EFFICACY OF PHOTOBIOMODULATION THERAPY ON PAIN PERCEPTION DURING LOCAL ANESTHESIA IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE

This systematic review and meta-analysis is the first to evaluate the impact of photobiomodulation therapy (PBMT) on objective and physiological measures of local anesthesia injection pain in children aged 3-12.

METHODS

This review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines and is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024549936. A systematic search was conducted in Embase, PubMed, and the Cochrane Library to locate relevant Randomized Clinical Trials (RCTs) between January 2000 to September 2024. Study screening, data extraction, risk of bias evaluation, and certainty of evidence grading were performed independently by 2 reviewers. Meta-analyses focused on the pain assessment using following measures: Wong-Baker Faces Pain Rating Scale (PRS), Sound, Eye, and Motor Scale (SEM), Face, Legs, Activity, Cry, Consolability Scale (FLACC), and heart rate (HR). Sensitivity analyses were conducted using a leave-one-study-out approach to assess the robustness of the findings, while publication bias and heterogeneity were evaluated through established statistical methods.

RESULTS

Out of 1322 identified studies, 7 RCTs met inclusion criteria. PBMT significantly reduced pain, with moderate certainty, as measured by the objective FLACC scale (SMD = -0.41, 95% CI: -0.72, -0.09, P = .011) and the physiological HR method (SMD = -0.50, 95% CI: -0.86, -0.14, P = .006), demonstrating moderate and no heterogeneity, respectively. However, no statistically significant effect was observed on subjective measures using the PRS (SMD = -0.66, 95% CI: -1.63, 0.32, P = .185) and SEM (SMD = 0.18, 95% CI: -1.09, 1.45, P = .780) scales. Five studies had low risk of bias, and GRADE analysis indicated very low to moderate certainty. Funnel plots showed minimal publication bias, except for slight asymmetry in PRS.

CONCLUSIONS

PBMT demonstrates potential as a nonpharmacological method to reduce injection pain in children, as reflected in FLACC and HR outcomes. However, no significant effect of PBMT was observed on the SEM scale. Further research is needed to clarify its impact on subjective pain measures (PRS) and to optimize PBMT protocols.