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Providing tools for a multimodal strategy

01 March 2014, at 12:00am

John Bonner hears how a young company got involved with laser therapy for treating muscoloskeletal conditions

ADMINISTERING a magic bullet would be an appealing treatment option for any veterinarian. Unfortunately, while the expression is in common use, such products are not – and so the term is more likely to be found in the pages of a Harry Potter novel than the NOAH data sheet compendium.

From his days as a practitioner in Cheshire, 1999 Glasgow graduate Stephen Barabas can remember how frustrating it can be to treat chronic conditions like osteoarthritis and how clinical progress will usually rely on using a range of different treatments.

So when he set up his veterinary supplies company, VBS Direct Ltd, in 2010 his goal was to provide colleagues with the tools needed to develop a multimodal strategy for treating OA and other challenging conditions.

The company began by importing a range of long-established nutritional supplements from North America for use in managing various small animal conditions. More recently, it has become the UK agent for a novel cell therapy for joint disease cases seen in small animal and equine practice [see report on previous pages]. But the company is becoming better known as the UK supplier of a laser treatment technology described at a meeting in London in January.

Two years ago, the company started importing therapeutic lasers produced by the Tennessee-based company K- Laser and providing training and technical support in using the kit. The lasers are available to both human and veterinary practitioners and are in regular use at around 50 small animal clinics across the country, Mr Barabas said.

Far from being a new idea, therapeutic lasers have been used by veterinary staff since the 1960s, he points out. But the low power output from earlier technologies meant that treatment sessions would take far too long to be cost effective.

These were Class 3 lasers delivering less than 0.2W in power while the current technology is a Class 4 device providing up to 12W. So it is capable of administering energy as red and infrared light to deeper-lying tissues and within a much shorter period of a few minutes.

Along with the power output, the other important factor for a clinical laser is wavelength. The K-Laser machines are designed to produce waves at the peak absorption frequencies of three key intracellular constituents: water, haemoglobin and the enzyme Cytochrome-C. As a result, irradiation has a number of different effects, creating a temperature gradient within the cell, increasing local blood flow, causing the haemoglobin molecule to release its oxygen load and stimulating the enzyme to increase local levels of adenosine triphosphate.

Together these have a bio-stimulatory effect which studies suggest can accelerate healing of a wide range of injuries. Those practices currently using the equipment most regularly apply it to musculoskeletal conditions and both pre- and post- operatively to encourage healing of surgical wounds. But there are many other potential applications in treating chronic injuries such as lick granulomas and lymphocytic-plasmacytic gingivitis stomatitis, he suggests.

At higher doses, laser therapy has also been shown to have analgesic effects, which practitioners have found to be valuable in providing quality of life improvements in severely arthritic dogs. This may be linked to reduced levels of inflammatory cytokines, such as tissue necrosis factor, but Mr Barabas acknowledges that here the mechanism of action is something of a mystery. That certainly shouldn’t preclude the use of laser therapy in those patients.

“In truth, we still don’t really understand everything about the way NSAIDs function. There are loose ends with the science for many of the things that we routinely use in practice.”

Applying an energy source to living tissue would always have the potential for causing harm although the worst that might be expected with the laser is some singeing of hair and surface tissues. This is best avoided by giving appropriate training for the vets and VNs likely to be using the equipment.

His company provides both face-to- face and on-line education based on the systems introduced for technicians in human hospitals. The US company also provides regular software updates for client practices as knowledge accumulates and new treatment protocols are devised.

Most of that information comes from trials in human patients or from preclinical studies in rodents. Mr Barabas is confident that the evidence from small animal studies will start to come through but in the meantime practitioners, clients and their animals can safely make use of the benefits derived from work on human guinea pigs.

One important subject for future trials would be an attempt to explain the sustained benefits seen in some studies which are unlikely to result from short- term effects such as blood flow and local oxygenation levels.

One recent Hungarian study, for example, in human patients with severe osteoarthritis of the knee joint suggested that patients experienced a 71% reduction in pain levels and a 10% improvement in joint mobility two months after a single laser treatment.

Individualised treatment plans

Mr Barabas thinks it unlikely that such spectacular progress is likely to be achieved with such minimal input in many canine OA patients.

Indeed, clinicians are encouraged to draw up individualised treatment plans for these patients involving other forms of therapy. But a typical protocol for a dog with an elbow problem may involve a thrice-weekly laser treatment in combination with standard NSAIDs, a further fortnight of twice weekly sessions and a maintenance treatment thereafter every second week.

Yet there is one area where the benefits of laser therapy in veterinary patients may outweigh those for equivalent cases in human medicine. Encouraging wound healing following surgery is one area where the technology is commonly applied for both species but human patients are generally more grateful for the surgeon’s efforts.

“Animals don’t appreciate that you have performed heroic surgery – it is itchy and they want to chew the stitches out. So anything that improves the rate of wound healing and reduces inflammation is a very positive thing,” he notes.

The company website ( features testimonials from a number of UK client practices highlighting the clinical value of the technology. But are all users of the equipment likely to be so positive, and would those making a fairly expensive acquisition be able to recoup the investment?

“I don’t recall any case where the technology hasn’t paid for itself within nine months. Clients are very enthusiastic about this service and are happy to bring their animals into the practice. There are other benefits as well because the staff are seeing the clients on a regular basis and can explain the other services that will improve the animal’s health.”