Effectiveness of photobiomodulation for pain management and wound healing in the immediate postoperative period after cesarean section: A systematic review

BACKGROUND: Photobiomodulation with low-level laser therapy has been investigated as an adjunctive strategy for postoperative pain and wound healing after cesarean section, but the available trials use heterogeneous protocols and outcomes. OBJECTIVE: To evaluate the effects of low-level laser therapy, compared with sham treatment or usual care, on postoperative pain, wound healing, analgesic use, global perception of change, and adverse-event reporting after cesarean section. METHODS: This systematic review followed a protocol registered in PROSPERO (CRD420251077815) and was conducted and reported according to PRISMA 2020 guidance. Electronic databases were searched from inception through June 4, 2025, without language or date restrictions. Randomized and quasi-randomized trials were eligible, although all included studies were randomized controlled trials. RESULTS: Four randomized controlled trials involving 473 women were included (Poursalehan et al., 2018, n = 80; de Holanda Araújo et al., 2019, n = 88; Saffarieh et al., 2020, n = 65; Kahkhaie et al., 2023, n = 240). A random-effects meta-analysis was considered for pain outcomes but was not performed because of substantial clinical and methodological heterogeneity in laser parameters, comparators, follow-up times, outcome scales, and reporting of effect estimates. Individual studies reported reductions in pain scores or analgesic use in some comparisons, but findings were not sufficiently consistent or reproducible across protocols. Wound-healing outcomes were reported by a limited subset of studies using different indicators. The certainty of evidence was rated low to very low, mainly because of risk of bias, inconsistency, imprecision, and indirectness. CONCLUSIONS: The available evidence is insufficient to support routine clinical use of low-level laser therapy after cesarean section. Photobiomodulation should be considered an experimental or insufficiently validated adjunct in this context until adequately designed trials establish standardized dosimetry, clinically meaningful outcomes, and reproducible effects.