ShapeShapeauthorShapecrossShapeShapeShapeGrouphamburgerhomeGroupmagnifyShapeShapeShapeShape
Sponsor message A whole new perspective on canine OA

Increasing the use of laser therapy – 1

by
01 September 2014, at 1:00am

Steohen Barabas of VBS Direct gives an insight of the science, clinical aspects and practical management of incorporating low level light therapy (LLLT) into veterinary practice.

SINCE 2006, laser therapy has become a standard part of North American veterinary small animal and equine practices, and used by wound care specialists, elite athletes’ physiotherapists, rehabilitation and pain clinics in human medicine. In this first part of the article I will show how it can bene t practice staff, patients, clients and finances.

Although high-quality medical surgical and therapeutic lasers are developed in Europe, European veterinarians and medical practitioners were slower to adopt this new form of therapy than their North American colleagues.

This was partly due to poor clinical experiences by some early pioneers with less powerful therapeutic lasers (Class II and 3b), as well as the tendency for equipment to have been less-user friendly for general practice and lack of knowledge amongst vets and veterinary nurses about the benefits of laser therapy through their university curriculum.

Why have more than 8,000 USA vet practices and over 100 in the UK invested in modern laser therapy? To understand laser therapy’s rapid growth, one needs to recall practice trends during the last decade. Direct marketing campaigns targeting pet owners transferred purchases of medications, anti- parasitic drugs, food and pet products from veterinary practices to online and big pet stores. Also, clients were looking for alternatives to drugs for pain management problems for their long-lived pets and their own personal health ailments.

In the UK market, improvements in technology and the arrival of Class IV laser light technology (>0.5W power), with a recognition of the need to increase footfall within practices, developed renewed appreciation for sustainable practice-based service revenue achieved through laser therapy in combination with existing good medical and surgical techniques. The combination of all these factors has contributed to the rapid acceptance of therapeutic lasers in referral and general veterinary practice.

Science behind laser therapy

Therapeutic laser light therapy does not treat conditions, rather it stimulates the body’s inherent healing mechanisms via a process called photo- biomodulation or bio-stimulation through a combination of different wavelengths, power and frequency of laser light.

The healing potential of lasers was first discovered by chance in 1967 by Dr Endre Mester, at the Semmelweis University of Budapest. Work by Dr Tinaa Karu of the Russian Space Agency showed that chromophores, biological molecules that absorb specific wavelengths of light energy, can change the tissue’s metabolism when exposed to laser light energy in the infra-red and red spectrum.

Haemoglobin, cytochrome C and water are all target chromophores, having a direct effect on cellular metabolism and the healing process (Chung et al, 2012; Manteifel and Karu, 2005). 

At higher laser light power (J/s or Watt), neuronal pain sensitivity can be reduced, whereas at higher frequency the light energy can be more anti- inflammatory in action. The results mean that for an osteoarthritic joint or for rehabilitation of post-surgical tissues, you can use laser therapy to decrease pain sensation and inflammation, speed up the healing, improve the range of movement for the patients, and thus reduce the time to full recovery.

It is not a panacea, but used effectively it can be an important piece of practice equipment in running pain management and rehabilitation clinics by properly trained vets, physiotherapists or veterinary nurses.

To have a biological effect, laser light needs to be the correct wavelength for specific molecules, with different frequencies for types of tissue and sufficient power to provide a therapeutic dose (2-15J/ cm2) to accelerate patient tissue healing from superficial skin down to a deep musculoskeletal injury.

At signi cantly higher power (W or J/s), pain relief for osteoarthritic management is possible. The more powerful the laser, the shorter the treatment sessions (Baltzer et al, 2011; Chow et al, 2009; Stephens et al, 2011).

Key considerations when investing in a laser therapy are:

  1. Who is going to give the laser therapy within the clinic?
  2. What clinical cases are we going to treat with the laser therapy?
  3. How are we going to market the laser therapy?
  4. What are we going to charge for laser therapy?
  5. What financial returns are we expecting from laser therapy?

Who is going to give the laser therapy? 

Most veterinary practices choose to purchase a therapeutic laser to allow them the opportunity of starting osteoarthritic pain management clinics and for improving post-surgical rehabilitation, utilising trained nurses or physiotherapists to run the clinics.

It is essential that the company you purchase from spends time training staff and ensuring all practice laser users are competent, safe and are able to record good clinical notes on the progress of the patients treated with laser therapy.

Poorly trained staff will be a liability and result in poor treatment of cases and client compliance, lack of clinical success and possible danger to others in the vicinity.

Nurses given the responsibility of laser therapy can have a very positive impact on improved clinical therapies for patients, improved staff management and teamwork between vets and nurses, and increased financial practice profit.

What clinical cases?

Most initial calculations for investing in a Class IV laser are based on musculoskeletal and pain management cases, but superficial wounds, chronic allergic dermatitis, otitis, dental surgeries and soft tissue injuries have all been successfully treated using laser therapy, dramatically increasing practice revenue and clinical results, and differentiating them from the neighbouring practices.

In most clinics the laser becomes the most used piece of equipment, when used broadly across acute to chronic superficial and musculoskeletal disorders.

Pain management and musculoskeletal rehabilitation are the main areas of clinical use in human and veterinary medicine, with an increasingly aged population in developed countries and a decrease in either effectiveness or reluctance to use more traditional pharmaceutical pain relief due to potential side-effects.

In vivo and in vitro studies have shown significant improvement in speed and quality of healing in bone, cartilage and soft tissue structures (Khadra, 2005; Oliviera, 2009; Carvalho, 2010).

Pain studies in animals and humans depend on a combination of wavelength, frequency and power, and can result in rapid reduction in inflammation or control of chronic pain.

Ensure your laser has the protocols necessary for all species, coat colours and body sizes within an economic time-frame so that it is simple to use for trained staff.

Class IV laser therapy enables short, rapid treatments in 2-8 minute sessions, able to t into even the most busy of veterinary practice routines (Carvalho, 2010; Chow, 2009; Enwemeka, 2004). More intriguing is the proactive uses of laser therapy to bio-stimulate the tissue pre-surgery and reduce trauma and time to heal during the rehabilitation.

A radiographic and force-plate study in Oregon State vet school on tibial plateau levelling osteotomy canine subjects showed significant improvement at eight weeks post- surgery between control and dogs K-Lasered only once pre-surgery (Baltzer, 2011).

Both veterinary and human dermatologists, podiatrists and cosmetic plastic surgeons are using an ever increasing array of laser lights to reduce scarring or inflammation and improve healing in skin or superficial structures.

Even on standard neutering wounds and dentals, improved speed of wound healing and prevention of post-surgical trauma have resulted in UK vets using therapeutic lasers for routine operations (Cardona, 2013; Carvalho, 2010; Enwememka 2004; Minatel, 2009).

  • continued next month 

Further reading

  • Baltzer, W. et al (2011) Preoperative LLLT in dogs undergoing tibial plateau levelling osteotomy: double- blinded, placebo-controlled clinical trial (awaiting publication).
  • Cardona, M. (2013) Treatment of immune-mediated neutrophilic vasculitis in a Shar Pei with Low level laser therapy. SEVC 2013.
  • Carvalho, R. L. (2010) Effects of Low-Level Laser therapy on pain and scar formation after inguinal herniation surgery: A randomized controlled single-blind study. Photomedicine and Laser Surgery 28 (3) 417-422. 
  • Chow, R. T. et al (2009) Efficacy of LLLT in the management of neck pain: a systematic review and meta- analysis of randomised placebo or active treatment controlled trials. The Lancet 374: 1,897-1,908.
  • Chung, H. et al (2012) The nuts and bolts of Low level laser light therapy. Ann Biomed Eng 40 (2): 516-533. 
  • Enwemeka, C. S. et al (2004) The efficacy of Low power lasers in tissue repair and pain control: a meta-analysis study. Photomedicine and Laser Surgery 22 (4): 323-329. Health and Safety (2010) The Control of Artificial Optical Radiation at Work Regulations 2010, No. 1140. 
  • Khadra, M. et al (2005) Effects of laser therapy on attachment, proliferation and differentiation of human osteoblastic like cells attached on titanium implant materials. Biomaterials 26: 3,503-3,509.
  • Manteifel, V. M. and Karu T. I. (2005) Structure of mitochondria and activity of their respiratory chain in successive generation of yeast cells exposed to He-Ne laser light. Biology Bulletin 32 (6): 556-566.
  • Minatel, D. G. (2009) Phototherapy promotes healing of chronic diabetic leg ulcers that failed to respond to other therapies. Lasers in Surgery and Medicine 41: 433-441.
  • Oliveira, F. S. et al (2009) Effects of LLLT (830nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneous tendon. Lasers in Surgery and Medicine 41: 271-276.
  • Stephens, B., Baltzer, W. and Harrington, P. (2011) Internal dosimetry: combining simulation with phantom and ex vivo measurements. NAALT Congress 2011.