Non-Cochrane · intervention · PM42080480
Effect of photobiomodulation on pain relief and functional improvement in fractures: a systematic review and meta-analysis.
Wang Weifeng, Xiu Ruijuan, Zhao Xiaohua, et al. · Annals of medicine · 2026 · PubMed · doi:10.1080/07853890.2026.2667061
Findings
23 findings
| Population | ||||
|---|---|---|---|---|
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Nocturnal pain (present or absent) 7-26 weeks (four measurement points) | RR 0.49 [0.29, 0.82] GRADE not reported 2 studies · 412 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Control-group analysis, overall (PBM vs placebo, acupuncture vs placebo, PBM vs acupuncture; Liu 2022 contributes three comparisons) | SMD -0.57 [-1.06, -0.08] GRADE not reported 3 studies · 264 participants |
| Adults (>18 years) with fractures (limb, rib, mandibular) | Photobiomodulation (low-level laser therapy) | Placebo (sham laser) or conventional/no treatment | Maximum mouth opening (mm), mandibular fractures 1 week · Mandibular fractures (fixed effect, I2 0%) | MD 1.88 [0.96, 2.8] GRADE not reported 2 studies · 46 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain and disability (PRWE total score) 8 weeks | MD -2.61 [-16.82, 11.6] GRADE not reported 2 studies · 96 participants |
| Adults (>18 years) with fractures (limb, rib, mandibular) | Photobiomodulation (low-level laser therapy) | Placebo (sham laser) or conventional/no treatment | Pain score (VAS or NRS) Within 1 week after intervention · Control group: PBM versus placebo (random effects, I2 0%) | SMD -0.73 [-1.11, -0.36] GRADE not reported 3 studies · 118 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Use of analgesic drugs 7-26 weeks (four measurement points) | RR 0.66 [0.41, 1.08] Low Downgraded: imprecision, inconsistency 2 studies · 412 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Fracture-site subgroup analysis, overall (limb + mandibular, 5 studies; Liu 2022 not included) | SMD -0.76 [-1.08, -0.44] GRADE not reported 5 studies · 164 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain and disability (PRWE total score) 4 weeks | MD -7.3 [-14.07, -0.54] Low Downgraded: risk of bias, indirectness 3 studies · 121 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain and disability (PRWE total score) 26 weeks | MD -4.37 [-9.3, 0.56] GRADE not reported 2 studies · 96 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Use of analgesic drugs 7-26 weeks (four measurement points) | RR 0.58 [0.11, 3.1] Low Downgraded: imprecision, inconsistency 2 studies · 412 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week | SMD -0.72 [-1.19, -0.24] Moderate Downgraded: risk of bias 6 studies · 236 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week | SMD -0.74 [-1.0, -0.47] Moderate Downgraded: risk of bias 6 studies · 236 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Energy-density analysis, overall (5 studies; low-density Nesioonpour 2014 single study) | SMD -0.73 [-1.01, -0.45] GRADE not reported 5 studies · 210 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain and disability (PRWE total score) 12 weeks | MD -4.26 [-20.29, 11.77] GRADE not reported 2 studies · 96 participants |
| Patients with upper limb (distal radius or hand) fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Grip strength (kg) 4 weeks | MD 5.03 [4.29, 5.78] Moderate Downgraded: imprecision 2 studies · 95 participants |
| Patients with mandibular fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Maximum mouth opening distance (mm) 1 week | MD 1.0 [-0.69, 2.69] Moderate Downgraded: imprecision 3 studies · 86 participants |
| Patients with mandibular fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS) Within 1 week · Mandibular fracture subgroup | SMD -1.12 [-1.86, -0.38] GRADE not reported 2 studies · 34 participants |
| Patients with limb fractures | Photobiomodulation (low-level laser) therapy | Placebo (sham laser) or no treatment | Pain score (VAS) Within 1 week · Limb fracture subgroup | SMD -0.68 [-1.03, -0.32] GRADE not reported 3 studies · 130 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy irradiating acupoints | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Irradiation site subgroup: acupoints | SMD -0.73 [-1.11, -0.36] GRADE not reported 3 studies · 118 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy irradiating the fracture site | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Irradiation site subgroup: fracture site | SMD -0.74 [-1.12, -0.36] GRADE not reported 3 studies · 118 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy, long (infrared) wavelength only | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Wavelength subgroup: long wave only | SMD -0.76 [-1.06, -0.45] GRADE not reported 5 studies · 182 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy, medium energy density (5.1-10 J/cm2) | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Energy density subgroup: medium | SMD -0.81 [-1.32, -0.29] GRADE not reported 2 studies · 64 participants |
| Patients (over 18 years) with fractures | Photobiomodulation (low-level laser) therapy, high energy density (10.1 J/cm2 and above) | Placebo (sham laser) or no treatment | Pain score (VAS or NRS) Within 1 week · Energy density subgroup: high | SMD -0.72 [-1.15, -0.3] GRADE not reported 2 studies · 92 participants |
Included primary studies 12
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Acosta-Olivo 2017 Laser Treatment on Acupuncture Points Improves Pain and Wrist Functionality in Patients Undergoing Rehabilitation Therapy after Wrist Bone… DOI:10.3727/036012917x14908026365007 | 2017 | this review only | not stated | not extracted yet |
| Bandari 2022 Therapeutic Effect of a Low-Level Laser on Acute Pain and Post-operative Mouth Opening After Closed Reduction of Mandibular-Condylar… PMID:36743149 | 2022 | this review only | not stated | not extracted yet |
| Bonfim 2024 Effectiveness of 780 nm photobiomodulation as adjunct treatment for bone exposed fractures: A pilot study on radiograph, pain, and… DOI:10.1002/jbio.202300348 | 2024 | this review only | not stated | not extracted yet |
| Chang 2014 Therapeutic Outcomes of Low-Level Laser Therapy for Closed Bone Fracture in the Human Wrist and Hand DOI:10.1089/pho.2012.3398 | 2014 | this review only | not stated | not extracted yet |
| Dos Santos 2021 Effect of oral exercises and photobiomodulation therapy in the rehabilitation of patients with mandible fractures: randomized double-blind… DOI:10.1007/s10103-021-03423-w | 2021 | this review only | not stated | not extracted yet |
| Lauriti 2018 Evaluation of the Effect of Phototherapy in Patients with Mandibular Fracture on Mandibular Dynamics, Pain, Edema, and Bite Force: A Pilot… DOI:10.1089/pho.2017.4334 | 2018 | this review only | not stated | not extracted yet |
| Liu 2022 Acupuncture Analgesia in Patients With Traumatic Rib Fractures: A Randomized-Controlled Trial DOI:10.3389/fmed.2022.896692 | 2022 | this review only | not stated | not extracted yet |
| Nayak 2025 Efficacy of photobiomodulation therapy on pain, swelling, and trismus following fixation of mandibular fractures DOI:10.1111/wrr.70026 | 2025 | this review only | not stated | not extracted yet |
| Nesioonpour 2014 The effect of low-level laser on postoperative pain after tibial fracture surgery: a double-blind controlled randomized clinical trial. PMID:25237637 | 2014 | this review only | not stated | not extracted yet |
| Pavelski 2024 Evaluation of the Low-Level Laser Therapy in Pain, Bite Force, and Mouth Opening Following Midfacial Trauma. PMID:39768334 | 2024 | this review only | not stated | not extracted yet |
| Saebo 2021 Treatment of Distal Radius Fracture During Immobilization with an Orthopedic Cast: A Double-Blinded Randomized Controlled Trial of… DOI:10.1089/photob.2020.4964 | 2021 | this review only | not stated | not extracted yet |
| Saebo 2022 Pain and Disability of Conservatively Treated Distal Radius Fracture: A Triple-Blinded Randomized Placebo-Controlled Trial of… DOI:10.1089/photob.2021.0125 | 2022 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients with fractures older than 18 years | Adults with limb, rib or mandibular fractures (n=476) |
| Intervention | Photobiomodulation or low-level laser therapy | Photobiomodulation (n=257) |
| Comparison | Placebo or conventional therapy | Placebo laser or no treatment (n=219) |
| Outcomes | Pain score (VAS, NRS, MPQ); secondary: bone healing, fracture rehabilitation, functional recovery, analgesic consumption, side effects | Pain score; PRWE pain and disability; grip strength; maximum mouth opening; nocturnal pain; analgesic use; fracture line and cortical bridging (single study) |
| Study designs | RCTs | RCTs (n=12; 9 in meta-analysis) |
| Timing | Not specified | Pain within 1 week; PRWE at 4, 8, 12 and 26 weeks |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |