High-intensity laser for the treatment of pain: systematic review

Silva, Ulli Uldiery Oliveira; Servin, Elizabeth Teixeira Noguera; Leal, Plínio da Cunha; Barros de-Oliveira, Caio Marcio; Moura, Ed Carlos Rey; Silva-Junior, Otávio de Melo

doi:10.5935/2595-0118.20230030-en

Ulli Uldiery Oliveira Silva Correspondence to: Ulli Uldiery Oliveira Silva, E-mail: ulliuld@gmail.com

Statistical Analysis

Data Collection

Conceptualization

Research

Methodology

Writing - Preparation of the Original

Federal University of Maranhão, São Luís, MA, Brazil

https://orcid.org/0000-0001-7309-6523

Elizabeth Teixeira Noguera Servin

Conceptualization

Project Management

Writing - Review and Editing

Supervision

Validation

Federal University of Maranhão, São Luís, MA, Brazil

https://orcid.org/0000-0003-0027-5306

Plínio da Cunha Leal

Supervision

Validation

Visualization

Federal University of Maranhão, São Luís, MA, Brazil

https://orcid.org/0000-0003-1336-8528

Caio Marcio Barros de-Oliveira

Supervision

Validation

Visualization

Federal University of Maranhão, São Luís, MA, Brazil

https://orcid.org/0000-0002-5068-9067

Ed Carlos Rey Moura

Supervision

Validation

Visualization

Federal University of Maranhão, São Luís, MA, Brazil

https://orcid.org/0000-0002-7752-0683

Otávio de Melo Silva-Junior

Methodology

Regenius Institute, Belo Horizonte, MG, Brazil

https://orcid.org/0000-0003-1684-4809

Conflict of interests: none

Correspondence to: Ulli Uldiery Oliveira Silva, E-mail: ulliuld@gmail.com

Authors	Protocol for intervention	Duration	Pain assessment method	Outcome
Nazari et al.²²22 Nazari A, Moezy A, Nejati P, Mazaherinezhad A. Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow-up. Lasers Med Sci. 2019;34(3):505-16. Knee osteoarthritis	n=93 G1= HIL 3x/week + exercise G2 = Conventional Therapy (TENS and US) + exercise G3 = exercise	12 weeks	VAS	HIL + exercise was more effective for pain reduction than conventional therapy + exercise and exercise alone.
Angelova and Ilieva²³23 Angelova A, Ilieva EM. Effectiveness of high intensity laser therapy for reduction of pain in knee osteoarthritis. Pain Res Manag. 2016;2016:9163618. Knee osteoarthritis	n=72 G1= HIL 3 sessions: 300 J/ 2 min 4 sessions 3.000 J/ 10 min G2= placebo laser	12 weeks	VAS and dolorimetry	Pain scores were significantly reduced in G1 after 7 days of treatment and were better when compared to G2.
Kheshie, Alayat and Ali²⁴24 Kheshie AR, Alayat MSM, Ali MME. High intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci. 2014;29(4):1371-6. Knee osteoarthritis	n=53 G1=HIL+exercise 1250 J/ 15 min G2=LIL+exercise 1250 J/32min and 33 seconds G3=placebo laser + exercise	6 weeks	VAS	HIL and LIL associated with exercise are more effective than exercise alone in reducing VAS scores. HIL + exercise was more effective than LIL + exercise
Stiglicć-Rogoznica et al.²⁵25 Stiglicć-Rogoznica N, Stamenkovicć D, Frlan-Vrgoc L, Avancini-Dobrovicć V, Vrbanicć TS. Analgesic effect of high intensity laser therapy in knee osteoarthritis. Coll Antropol. 2011;35(Suppl 2):183-5. Knee osteoarthritis	n=96 G1= HIL 20 min/day - 10 days	2 weeks	VAS	HIL significantly reduced pain, from 45-70mm to 10-30mm (p>0.001)
Alayat et al.³⁷37 Alayat MSM, Atya AM, Ali MME, Shosha TM. Long-term effect of highintensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebocontrolledtrial. Lasers Med Sci. 2014;29(3):1065-73. Low back pain	n=72 G1= HIL+exercise 3x/week, 15 min by 4 weeks G2: placebo laser + exercise 3x/week by 4 weeks G3= HIL	12 weeks	VAS	G1 significantly reduced VAS scores when compared to G2, with the smallest effect experienced by G3 at both 4 and 12 weeks
Authors	Protocol for intervention	Duration	Pain assessment method	Outcome
Fiore et al.³⁸38 Fiore P, Panza F, Cassatella G, Russo A, Frisardi V, Solfrizzi V, Ranieri M, Di Teo L, Santamato A. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(3):367-73. Low back pain	n=30 G1= HIL by 10 min, 15 sessions G2= US 10 min, 15 sessions. Both 3 weeks 5x/week	3 weeks	VAS and OLBPDQ	HIL significantly reduced pain when compared to US.
Boyraz et al.³⁹39 Boyraz I, Yildiz A, Koc B, Sarman H. Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy. Biomed Res Int. 2015;2015:304328. Discopathy	n=65 G1= 10 sessions HIL G2= 10 sessions US G3= isometric exercises	12 weeks	VAS	HIL significantly reduced pain at the 3-month assessment when compared to groups 2 and 3, but there were no significant differences after 10 days of treatment
Chen et al.⁴⁰40 Chen L, Liu D, Zou L, Huang J, Chen J, Zou Y, Lai J, Chen J, Li H, Liu G. Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: a randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(1):191-6. Low back pain	n=63 G1= HIL+ decompression (1 session 10 min) G2= decompression	6 weeks	VAS	HIL reduced pain (lower back and lower limbs) non-significantly (p>0.05) at week 2, and significantly at week 4
Cantero-Téllez et al.⁴¹41 Cantero-Téllez R, Villafañe JH, Valdes K, García-Orza S, Bishop MD, Medina- Porqueres I. Effects of high-intensity laser therapy on pain sensitivity and motor performance in patients with thumb carpometacarpal joint osteoarthritis: a randomized controlled trial. Pain Med. 2020;21(10):2357-65. thumb OA	n=43 G1: HIL 3x/week- 4 weeks G2: placebo laser	12 weeks	VAS	HIL reduced pain significantly after a period of 4 weeks when compared to G2.
Atan and Bahar-Ozdenir⁴²42 Atan T, Bahar-Ozdemir Y. Efficacy of high-intensity laser therapy in patients with adhesive capsulitis: a sham-controlled randomized controlled trial. Lasers Med Sci. 2021;36(1):207-17. Adhesive Capsulitis	n=36 G1= HIL+ exercise G2= placebo laser+ exercise G3= exercise 5x/week	3 weeks	VAS SPAID	HIL + exercise was more beneficial than placebo laser + exercise, and than exercise alone (p<0.05)
Korkmaz et al.⁴³43 Korkmaz N, Gurcay E, Demir Y, Tezen Ö. Korkmaz Iï, Atar MÖ, Yaşar E. The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain a prospec. Lasers Med Sci, 2022;37(1):645-53. Post-stroke shoulder	n=44 G1= HIL, + exercise G2= exercises only	3 weeks	VAS SPAID	HIL associated with exercise was better at relieving pain, reducing dysfunction, and improving quality of life than exercise alone (p<0.05)
Aceituno-Gómez et al.⁴⁴44 Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J, García-Madero VM, Ávila-Martín G, Serrano-Muñoz D, González-González J, Criado-Álvarez JJ. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil. 2019;33(5):894-903. Impaction syndrome	n=46 G1- HIL G2= placebo laser G3= exercise 5 sessions/week by 3 weeks	3 weeks	VAS and ECM	HIL + exercise was no more effective than exercise alone in reducing pain and improving function
Ezzati et al.⁴⁵45 Ezzati K, Laakso EL, Saberi A, Yousefzadeh Chabok S, Nasiri E, Bakhshayesh Eghbali B. A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med. 2020;56(6):733-40. Carpal tunnel	n=98 G1= exercise + LIL (8J/cm2) G2= exercise + LIL (20J/cm2) G3= exercise + HIL (8J/cm2) G4= exercise + HIL (20J/cm2) G5= exercise	3 weeks	VAS	All groups had significant pain reduction. HIL + exercise was superior to all other groups LIL with low fluence (8J/cm2) obtained the most significant pain reduction
Venosa et al.⁴⁶46 Venosa M, Romanini E, Padua R, Cerciello S. Comparison of high-intensity laser therapy and combination of ultrasound treatment and transcutaneous nerve stimulation in patients with cervical spondylosis: a randomized controlled trial. Lasers Med Sci. 2019;34(5):947-53. Cervical spondylosis	n=84 G1= HIL + exercise G2= US, TENS and exercise	4 weeks	VAS	Pain reduction was observed in all groups. HIL was more effective than US+TENS+exercise in reducing pain (p<0.05)
Thabet and Alshehri⁴⁷47 Thabet AAE, Alshehri MA. Effect of pulsed high-intensity laser therapy on pain, adhesions, and quality of life in women having endometriosis: a randomized controlled trial. Photomed Laser Surg. 2018;36(7):363-9. Endometriosis	n=40 G1= HIL, 3x/week G2= placebo laser 3x/week	8 weeks	VAS and NRS	HIL significantly reduced pain when compared to the placebo laser
Ordahan, Karahan and Kaydok⁴⁸48 Ordahan B, Karahan AY, Kaydok E. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci. 2018;33(6):1363-9. Faceitis plantaris	n=75 G1= LIL (3 sessions/ week) G2= HIL (3 sessions/ week)	3 weeks	VAS	Both lasers improved pain, but in the HIL group the reductions were significant (p<0.05)
El-Shamy e Abdelaal⁴⁹ Hemophilic arthropathy	n=30 G1= HIL + physiotherapy G2= placebo laser + physiotherapy Both 3x/week	12 weeks	VAS	HIL was shown to be more effective in improving pain, functional capacity, and gait when compared to the placebo group
Thabet et al.⁵⁰50 Thabet AAE, Elsodany AM, Battecha KH, Alshehri MA, Refaat B. High-intensity laser therapy versus pulsed electromagnetic field in the treatment of primary dysmenorrhea. J Phys Ther Sci. 2017;29(10):1742-8. Primary dysmenorrhea	n=52 G1= HIL G2= PEMF Both 3 cycles of 3 sessions	6 months	VAS and NRS	Both therapies promoted pain relief, but HIL was the one that generated the most significant result (p<0.05)
Ebid et al.⁵¹51 Ebid AA, Ibrahim AR, Omar MT, El Baky AMA. Long-term effects of pulsed high-intensity laser therapy in the treatment of post-burn pruritus: a double-blind, placebo-controlled, randomized study. Lasers Med Sci. 2017;32(3):693-701. Burned	n=49 G1= HIL 3x/week by 6 weeks G2= placebo laser	18 weeks	VAS	HIL significantly reduced pain and pruritus compared to the placebo group
Alayat et al.⁵²52 Alayat MS, Mohamed AA, Helal OF, Khaled OA. Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebocontrol trial. Lasers Med Sci. 2016;31(4):687-94. Chronic cervical pain	n=60 G1= HIL + exercise G2= placebo laser + exercise	6 weeks	VAS	There was pain reduction in both groups, but significant pain reduction in the HIL group after 6 weeks of treatment
Authors	Protocol for intervention	Duration	Pain assessment method	Outcome
Ebid and El-Sodany⁵³53 Ebid AA, El-Sodany AM. Long-term effect of pulsed high-intensity laser therapy in the treatment of post-mastectomy pain syndrome: a double blind, placebocontrol, randomized study. Lasers Med Sci. 2015;30(6):1747-55. Post-mastectomy	n=61 G1= HIL 3x/week G2= HIL 3x/week	12 weeks	VAS	Pain was significantly reduced in the HIL group when compared to the placebo group.
Kim et al.⁵⁴54 Kim SH, Kim YH, Lee HR, Choi YE. Short-term effects of high-intensity laser therapy on frozen shoulder: A prospective randomized control study. Man Ther. 2015;20(6):751-7. Frozen shoulder syndrome	n= 63 G1= HIL 3x/week by 3 weeks G2= placebo laser	12 weeks	VAS	HIL group had significantly lower VAS scores at 3 and 8 weeks, but this difference was not maintained at week 12
Dundar et al.⁵⁵55 Dundar U, Turkmen U, Toktas H, Ulasli AM, Solak O. Effectiveness of highintensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci. 2015;30(3):1097-107. Lateral epicondylitis	n=93 15 days in a row: G2= HIL 1 sessions/day G2= placebo laser 1 sessions/day G3= use of counterforce belt	12 weeks	VAS	HIL and counterforce belt reduced pain at 4 and 12 weeks with significance compared to G2.
Dundar et al.⁵⁶56 Dundar U, Turkmen U, Toktas H, Solak O, Ulasli AM. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study. Lasers Med Sci. 2015;30(1):325-32. Trapezium	n=76 G1= HIL 1x/day by 15 days + exercise G2= placebo laser + exercise	12 weeks	VAS	HIL reduziu os escores da VAS na 4ª e 12ª semanas de forma significante em comparação com o grupo placebo
Nouri et al.⁵⁷57 Nouri F, Raeissadat SA, Eliaspour D, Rayegani SM, Rahimi MS, Movahedi B. Efficacy of high-power laser in alleviating pain and improving function of patients with patellofemoral pain syndrome: a single-blind randomized controlled trial. J Lasers Med Sci. 2019;10(1):37-43. Patellofemoral pain	n=40 G1=placebo laser + exercise G2= HIL 5 sessions + exercise	12 weeks	VAS and WOMAC	The reductions in VAS with HIL were more significant than those in the placebo group. The reductions in WOMAC scale were not different between groups (p>0.05)
Yesil et al.⁵⁸58 Yesil H, Dundar U, Toktas H, Eyvaz N, Yeşil M. The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebocontrolled study. Lasers Med Sci. 2020;35(4):841-52 Heel pain	n=42 G1=HIL+exercise G2= placebo laser+ exercise	12 weeks	VAS and RMS	Both VAS and RMS were significantly reduced in both groups at weeks 4 and 12 compared to pre-treatment measurements, however there was no difference between groups at any time point.
Song et al.²⁶26 Song HJ, Seo HJ, Lee Y, Kim SK. Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(51):e13126. Musculoskeletal pain	n=736(12 studies) GL= HIL GC= placebo, exercise, US, TENS, bandages	2-12 weeks	VAS	In 11 studies HIL significantly reduced pain when compared to the control groups. The quality of the included studies was moderate; however, there was significant heterogeneity.
Ezzati et al.²⁸28 Ezzati K, Laakso EL, Salari A, Hasannejad A, Fekrazad R, Aris A. The beneficial effects of high-intensity laser therapy and co-interventions on musculoskeletal pain management: a systematic review. J Lasers Med Sci. 2020;11(1):81-90. Musculoskeletal pain	n= 19 studies G1= HIL (11 studies) G2= other interventions (8 studies)		VAS	It has been observed that the addition of HIL-related co-interventions can enhance the beneficial effects of laser therapy
Starzec-Prosepio et al.²⁹29 Starzec-Proserpio M, Grigol Bardin M, Fradette J, Tu LM, Bérubè-Lauzière Y, Paré J, Carroll MS, Morin M. High-Intensity Laser Therapy (HILT) as an emerging treatment for vulvodynia and chronic musculoskeletal pain disorders: a systematic review of treatment efficacy. J Clin Med. 2022;11(13):3701. Vulvodynia and chronic muscle pain	n=726(13 studies) GL= HIL GP= placebo laser, LIL, US, PEMF or exercise	Up to 12 weeks	VAS	There was pain reduction in all 13 HIL groups in all 13 studies, with only 1 study showing no statistically significant difference (HIL vs. LIL). However, the findings on LIL in vulvodynia are insufficient to recommend its use in clinical settings
Wyszynska and Bal-Bochenska³⁰30 Wyszyńska J, Bal-Bocheńska M. Efficacy of high-intensity laser therapy in treating knee osteoarthritis: a first systematic review. Photomed Laser Surg. 2018;36(7):343-53. Knee osteoarthritis	n=395 (6 studies) GL= HIL GC=placebo, other rehabilitation therapies, pharmacotherapies	2-6 weeks	VAS, WOMAC, Fisher’s dolorimeter	HIL showed favorable results in pain relief, more than the other interventions, and is efficient in pain reduction and functional improvement in patients with knee OA. However, the quality assessment indicated a high risk of bias in four of the six studies
Alayat et al.²⁷27 Alayat MSM, Alshehri MA, Shousha TM, Abdelgalil AA, Alhasan H, Khayyat OK, Al-Attar WS. The effectiveness of high intensity laser therapy in the management of spinal disorders: a systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2019;32(6):869-84 Spinal pain	n=750 (10 studies) G1= HIL G2=conventional therapy (exercise, US, traction, drugs)	1-12 weeks	VAS	The combination of HIL and exercise or conservative physical therapy was superior to placebo, exercise, or physical therapy alone. However, the quality of the body of evidence was rated from “very low” to “low”.

Authors	Model	Wavelength (nm)	Energy density (J/cm²)	Maximum power (W)	Mode	Frequency (Hz)	Time per spot	Sessions
Cantero-Tellez et al.⁴¹41 Cantero-Téllez R, Villafañe JH, Valdes K, García-Orza S, Bishop MD, Medina- Porqueres I. Effects of high-intensity laser therapy on pain sensitivity and motor performance in patients with thumb carpometacarpal joint osteoarthritis: a randomized controlled trial. Pain Med. 2020;21(10):2357-65.	KLaser, K1200	800 + 970	15	3	Pulsed	2	15seg	12
Aceituno-Gómez et al.⁴⁴44 Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J, García-Madero VM, Ávila-Martín G, Serrano-Muñoz D, González-González J, Criado-Álvarez JJ. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil. 2019;33(5):894-903.	iLux	1064	50 250	15	Pulsed	50	-	15
Venosa et al.⁴⁶46 Venosa M, Romanini E, Padua R, Cerciello S. Comparison of high-intensity laser therapy and combination of ultrasound treatment and transcutaneous nerve stimulation in patients with cervical spondylosis: a randomized controlled trial. Lasers Med Sci. 2019;34(5):947-53.	HIRO3	1064	-	3000	Continuous	10 - 40	120-150 µs	12
Nazari et al.²²22 Nazari A, Moezy A, Nejati P, Mazaherinezhad A. Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow-up. Lasers Med Sci. 2019;34(3):505-16.	E20780	1064	60	5	Continuous	30	-	12
Thabet and Alshehri⁴⁷47 Thabet AAE, Alshehri MA. Effect of pulsed high-intensity laser therapy on pain, adhesions, and quality of life in women having endometriosis: a randomized controlled trial. Photomed Laser Surg. 2018;36(7):363-9.	HIRO3	1064	0.51 0.65	3000	Continuous	10 - 40	14 s	24
Ordahan, Karahan and Kaydok⁴⁸48 Ordahan B, Karahan AY, Kaydok E. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci. 2018;33(6):1363-9.	BLT-6000	1064	6 120 - 150	12	Pulsed	-	Phase 1: 75s Phase 2: 30s	9
El-Shamy and Abdelaa⁴⁹49 El-Shamy SM, Abdelaal AAM. Efficacy of pulsed high-intensity laser therapy on pain, functional capacity, and gait in children with haemophilic arthropathy. Disabil Rehabil. 2018;40(4):462-8.	HIRO3	1064	0.61 0.71 0.81	-	Pulsed	-	14 s	36
Thabet et al.⁵⁰50 Thabet AAE, Elsodany AM, Battecha KH, Alshehri MA, Refaat B. High-intensity laser therapy versus pulsed electromagnetic field in the treatment of primary dysmenorrhea. J Phys Ther Sci. 2017;29(10):1742-8.	HIRO3	1064	0.51 - 0.64	3000	Pulsed	10 - 40	14 s	-
Ebid et al.⁵¹51 Ebid AA, Ibrahim AR, Omar MT, El Baky AMA. Long-term effects of pulsed high-intensity laser therapy in the treatment of post-burn pruritus: a double-blind, placebo-controlled, randomized study. Lasers Med Sci. 2017;32(3):693-701.	HIRO3	1064	0.61 0.71 0.81	3000	Pulsed	10 - 40	14 s	18
Alayat et al.⁵²52 Alayat MS, Mohamed AA, Helal OF, Khaled OA. Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebocontrol trial. Lasers Med Sci. 2016;31(4):687-94.	HIRO3	1064	27.3	3000	Pulsed	10 - 40	14 s	12
Angelova and Ilieva²³23 Angelova A, Ilieva EM. Effectiveness of high intensity laser therapy for reduction of pain in knee osteoarthritis. Pain Res Manag. 2016;2016:9163618.	BTT	1064	12 - 120	12	Pulsed	25	120 s	7
Ebid and El Sodany⁵³53 Ebid AA, El-Sodany AM. Long-term effect of pulsed high-intensity laser therapy in the treatment of post-mastectomy pain syndrome: a double blind, placebocontrol, randomized study. Lasers Med Sci. 2015;30(6):1747-55.	HIRO 3	1064	0.61 0.71 0.81	3000	Pulsed	10 - 40	14 s	12
Boyraz et al.³⁹39 Boyraz I, Yildiz A, Koc B, Sarman H. Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy. Biomed Res Int. 2015;2015:304328.	GaAIAs	1064	-	3,8	Pulsed	-	-	10
Kim et al.⁵⁴54 Kim SH, Kim YH, Lee HR, Choi YE. Short-term effects of high-intensity laser therapy on frozen shoulder: A prospective randomized control study. Man Ther. 2015;20(6):751-7.	Hilthera	1064	-	8000	-	20 - 30	5 s	9
Dundar, et al.⁵⁵55 Dundar U, Turkmen U, Toktas H, Ulasli AM, Solak O. Effectiveness of highintensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci. 2015;30(3):1097-107.	HIRO3	1064	1.78	3000	Pulsed	-	6 s	15
Dundar and Turkmen⁵⁶56 Dundar U, Turkmen U, Toktas H, Solak O, Ulasli AM. Effect of high-intensity laser therapy in the management of myofascial pain syndrome of the trapezius: a double-blind, placebo-controlled study. Lasers Med Sci. 2015;30(1):325-32.	HIRO 3	1064	0.36 0.41 0.50	3000	Pulsed	10 - 40	6 s	15
Authors	Model	Wavelength (nm)	Energy density (J/cm²)	Maximum power (W)	Mode	Frequency (Hz)	Time per spot	Sessions
Alayat et al.³⁷37 Alayat MSM, Atya AM, Ali MME, Shosha TM. Long-term effect of highintensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebocontrolledtrial. Lasers Med Sci. 2014;29(3):1065-73.	HIRO 3	1064	0.61 0.71 0.81	3000	Pulsed	10 - 40	14 s	12
Kheshie, Alayat and Ali²⁴24 Kheshie AR, Alayat MSM, Ali MME. High intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci. 2014;29(4):1371-6.	HIRO 3	-	0.61 0.71 0.81	-	Pulsed	-	14 s	12
Fiore et al.³⁸38 Fiore P, Panza F, Cassatella G, Russo A, Frisardi V, Solfrizzi V, Ranieri M, Di Teo L, Santamato A. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(3):367-73.	HIRO 1	1064	0.76	6	Pulsed	-	-	15
Nouri et al.⁵⁷57 Nouri F, Raeissadat SA, Eliaspour D, Rayegani SM, Rahimi MS, Movahedi B. Efficacy of high-power laser in alleviating pain and improving function of patients with patellofemoral pain syndrome: a single-blind randomized controlled trial. J Lasers Med Sci. 2019;10(1):37-43.	BTL-6000	1064	120	12	-	-	120 s	5
Stiglicć-Rogoznica et al.²⁵25 Stiglicć-Rogoznica N, Stamenkovicć D, Frlan-Vrgoc L, Avancini-Dobrovicć V, Vrbanicć TS. Analgesic effect of high intensity laser therapy in knee osteoarthritis. Coll Antropol. 2011;35(Suppl 2):183-5.	HIRO 3	1064	-	3000	Pulsed	-	< 120 s	10
Yesil et al.⁵⁸58 Yesil H, Dundar U, Toktas H, Eyvaz N, Yeşil M. The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebocontrolled study. Lasers Med Sci. 2020;35(4):841-52	HIRO 3	1064	0.36 - 1.78	3000	Pulsed	10 - 40	120 - 150 µs	15
Korkmaz et al.⁴³43 Korkmaz N, Gurcay E, Demir Y, Tezen Ö. Korkmaz Iï, Atar MÖ, Yaşar E. The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain a prospec. Lasers Med Sci, 2022;37(1):645-53.	BTL-6000	1064	12 100	12	Phase 1: Pulsed Phase 2: Continuous	25	-	9
Atan and Bahar-Ozdemir⁴²42 Atan T, Bahar-Ozdemir Y. Efficacy of high-intensity laser therapy in patients with adhesive capsulitis: a sham-controlled randomized controlled trial. Lasers Med Sci. 2021;36(1):207-17.	iLux	1064	100	15	Continuous	-	-	15
Ezzati et al.⁴⁵45 Ezzati K, Laakso EL, Saberi A, Yousefzadeh Chabok S, Nasiri E, Bakhshayesh Eghbali B. A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med. 2020;56(6):733-40.	-	808	High fluency: 8 Low fluency: 20	1.6		10	100 - 250 s	5
Chen et al.⁴⁰40 Chen L, Liu D, Zou L, Huang J, Chen J, Zou Y, Lai J, Chen J, Li H, Liu G. Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: a randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(1):191-6.	BLT -6000	1064	150	12	-	-	-	10

Authors	Crit. 1	Crit. 2	Crit. 3	Crit. 4	Crit. 5	Crit. 6	Crit. 7	Crit. 8	Crit. 9	Crit. 10	Crit. 11	Total score
Cantero-Tellez et al.⁴¹41 Cantero-Téllez R, Villafañe JH, Valdes K, García-Orza S, Bishop MD, Medina- Porqueres I. Effects of high-intensity laser therapy on pain sensitivity and motor performance in patients with thumb carpometacarpal joint osteoarthritis: a randomized controlled trial. Pain Med. 2020;21(10):2357-65.	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	9/10
Ezzati et al.⁴⁵45 Ezzati K, Laakso EL, Saberi A, Yousefzadeh Chabok S, Nasiri E, Bakhshayesh Eghbali B. A comparative study of the dose-dependent effects of low level and high intensity photobiomodulation (laser) therapy on pain and electrophysiological parameters in patients with carpal tunnel syndrome. Eur J Phys Rehabil Med. 2020;56(6):733-40.	Yes	Yes	No	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	8/10
Aceituno-Gómez et al.⁴⁴44 Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J, García-Madero VM, Ávila-Martín G, Serrano-Muñoz D, González-González J, Criado-Álvarez JJ. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil. 2019;33(5):894-903.	Yes	Yes	No	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	8/10
Venosa et al.⁴⁶46 Venosa M, Romanini E, Padua R, Cerciello S. Comparison of high-intensity laser therapy and combination of ultrasound treatment and transcutaneous nerve stimulation in patients with cervical spondylosis: a randomized controlled trial. Lasers Med Sci. 2019;34(5):947-53.	No	Yes	No	Yes	No	No	No	No	No	Yes	Yes	4/10
Nazari et al.²²22 Nazari A, Moezy A, Nejati P, Mazaherinezhad A. Efficacy of high-intensity laser therapy in comparison with conventional physiotherapy and exercise therapy on pain and function of patients with knee osteoarthritis: a randomized controlled trial with 12-week follow-up. Lasers Med Sci. 2019;34(3):505-16.	Yes	Yes	No	Yes	No	No	Yes	Yes	No	Yes	Yes	6/10
Thabet and Alshehri⁴⁷47 Thabet AAE, Alshehri MA. Effect of pulsed high-intensity laser therapy on pain, adhesions, and quality of life in women having endometriosis: a randomized controlled trial. Photomed Laser Surg. 2018;36(7):363-9.	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	9/10
Ordahan, Karahan and Kaydok⁴⁸48 Ordahan B, Karahan AY, Kaydok E. The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: a randomized clinical trial. Lasers Med Sci. 2018;33(6):1363-9.	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	8/10
El-Shamy and Abdelaal⁴⁹	Yes	Yes	Yes	Yes	Yes	No	No	No	No	Yes	Yes	6/10
Chen et al.⁴⁰40 Chen L, Liu D, Zou L, Huang J, Chen J, Zou Y, Lai J, Chen J, Li H, Liu G. Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: a randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(1):191-6.	Yes	Yes	Yes	Yes	No	No	No	Yes	Yes	Yes	Yes	7/10
Thabet et al.⁵⁰50 Thabet AAE, Elsodany AM, Battecha KH, Alshehri MA, Refaat B. High-intensity laser therapy versus pulsed electromagnetic field in the treatment of primary dysmenorrhea. J Phys Ther Sci. 2017;29(10):1742-8.	No	Yes	No	Yes	No	No	No	No	No	Yes	Yes	4/10
Ebid et al.⁵¹51 Ebid AA, Ibrahim AR, Omar MT, El Baky AMA. Long-term effects of pulsed high-intensity laser therapy in the treatment of post-burn pruritus: a double-blind, placebo-controlled, randomized study. Lasers Med Sci. 2017;32(3):693-701.	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	Yes	No	7/10
Alayat et al.⁵²52 Alayat MS, Mohamed AA, Helal OF, Khaled OA. Efficacy of high-intensity laser therapy in the treatment of chronic neck pain: a randomized double-blind placebocontrol trial. Lasers Med Sci. 2016;31(4):687-94.	Yes	Yes	No	Yes	No	No	No	No	No	Yes	Yes	4/10
Angelova and Ilieva²³23 Angelova A, Ilieva EM. Effectiveness of high intensity laser therapy for reduction of pain in knee osteoarthritis. Pain Res Manag. 2016;2016:9163618.	Yes	Yes	No	Yes	No	No	No	Yes	Yes	Yes	Yes	6/10
Ebid and El-Sodany⁵³53 Ebid AA, El-Sodany AM. Long-term effect of pulsed high-intensity laser therapy in the treatment of post-mastectomy pain syndrome: a double blind, placebocontrol, randomized study. Lasers Med Sci. 2015;30(6):1747-55.	No	Yes	No	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	8/10
Boyraz et al.³⁹39 Boyraz I, Yildiz A, Koc B, Sarman H. Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy. Biomed Res Int. 2015;2015:304328.	Yes	Yes	No	Yes	No	No	No	No	No	Yes	No	3/10
Kim et al.⁵⁴54 Kim SH, Kim YH, Lee HR, Choi YE. Short-term effects of high-intensity laser therapy on frozen shoulder: A prospective randomized control study. Man Ther. 2015;20(6):751-7.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes	9/10
Dundar et al.⁵⁵55 Dundar U, Turkmen U, Toktas H, Ulasli AM, Solak O. Effectiveness of highintensity laser therapy and splinting in lateral epicondylitis; a prospective, randomized, controlled study. Lasers Med Sci. 2015;30(3):1097-107.	Yes	Yes	Yes	Yes	No	No	Yes	Yes	No	Yes	Yes	7/10
Authors	Crit. 1	Crit. 2	Crit. 3	Crit. 4	Crit. 5	Crit. 6	Crit. 7	Crit. 8	Crit. 9	Crit. 10	Crit. 11	Total score
Dundar et al.⁵⁸58 Yesil H, Dundar U, Toktas H, Eyvaz N, Yeşil M. The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebocontrolled study. Lasers Med Sci. 2020;35(4):841-52	Yes	Yes	Yes	Yes	No	Yes	Yes	Yes	No	Yes	Yes	8/10
Alayat et al.⁵³⁷	Yes	Yes	No	Yes	Yes	No	No	No	No	Yes	Yes	5/10
Kheshie, Alayat and Ali²⁴24 Kheshie AR, Alayat MSM, Ali MME. High intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial. Lasers Med Sci. 2014;29(4):1371-6.	Yes	Yes	No	Yes	Yes	No	Yes	Yes	No	Yes	Yes	7/10
Fiore et al.³⁸38 Fiore P, Panza F, Cassatella G, Russo A, Frisardi V, Solfrizzi V, Ranieri M, Di Teo L, Santamato A. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(3):367-73.	Yes	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes	8/10
Nouri et al.⁵⁷57 Nouri F, Raeissadat SA, Eliaspour D, Rayegani SM, Rahimi MS, Movahedi B. Efficacy of high-power laser in alleviating pain and improving function of patients with patellofemoral pain syndrome: a single-blind randomized controlled trial. J Lasers Med Sci. 2019;10(1):37-43.	Yes	Yes	No	Yes	Yes	No	No	Yes	No	Yes	Yes	6/10
Rofoznica et al²⁵.	No	No	No	No	No	No	No	Yes	Yes	Yes	No	3/10
Yesil et al.⁵⁸58 Yesil H, Dundar U, Toktas H, Eyvaz N, Yeşil M. The effect of high intensity laser therapy in the management of painful calcaneal spur: a double blind, placebocontrolled study. Lasers Med Sci. 2020;35(4):841-52	No	Yes	No	Yes	Yes	No	Yes	Yes	No	Yes	Yes	7/10
Korkmaz et al.⁴³43 Korkmaz N, Gurcay E, Demir Y, Tezen Ö. Korkmaz Iï, Atar MÖ, Yaşar E. The effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain a prospec. Lasers Med Sci, 2022;37(1):645-53.	No	Yes	Yes	Yes	No	No	No	Yes	No	Yes	Yes	6/10
Atan and Bahar-Ozdemir³¹31 Freitas RL, Silva JA. The challenge of measuring pain. BrJP. 2018;1(1):2-3. 32 Martinez JE, Grassi DC, Marques LG. Análise da aplicabilidade de três instrumentos de avaliação de dor em distintas unidades de atendimento: ambulatório, enfermaria e urgência. Rev Bras Reumatol. 2011;51(4):304-308. 33 Sousa FA. Silva JA. Avaliação e mensuração da dor em contextos clínicos e de pesquisa. Rev Dor. 2004;5(4):408-29. 34 Galvão Taís Freire, Pereira Mauricio Gomes. Revisões sistemáticas da literatura: passos para sua elaboração. Epidemiol Serv Saúde. 2014;3(1):183-4. 35 Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Gestão e Incorporação de Tecnologias em Saúde. Diretrizes metodológicas: elaboração de revisão sistemática e meta-análise de ensaios clínicos randomizados / Ministério da Saúde, Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde, Departamento de Gestão e Incorporação de Tecnologias em Saúde. - Brasília: Ministério da Saúde, 2021. 36 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. 37 Alayat MSM, Atya AM, Ali MME, Shosha TM. Long-term effect of highintensity laser therapy in the treatment of patients with chronic low back pain: a randomized blinded placebocontrolledtrial. Lasers Med Sci. 2014;29(3):1065-73. 38 Fiore P, Panza F, Cassatella G, Russo A, Frisardi V, Solfrizzi V, Ranieri M, Di Teo L, Santamato A. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of low back pain: a randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(3):367-73. 39 Boyraz I, Yildiz A, Koc B, Sarman H. Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy. Biomed Res Int. 2015;2015:304328. 40 Chen L, Liu D, Zou L, Huang J, Chen J, Zou Y, Lai J, Chen J, Li H, Liu G. Efficacy of high intensity laser therapy in treatment of patients with lumbar disc protrusion: a randomized controlled trial. J Back Musculoskelet Rehabil. 2018;31(1):191-6. 41 Cantero-Téllez R, Villafañe JH, Valdes K, García-Orza S, Bishop MD, Medina- Porqueres I. Effects of high-intensity laser therapy on pain sensitivity and motor performance in patients with thumb carpometacarpal joint osteoarthritis: a randomized controlled trial. Pain Med. 2020;21(10):2357-65.-⁴²42 Atan T, Bahar-Ozdemir Y. Efficacy of high-intensity laser therapy in patients with adhesive capsulitis: a sham-controlled randomized controlled trial. Lasers Med Sci. 2021;36(1):207-17.	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	No	Yes	Yes	8/10

Autor / Ano	Cr1	Cr2	Cr3	Cr4	Cr5	Cr6	Cr7	Cr8	Cr9	Cr10	Cr11	Cr12	Cr13	Cr14	Cr15	Cr16	Confiança geral
Song et al.²⁶26 Song HJ, Seo HJ, Lee Y, Kim SK. Effectiveness of high-intensity laser therapy in the treatment of musculoskeletal disorders: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(51):e13126.	Y	PY	Y	PY	Y	N	Y	Y	Y	N	Y	Y	N	Y	Y	Y	Baixa
Alayat et al.²⁷27 Alayat MSM, Alshehri MA, Shousha TM, Abdelgalil AA, Alhasan H, Khayyat OK, Al-Attar WS. The effectiveness of high intensity laser therapy in the management of spinal disorders: a systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2019;32(6):869-84	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	N	Y	Baixa
Ezzati et al.²⁸28 Ezzati K, Laakso EL, Salari A, Hasannejad A, Fekrazad R, Aris A. The beneficial effects of high-intensity laser therapy and co-interventions on musculoskeletal pain management: a systematic review. J Lasers Med Sci. 2020;11(1):81-90.	Y	PY	Y	PY	Y	Y	Y	PY	Y	Y	-	-	Y	Y	-	Y	Moderada
Starzec-Prosepio et al.²⁹29 Starzec-Proserpio M, Grigol Bardin M, Fradette J, Tu LM, Bérubè-Lauzière Y, Paré J, Carroll MS, Morin M. High-Intensity Laser Therapy (HILT) as an emerging treatment for vulvodynia and chronic musculoskeletal pain disorders: a systematic review of treatment efficacy. J Clin Med. 2022;11(13):3701.	Y	Y	Y	PY	Y	Y	Y	Y	Y	Y	-	-	Y	Y	-	Y	Moderada
Wyszynska & Bal-Bochenska³⁰30 Wyszyńska J, Bal-Bocheńska M. Efficacy of high-intensity laser therapy in treating knee osteoarthritis: a first systematic review. Photomed Laser Surg. 2018;36(7):343-53.	Y	Y	Y	PY	Y	Y	Y	Y	Y	Y	-	-	N	Y	-	Y	Baixa

[1] Conflict of interests: none

Brasil

Brasil

High-intensity laser for the treatment of pain: systematic review

HIGHLIGHTS

ABSTRACT

BACKGROUND AND OBJECTIVES:

CONTENTS:

CONCLUSION: