Low-level laser therapy in neck pain

Australian researchers did a meta-analysis to assess the efficacy of low-level laser therapy (LLLT) in neck pain. LLLT is a non-invasive treatment by applying low-intensity laser beam to sites of pain. The study was published in The Lancet.

Researchers pooled data from 16 RCTs involving 820 patients with chronic neck pain comparing the efficacy of LLLT using wavelength vs placebo or active control. The authors reported that although the mechanism was unknown, LLLT was found effective in short and medium-term pain relief with moderate benefits. They also said that adverse effects from this treatment were minimal.

In an accompanying editorial, the author said that "this evidence is more solid than that for many current interventions" and "LLLT is an option worthy of consideration for management of nonspecific neck pain."


Critics warned that all 16 trials had relatively small sample sizes from 20 to 90 subjects, so the risk of bias could not be ruled out. Furthermore, many of the trials did not provide data on the side effects nor withdrawls and drop-outs that would affect the trial outcome.

Source :
Chow R, et al "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials" Lancet 2009; DOI: 10.1016/S0140-6736(09)61522-1. (f/t via Athens)



Editorial: Guzman J "Neck pain and low-level laser: Does it work and how?" Lancet 2009; DOI: 10.1016/S0140-6736(09)61837-7. ( f/t via Athens)

Avandia and myocardial infarction

A leading cardiologist, Steven Nissen, found that Avandia (generic name: rosiglitazone), a diabetes drug, "was associated with significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes that had borderline significance."

The study concluded that despite the study's limitation, " patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes."

His findings were based on an analysis of 42 RCTs and published online on May 21 by NEJM. "Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes". The article will appear in the June 14 issue of the Journal.

Avandia is a top-selling diabetes drug manufacturered by GlaxoSmithKline, introduced in 1999 and is widely used to lower blood glucose levels in patients with type 2 diabetes mellitus. Nissen’s analysis on Avandia has caused the Glaxo stock down more than 6% in midday trading.

Dr. Nissen is a strong critic on drug safety, he and colleague, Eric Topol, a well-known cardiologist, raised concerns about the safety of Vioxx in JAMA in 2001 that led to the withdrawal of the drug from the market in 2004. Dr Topol lost his job after testimony against the drug manufacturer Merck in federal trial.