To evaluate the efficacy of energy-based treatments for pain reduction and healing in postpartum women following episiotomy.

A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases searched in December 2024 included MEDLINE (via Ovid and PubMed), The Cochrane Central Register of Controlled Trials (CENTRAL), Embase, ClinicalTrials.gov, and Web of Science. Eligible studies included prospective randomized and non-randomized trials comparing energy-based interventions with placebo, standard care, no treatment, or another intervention. Standardized mean differences (SMDs) were used to pool results across studies due to variations in measurement scales.

Out of 173 identified studies, 13 met the inclusion criteria (10 randomized controlled trials and 3 non-randomized trials), comprising a total of 1377 postpartum women. Analyses were stratified by intervention type: infrared irradiation vs. standard care or no treatment (n=1088), LLLT vs. placebo (n=209), LLLT vs. therapeutic ultrasound (n=80). Infrared irradiation reduced postpartum pain compared to standard care or no treatment (SMD = -0.50, 95% CI: -0.98 to -0.02, I² = 88%, p < 0.01).  However, it did not significantly improve healing measures compared to other interventions (SMD: -1.05, 95% CI: -3.02 to 0.92, I² = 99%, p < 0.01), (Figure 1). LLLT showed no significant improvement in pain reduction (SMD: -0.31, 95% CI: -0.72 to 0.11, I² = 53%, p = 0.1) or healing (SMD: 0.23, 95% CI: -0.18 to 0.63, I² = 0%, p = 0.85) compared to placebo (Figure 2). When comparing LLLT to therapeutic US, two studies were included, and demonstrated pooled SMDs of 0.10 (95% CI: -3.52 to 3.73, I² = 97%, p < 0.01) for pain reduction and -1.18 (95% CI: -6.40 to 4.04, I² = 98%, p < 0.01) for healing.

The findings suggest that infrared irradiation may be beneficial for postpartum pain reduction, but its effect on healing remains inconclusive. Variability in treatment protocols and assessment methods across studies may have contributed to the lack of significant improvement in healing outcomes. LLLT showed no clear advantage over placebo for pain relief or healing, possibly due to inconsistencies in treatment protocols, small sample sizes, or variations in laser parameters across studies. The comparison of LLLT to therapeutic US was hindered by the small number of studies and the substantial heterogeneity observed (I² = 97–98%), which limits the reliability of the pooled estimates.

Our meta-analysis suggests that while some energy-based devices may provide moderate pain relief following episiotomy, their effect on wound healing remains uncertain. Further well-designed, high quality studies are needed to establish the efficacy of energy-based treatments in episiotomy care.