with the standardized exercise program alone, LLLT plus the standardized exercise program provided no extra advantage in the relief of symptoms. On the other hand, the results of the only RCT using combined LLLT/LED phototherapy showed significant improvement in most outcomes except for depression when compared to placebo. When compared with pure exercise therapy, combined LLLT/LED phototherapy plus exercise therapy had additional benefits in reducing the severity of pain, number of tender points, and fatigue.
There were some limitations in this review, mostly because of the low-to-middle methodological quality of the selected studies; for example, there was no clear allocation process and only patients were blinded in most studies. In addition, one study used per-protocol analysis with a 20% loss to follow-up. On the other hand, the differences in laser types, energy sources, exposure times, and associated medication status in these studies may have resulted in some heterogeneity.
Our results provided the most up-to-date and relevant evidence regarding the effects of LLLT in fibromyalgia. LLLT is an effective, safe, and well-tolerated treatment for fibromyalgia.
Low-level laser therapy, fibromyalgia, meta-analysis, FIQ, pain, tender points,exercise.
纤维肌痛是一种以广泛疼痛和压痛为特征的慢性疾病。低水平激光疗法（LLLT）作为一种新兴的非药物治疗方法，已被用于缓解肌肉骨骼或神经病理性疼痛。
本综述和荟萃分析的目的是确定 LLLT 对纤维肌痛患者的疗效。
本研究为系统评价和已发表的随机对照试验（RCT）的定量荟萃分析。
本研究评估了所有评估 LLLT 对纤维肌痛影响的 RCT。
我们对评估 LLLT 对纤维肌痛患者影响的 RCT 进行了系统评价和荟萃分析。在 2018 年 8 月之前，我们在 PubMed、EMBASE 和 Cochrane 图书馆中搜索了发表的文章。符合我们选择标准的 RCT 被纳入。根据 Cochrane 偏倚风险方法评估 RCT 的方法学质量。使用 Review Manager 版本 5.3 进行荟萃分析。主要结局是纤维肌痛影响问卷（FIQ）的总分、疼痛严重程度和压痛点数。次要结局是疲劳、僵硬、焦虑和抑郁的变化。对于结局分析，计算了标准化均数差（SMD）、95%置信区间（CI）和 P 值。
我们确定了 9 项 RCT，其中包括 325 名接受 LLLT 或安慰剂激光治疗加或不加运动方案的纤维肌痛患者。荟萃分析显示，接受 LLLT 的患者 FIQ 评分（SMD：1.16；95%CI，0.64-1.69）、疼痛严重程度（SMD：1.18；95%CI，0.82-1.54）、压痛点数（SMD：1.01；95%CI，0.49-1.52）、疲劳（SMD：1.4；95%CI，0.96-1.84）、僵硬（SMD：0.92；95%CI，0.36-1.48）、抑郁（SMD：1.46；95%CI，0.93-2.00）和焦虑（SMD：1.46；95%CI，0.45-2.47）均有显著改善，优于接受安慰剂激光的患者。此外，与单独的标准化运动方案相比，LLLT 加标准化运动方案在缓解症状方面没有提供额外的优势。另一方面，唯一一项使用联合 LLLT/LED 光疗的 RCT 结果显示，与安慰剂相比，除抑郁外，大多数结局均有显著改善。与单纯运动疗法相比，联合 LLLT/LED 光疗加运动疗法在减轻疼痛严重程度、压痛点数和疲劳方面具有额外的益处。
由于所选研究的方法学质量低到中等，本综述存在一些局限性；例如，大多数研究没有明确的分配过程，只有患者被盲法。此外，一项研究采用了意向治疗分析，失访率为 20%。另一方面，这些研究中激光类型、能量源、暴露时间和相关药物状态的差异可能导致了一些异质性。
我们的结果提供了关于 LLLT 在纤维肌痛中作用的最新和最相关的证据。LLLT 是一种有效、安全且耐受良好的纤维肌痛治疗方法。
低水平激光疗法、纤维肌痛、荟萃分析、FIQ、疼痛、压痛点、运动。
