High- and Low-Level Laser Therapy for the Treatment of Orthopedic Pain: A Systematic Review.

Introduction

Chronic orthopedic pain is a leading cause of disability worldwide, compromising physical function, independence, and quality of life. While pharmacological treatments are widely used, their prolonged use is often limited by side effects and suboptimal efficacy. Among non-pharmacological approaches, photobiomodulation-particularly low-level laser therapy (LLLT) and high-intensity laser therapy (HILT)-has emerged as a promising strategy due to its analgesic, anti-inflammatory, and regenerative properties. However, evidence regarding its clinical efficacy remains heterogeneous and fragmented.

Methods

This systematic review was conducted in accordance with PRISMA guidelines and based on the PICO framework. Comprehensive searches were performed in PubMed, Embase, Scopus, LILACS, and Cochrane CENTRAL. Eligible studies were randomized controlled trials (RCTs) published in English, Spanish, or Portuguese over the past five years, involving adults (≥18 years) with orthopedic pain treated with LLLT or HILT. Outcomes of interest included pain intensity, physical function, and quality of life. Exclusion criteria included non-randomized trials, pediatric populations, and studies that did not isolate the effects of laser therapy.

Results

From 59,873 records initially retrieved, eight RCTs met the inclusion criteria. The studies addressed diverse musculoskeletal conditions such as knee osteoarthritis, chronic low back pain, patellofemoral pain syndrome, plantar fasciitis, subacromial impingement, and lateral epicondylalgia. Both LLLT and HILT demonstrated efficacy in reducing pain and enhancing physical function. In several studies, HILT was associated with faster symptomatic improvement. Nevertheless, considerable heterogeneity in laser parameters, treatment protocols, and outcome measures hindered direct comparison and meta-analysis.

Conclusion

The current evidence supports the use of both LLLT and HILT as safe and effective adjuncts in the management of orthopedic pain. Future trials should adopt standardized protocols and long-term follow-up to better define clinical guidelines and optimize treatment outcomes.