​ Abstract: Musculoskeletal disorders are a leading cause of pain and disability worldwide. Among the non-invasive interventions commonly used in physical therapy, laser therapy – specifically high-intensity laser therapy and low-level laser therapy – has emerged as a promising approach for pain management in rehabilitation. This preliminary network meta-analysis aimed to compare the analgesic effectiveness of both modalities with and without other physical therapy treatments in individuals with musculoskeletal pain. An electronic search was conducted in PubMed, Scopus, Web of Science, CINAHL, ScienceDirect, and the Physiotherapy Evidence Database (last updated 22 June 2025). The methodological quality of the included randomized controlled trials was assessed using the Physiotherapy Evidence Database scale. Pain intensity was the primary outcome, measured with instruments such as the Visual Analog Scale, the Numeric Pain Rating Scale, or equivalent tools. Standardized mean differences were calculated to pool results across studies and determine the overall effect size. A network meta-analysis was conducted to estimate the relative effectiveness of each intervention and generate treatment rankings. A total of 20 studies were included, with a mean PEDro score of 5.9 (SD = 1.5), and lower ratings were commonly observed for allocation concealment and therapist blinding. Substantial heterogeneity was observed across studies (I² > 50 %). HILT appears more effective than LLLT when applied as a standalone intervention (SMD = 0.9 95 % CI: 0.1, 1.7). However, when combining either modality with exercise or conventional physical therapy, there were no significant differences. Notably, physical therapy alone outperformed both laser modalities (SMD = 3.3 95 % CI: 0.9, 5.7). Further high-quality RCTs are needed to evaluate long-term outcomes and patient-centered outcomes.

Keywords: Pain management, Musculoskeletal pain, High-intensity laser therapy, Low-level light therapy, Physical therapy modalities