Neck Pain

Non Specific Neck Pain

Non specific neck pain has been an area of contention in the literature. This controversy has largely come from reviews of the literature rather than from actual trials involving real patients.

In 2021 Kenareh et al. compared laser (photobiomodulation) and ultrasound in the Treatment of Chronic Non-specific Neck Pain. In a randomized single-blind controlled trial they found that both laser treatment and ultrasound improved pain – visual analogue scale (VAS), Neck Disability Index (NDI), Neck Pain and Disability Scale (NPDS) and Bournemouth Questionnaire (BQN) scores. Laser treatment was found to be superior to ultrasound.

In 2018 Bier et al. published guidelines for the treatment of non specific neck pain in which LLLT was included in the low to very low evidence category. In a later response Rampazo et al. (2019) took many of the reviewed papers and listed their findings which are shown below (please note only LLLT is included).

The references cited to conclude that LLLT is not recommended for patients with neck pain were: Graham et al, (2013) Gross et al, (2013) and Chow et al.(2009). Graham et al, (2013) based on 8 randomized controlled trials (RCTs), reported that LLLT (wavelengths of 632.8 nm, 830 nm, 904 nm, or 905 nm) was actually better than placebo in reducing pain and better in improving function, global perceived effect, or quality of life for patients with acute, subacute, or chronic neck pain. Graham et al (2013) stated, “The current state of the evidence favors acupuncture, LLLT and intermittent traction for chronic neck pain.” In a systematic review with meta-analysis, Gross et al (2013) showed 10 studies supporting the use of LLLT over placebo to improve pain, disability, quality of life, and global perceived effect in the short and intermediate-term management of patients with neck pain. Consistent with Graham et al, (2013) Gross et al (2013) concluded, “We found diverse evidence for the use of LLLT in the treatment of various subtypes of neck pain. We found moderate quality evidence in favor of LLLT for chronic neck pain indicating further research is likely to have an important impact on our confidence in the estimate of effect and may change this estimate.” In another systematic review with meta-analysis, Chow et al (2009) presented evidence of reduced pain and improved global perceived effect following LLLT in patients with acute neck pain when compared to control and placebo-treated groups. Chow et al (2009) concluded, “We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.” We contend that these references (cited by authors of the CPG) present moderate evidence for use of LLLT (830 nm, 904 nm) in patients with neck pain—conclusions differing from those of the CPG. Additionally, we reference the more recent CPG from Cotè et al, (2016) who concluded that use of LLLT (830 nm or 904 nm) provided greater benefit compared with placebo treatment. Thus, we suggest that the conclusion of Bier et al—that LLLT has “no effects in contrast to other treatments or placebo”—is not an accurate interpretation the findings of the studies cited.

This prompted a second response from the authors.

On balance it would appear that laser is effectively used for the treatment of non specific neck pain it may not be the most cost effective way, or even the best way long term,  of dealing with neck pain but it does seem to work.