Guest Editorial

Photomedicine and Laser Surgery Volume 32, Number 1, 2014 ª Mary Ann Liebert, Inc. Pp. 1–2 DOI: 10.1089/pho.2013.9867

Low Level Laser Therapy (LLLT) in Veterinary Medicine Richard L. Godine, DVM

nary hospitals, but the abovementioned are some of the most common. This rapid increase in the use of PBM devices in veterinary medicine raises some interesting questions. Primarily, who is teaching and training the veterinarians? Veterinarians want to know how to pick an LED or laser device for their practice. They want to know how PBM works and what are the fundamental concepts needed to understand which parameters are important. They want to see past the marketing hype and be able to compare units and outcomes in common terms. Veterinarians want to know how PBM complements or replaces conventional treatment regimens. They want to know how to measure success, when treatments are no longer needed, and how often treatments should be given. They are also concerned about adequate training for their staff as well as safety for their patients, clients, and technicians. Where can this information be accessed? Who is available to teach veterinarians? Where are the unbiased randomized controlled trials (RCTs) in veterinary medicine that can offer some objectivity in answering veterinarians’ questions? Several laser vendors are rushing to fill this void. They are donating lasers to teaching hospitals and instructing the faculty on how to use their system while plugging why it is the best unit available. They are funding clinical trials designed just for their laser system. Although there is much to applaud about these efforts, objectivity is not part of them. Much work has been done by Jan Magnus Bjordal and the World Association for Laser Therapy (WALT) to compile treatment guidelines based on hundreds of published clinical trials in which important parameters are identified in the successful treatment of various human musculoskeletal diseases for both 904 and 780–860 nm lasers.5 These successful parameters are the same in animals, with minor tweaking to account for fur and anatomical size differences. Veterinarians would love to have a dosage recommendation chart for animals similar to that which WALT has provided for humans. This presents more of a challenge than one might think for veterinary medicine. If power density, total dose, and time of irradiation matter greatly for successful outcomes as many retrospective meta-analysis studies indicate, then veterinarians need to carefully consider not just the total dose to an area, but also the color of the coat and skin, the size of the animal, the depth of the target lesion, and the application technique being used. The preponderance of 6–12 W therapeutic lasers in small animal veterinary medicine presents a

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he use of therapeutic LEDs and lasers in veterinary medicine has seen a steep increase in the past decade.1 It is the fastest growing new treatment modality in present day veterinary clinical practice. Equine practitioners have long used photobiomodualtion (PBM) for treating wounds as well as tendon and joint injuries; however, companion animal veterinarians have largely fueled the recent growth. Spurred on by effusive testimonials in monthly veterinary news magazines and aggressive marketing by largely class IV laser companies, veterinarians are steadily adding light therapy to their practices. Companion animal veterinarians are finding success with low-level laser therapy (LLLT) in a wide variety of medical conditions. Common joint conditions include torn anterior cruciate ligaments and degenerative joint diseases associated with dysplasia of the hips and elbows. Also, tendonitis of the supraspinatus and biceps tendons, and strains of muscle such as the iliopsoas are commonly treated. Many other degenerative arthritides, as well as myofascial trigger points, are being effectively treated. Standard dermatological conditions include hot spots (acute moist pyotraumatic dermatitis), otitis externa, lick granulomas, and wounds of all causes. Almost all veterinarians use their LLLT device perioperatively, and see the benefit of decreased pain and inflammation, as well as faster healing times. The treatment of intervertebral disk herniation has become much more common, both as a primary treatment modality as well as postoperatively in those patients requiring a surgical hemilaminectomy.2 Other neurological conditions being treated include certain peripheral neuropathies, dementia, and obsessive-compulsive disorders. In addition, inflammatory conditions of internal organs are being successfully treated with LLLT. Feline lower urinary tract disease (FLUTD) is very similar to idiopathic sterile hemorrhagic cystitis in women, and this disease responds very well to PBM anti-inflammatory protocols. Acute pancreatitis is another internal organ inflammatory disorder in which LLLT significantly reduces the morbidity and hospital time of patients. We have even seen a palliative benefit in chronic renal failure at our hospital with the systemic effects of blood irradiation, stimulation of mesenchymal stem cells by bone marrow irradiation, and neuromodualtion of renal function by laser acupuncture of the nerve roots affecting the kidneys.3,4 There are many other conditions being treated with LLLT in small animal veteri-

Ruckersville Animal Hospital and Veterinary Laser Therapy Center, Ruckersville, Virginia.

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2 particular challenge in getting these therapeutic parameters in line with clinically proven ranges. Veterinary schools ought to be including laser therapy in their already overcrowded curricula. It is among the fastestgrowing treatment modalities in veterinary clinical practice. Students should not only understand how it works, but also what parameters offer the greatest likelihood of positive outcomes for commonly treated conditions. Also, universities need to be leading the way in evaluating the pros and cons of the top laser systems used by veterinarians. This will provide some third party objectivity to the confusing purchase options for practitioners. Finally, veterinary academia should be leading the way in RCTs, to help establish veterinary dosage recommendations based on good clinical data. It will only take one or two leaders in this field, and other veterinary colleges will follow. Veterinary schools should not ignore the role of PBM associations such as WALT and North American Association for Light Therapy (NAALT), as they seek to fill the void of teaching students about laser and LED therapy. Seasoned PBMi1 researchers and clinicians are eager to see good science being applied to the education of practitioners. References 1. Bartels, K.E. (2013). Use of lasers in veterinary medicine (Editorial). Laser Institute of America, February 19, 2013.

GUEST EDITORIAL 2. Draper, W.E., Schubert, T.A., Clemmons, R.M., and Miles, S.A. (2012). Low level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study. J. Small Anim. Pract. 53, 465–469. 3. Oliveira, F.A.M., Moraes, A.C., Paiva, A.P., Schinzel, V., Correa-Costa, M., Semedo, P., Castoldi, A., Cenedeze, M.A., Oliveira, R.S., Bastos, M.G., Caˆmara, N.O., and SandersPinheiro, H. (2012). LLLT decrease renal interstitial fibrosis. Photomed. Laser Surg. 30, 705–715. 4. Tuby, H., Maltz, L., and Oron, U. (2011). Induction of autologous mesenchymal stem cells in the bone marrow by LLLT has profound beneficial effects on the infarcted rat heart. Lasers Surg. Med. 43, 401–409. 5. Bjordal, J.M., (2012). Low level laser therapy (LLLT) and World Association for Laser Therapy (WALT) dosage recommendations. Photomed. Laser Surg. 30, 61–62.

Address correspondence to: Richard L Godine Ruckersville Animal Hospital and Veterinary Laser Therapy Center 8301 Seminole Trail Ruckersville, VA 22968 E-mail: [email protected]

Low level laser therapy (LLLT) in veterinary medicine.

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