Boaviagem A. et al. - Photobiomodulation After Cesarean Section, Pain, and Wound Healing: A Systematic Review

This systematic review of 4 randomized trials, involving a total of 473 women, was unable to perform a meta-analysis due to the wide variation in photobiomodulation protocols following cesarean section. Some comparisons reported a reduction in pain or analgesic use, but the results were neither consistent nor reproducible, and the authors consider the evidence insufficient to support routine use.

What this study measured

The Boaviagem team, affiliated with the Federal University of Pernambuco in Brazil, followed a protocol registered on PROSPERO (CRD420251077815) and the PRISMA 2020 guidelines. The databases were searched from their inception through June 4, 2025, with no restrictions on language or date.

The research question is specific: In women who have recently given birth via cesarean section, does low-intensity laser therapy, compared with sham treatment or usual care, affect postoperative pain, wound healing, analgesic use, overall perception of change, and the occurrence of adverse effects? Randomized and quasi-randomized trials were eligible; all included trials were randomized.

Key Findings

The final scope is narrow, and the authors draw a cautious conclusion from it.

• Four randomized controlled trials were included, involving a total of 473 women.
• Sample sizes per study: 80 (Poursalehan et al., 2018), 88 (de Holanda Araújo et al., 2019), 65 (Saffarieh et al., 2020), and 240 (Kahkhaie et al., 2023).
• A meta-analysis was planned for pain but not conducted due to clinical and methodological heterogeneity deemed too great.
• In some comparisons, individual trials report a reduction in pain scores or analgesic use, with no consistency across protocols.
• Wound healing was assessed in only some of the trials, using different indicators.
• Evidence certainty rated as low to very low.

How photobiomodulation works for this indication

The rationale behind the included studies is based on the mechanisms generally proposed for red and near-infrared light: absorption by cellular chromophores, modulation of local inflammation, and support for tissue repair processes. For a cesarean section scar, the hypothesis is that pain is alleviated and skin closure is accelerated.

The review does not validate these hypotheses: it notes, above all, that the irradiation parameters, control groups, evaluation time frames, and scales used vary from one study to another, making it impossible to link a mechanism to a measured effect.

Limits You Should Know

The first limitation is the inability to pool the data: without a meta-analysis, no average effect is available. The second relates to the quality of the trials, including a risk of bias, inconsistency among results, imprecision due to small sample sizes, and the indirect nature of the measurements. This results in a low to very low level of certainty.

The result is therefore negative in the sense that the authors conclude that the available data are insufficient to recommend routine low-intensity laser therapy following a cesarean section. They describe it as an experimental or insufficiently validated adjunct, pending trials with standardized dosimetry and clinically relevant criteria.

What This Means in Practice

For patients and obstetric teams alike, this review advises against presenting photobiomodulation as an established treatment for post-cesarean pain. While there are isolated positive findings, they have not been replicated across different trials.

The main message is directed at researchers: without comparable protocols, systematic reports of adverse effects, and common assessment scales, future reviews will remain at a standstill. Photobiomodulation is in no way a substitute for prescribed analgesia or postoperative scar monitoring.

Frequently Asked Questions

Does photobiomodulation relieve pain after a cesarean section?

According to this review, some trials report a decrease in pain scores or in the use of analgesics, but the results are inconsistent across the four studies, and the certainty of the evidence is low to very low. No firm conclusions can be drawn.

Why didn't the authors conduct a meta-analysis?

Because the laser settings, comparison groups, follow-up periods, measurement scales, and methods of reporting effects varied too widely from one trial to another to be reliably combined.

How many women participated in the studies analyzed?

A total of 473 women, distributed across 4 randomized trials with sample sizes ranging from 65 to 240 participants.

Reference

Boaviagem A, Nóbrega Júnior JC, da Silva RCB, Lemos A. Effectiveness of photobiomodulation for pain management and wound healing in the immediate postoperative period following cesarean section: A systematic review. Complement Ther Med, 2026, 101, 103403. PMID 42456438. View the abstract on PubMed

This summary is provided for informational purposes only and does not constitute medical advice. Photobiomodulation is not a substitute for prescribed treatment. Consult a healthcare professional.