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Therapeutic class IV lasers in small animal practice

Therapeutic lasers can be used in the management of osteoarthritis

18 February 2020, at 3:00pm

Class IV laser therapy has become an important modality in small animal practice in recent years. In many centres, it has become the standard of care for conditions such as osteoarthritis. But lack of regulation means variation in clinical efficacy among “therapy lasers”, as the CE or FDA mark only recognises safety and not clinical results for each device.

Advantages of proven devices include clinical efficacy, safety, ease of application, lack of adverse effects, good patient tolerance and compatibility with other treatment modalities.

Laser therapy in osteoarthritis management

The current recommended management of choice for canine and feline osteoarthritis (OA) is multimodal. This usually includes some or all of the following: analgesic medications, weight management, physical therapy, regenerative medicine and nutraceuticals. Many vet and medical centres now have access to laser therapy which provides a valuable addition to this armamentarium. Properly applied laser therapy has the following beneficial effects on patients with OA: analgesia, antiinflammatory effects, reduced lameness, reduced reliance on NSAIDs and stimulation of growth factors.

Hip radiograph
FIGURE (1) Radiographs of the Cocker Spaniel revealed marginal osteophytosis and remodelling changes consistent with bilateral coxofemoral joint osteoarthritis

Case study

A four-year-old neutered female Cocker Spaniel was presented with moderate lameness of the right pelvic limb. Several weeks’ treatment with carprofen had been unrewarding. Discomfort was elicited on manipulation of the hip and radiographs revealed changes consistent with coxofemoral joint osteoarthritis (Figure 1). In addition, assessment of her physique revealed a body fat percentage of around 50 percent. The findings were consistent with a diagnosis of arthrobesity. In this condition, the clinical effects of osteoarthritis are exacerbated by the pro-inflammatory adipokines that are released from fat-distended white fat cells (adipocytes).

A multimodal osteoarthritis management was formulated, including adiposity reduction, omega-3 fatty acid supplementation and class IV K-Laser therapy (Figures 2 and 3).

The rationale for this combination of treatments was to decrease the inflammation and pain associated with the osteoarthritic hip joint. The carprofen was continued at the recommended dose based on a lean physique. Laser treatment targets chromophores to stimulate changes in metabolism.

The patient was referred in-house to the trained laser therapists within the nursing team. After careful discussion of the case, an initial plan of six laser sessions (two per week) was implemented. The K-Laser settings were precalculated to provide appropriate deep tissue penetration to all the tissues of the hip joint. In addition, the lumbosacral nerve roots were treated to stimulate changes in chronic pain perception via dendritic outgrowths.

At a follow-up three weeks later, the lameness had reduced markedly. The patient had begun to play again as though she was a puppy. At this stage the carprofen was discontinued.

The laser was “topped up” two weeks later. Then a four-weekly single laser application was continued.

By the fourth month after initial presentation, the improvements had been maintained and steady further improvement was seen. No further NSAID had been needed.

During the next month a flare-up of the lameness was observed necessitating a week’s course of carprofen.

Monthly K-Laser treatments have continued for a period of two years. No further lameness exacerbations have occurred. The adiposity has also been successfully managed (Figures 4 to 7).

The combination of lowered joint inflammation by the reduction of adipokine production, the anti-inflammatory effects of the omega-3 fatty acids and the laser therapy have resulted in an excellent clinical response. These modalities have maintained the remission from the clinical signs of osteoarthritis without recourse to any further pharmaceuticals to date.

The future plan is to continue K-Laser treatment at a maintenance level. In the event of future exacerbations, a more intense laser course can be implemented at any stage. The multimodal framework for OA management has built in flexibility so that rapid adaptations can be made as the disease progresses. It is envisaged that laser therapy will continue to have an important role.

References
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Russell Chandler, BVSc, CertSAO, MSc (OrthoEng), MRCVS, graduated from Bristol Vet School. He established small animal orthopaedic surgery referral services in Hong Kong and Newport, south Wales. His current interests are in multimodal osteoarthritis management and regenerative medicine.

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