Photobiomodulation Therapy in the Management of Orofacial Neuropathic Pain—WALT Position Paper 2026

Disclaimer: This position paper is based on the recommendations from the 15th WALT Congress (PBM2024), held in London from 23 to 25 August 2024, and is further informed by a follow-up review of current evidence and the clinical observations of an international, multidisciplinary panel of clinicians and researchers with expertise in neuropathic pain in orofacial conditions and/or the clinical application and dosimetry of photobiomodulation (PBM). This article is intended for use by healthcare professionals and researchers, and for information purposes only. As with all clinical guidelines, content should be interpreted in the context of ongoing research and evolving clinical practice, which may lead to new insights and recommendations over time. The views expressed reflect the consensus of the contributing panel at the time of publication and do not necessarily represent those of individual authors. The authors assume no responsibility for clinical decisions or actions taken based on the content presented herein. Background/Objectives: Photobiomodulation (PBM) therapy has shown potential in managing orofacial neuropathic pain (ONP); however, inconsistent PBM dosimetry and methodological variability limit its clinical application. This World Association for Photobiomodulation Therapy (WALT) Position Paper aims to critically appraise current evidence and provide recommendations for Clinical Practice Guidelines (CPG) and Expert Consensus Opinion (ECO) where appropriate. Methods: Evidence evaluation was guided by the HANNA (Holistic Analysis & Novel Normative Actions) Framework, a structured multi-step methodology integrating systematic review, quality appraisal, and expert consensus. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Methodological quality was assessed using validated tools: AMSTAR 2 for systematic reviews, RoB2 for randomized controlled trials (RCTs), and ROBINS-I for non-randomized studies (NRCTs). The AGREE II Reporting Checklist was applied to ensure transparency and rigor in the development of WALT recommendations. The Somerfield Criteria were used to rate the level of evidence (LoE) for each included ONP condition, where deemed appropriate. Results: WALT CPG were established for primary burning mouth syndrome (BMS), supported by robust evidence (LoE I) from 204 patients across six “Low RoB” RCTs and NRCTs, and 557 patients included in a “High-Confidence” systematic review and meta-analysis of “low RoB” RCTs. WALT ECO were developed for idiopathic trigeminal neuralgia (TN) and post-herpetic neuralgia (PHN), both supported by LoE II. Insufficient evidence precluded formal recommendations for post-traumatic trigeminal neuralgia, glossopharyngeal neuralgia, and occipital neuralgia. Conclusions: This Position Paper introduces the HANNA Framework, for the first time, as a robust and transparent methodology for developing WALT recommendations by delivering evidence-based CPG for PBM in the management of neuropathic pain associated with primary BMS, along with ECO for both TN and PHN. These recommendations support PBM as a safe and effective therapeutic approach, and provide a structured roadmap for future research and periodic guidelines updates.