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Therapeutic Laser - Its Time Has Come

Robin Downing, DVM, CVPP, CCRP, DAAPM

Orthopedics

|August 2012|Web-Exclusive

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Therapeutic Laser - Its Time Has Come

Having been in practice for 26 years, I have had the privilege of witnessing multiple diagnostic and therapeutic transformations in our ability to serve patients. One such transformation is the use of therapeutic laser for enhancing healing and restoring homeostasis.

Therapeutic laser involves the delivery of low-level light  energy into the tissues to create a phenomenon called photobiomodulation. At a cellular level, this stimulates increased ATP production, increases leukocyte phagocytosis, and increases fibroblast activity. Grossly, laser application decreases inflammation, increases microcirculation, modulates nerve conduction velocities, and releases endorphins; all contribute to pain relief. Wavelength determines depth of penetration, and power determines the speed at which photons are delivered to tissues.

Therapeutic laser is enjoying application to a wide variety of conditions. A logical first use for therapeutic laser is pain management, both in acute and chronic pain patients. In my pain management and rehabilitation referral practice, I initially applied therapeutic laser to patients experiencing chronic maladaptive pain. I was able to provide an immediate reduction of musculoskeletal pain, demonstrated on post-treatment palpation; this allowed for the introduction of other physical medicine techniques, including stretching and therapeutic exercise.

Further, additional applications are emerging. At Colorado State University College of Veterinary Medicine, a recent study illuminated the benefits of therapeutic laser in treating dogs with rattlesnake bites. Reduction of both pain and inflammation are beneficial in postoperative patients. Therapeutic laser can be safely applied over surgical incisions as well as over postsurgical joints, including stifles (eg, TPLO, lateral imbrication), carpi, shoulders (eg, arthroscopy), and hips (eg, total hip replacement, FHO). Laser therapy may provide the patient with supplemental pain relief and may boost tissue healing. Lick granulomas may respond favorably as well.

Therapeutic laser is not, however, a panacea. For example, one suggested application is to stimulate acupuncture points and to use over myofascial trigger points to substitute needling. As a medical acupuncturist who uses needling techniques both at acupuncture and myofascial trigger points, I must disclose my disappointment in attempting to use laser technology for this purpose.

Not all therapeutic lasers are created equal, so it is important for veterinarians to be educated about the science and safety of therapeutic laser application. Veterinarians must investigate (eg, “do your homework”) so to not be seduced by marketing materials, as well as be prepared to continue learning as new information about applications becomes available.

There are ongoing clinical studies by human researchers evaluating the possible role of therapeutic laser in accelerating and enhancing nerve regeneration following traumatic injury. The primary goal of  human interest involves healing injured military veterans, but I look forward to understanding the application to my veterinary patients. Veterinarians must demand high-quality, placebo-controlled clinical studies to illuminate the evolving role of therapeutic laser in providing better care for our animal patients.


References

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