Cold Laser Therapy

A popular therapy among chiropractors who treat pets is low level laser or “cold laser” treatment. It is an impressive bit of showmanship to pull out a complex-looking device and with a serious expression wave a beam of light over a patient, but the evidence to suggest it is anything more than showmanship is weak at best.

An example of the enthusiasm, and irrationality, of some proponents of this treatment can be found at the joint web site of the International Association of Veterinary Chiropractors and American Animal Adjusting Association.

The article on cold laser begins by anticipating and defying criticism:

Invariably a new technique or process is often fraught with counter-intentions that are usually seen throughout the field of study and across the board.  The relative benefit of such a process or new technology is directly proportional to the amount of consternation, doubt, and criticism that, it in fact receives….This author has seldom seen a technology as valuable and inspiring, as this particular technology appears to be. Suffice to say you are witnessing the emergence of a completely new age in healing and certainly a total paradigm shift in veterinary health care.

So the existence and strength of opposition to the technique should be seen as evidence of its benefits? Interesting logic. And if I haven’t mentioned it before, the use of the term “paradigm shift,” not to mention “completely new age,” are not only examples of ludicrous hyperbole, they are highly correlated with quackery, if not pathognomonic for it.

The underlying theory presented to explain the benefits of cold laser treatment is a bit of pseudoscience known as the Biophoton or Ultraweak Photon Emission idea. It is possible to detect very low energy photons emitted from living cells as the result of biochemical reactions. The significance, if any, of this for health and disease has never been demonstrated, which makes it a gap in real scientific knowledge into which all kinds of mystical nonsense can be stuffed, much like the pseudoscientific misuse of quantum physics. The veterinary chiropractic site advertising this treatment explains it this way:

It has been proven that cells communicate through coherent light.  When a sperm and ovum fertilize, they immediately give off coherent light at precisely 632.8 nanometers.

Cells in the living matrix also communicate throughout the total body living things via a coherent light, and that communication is done instantaneously through the living matrix to direct all aspects of healing, growth, regulation of metabolism, and general cell survival.    

To be able to dial into this communication process via an artificial methodology such as a cold laser is the ability to emulate the exact methodology is that the cells themselves use to heal themselves and also to grow, to change, and to survive. It has been said, “it is the way God talks to all cells, tissues, organisms and creatures.”

None of this is based on any sound science. It is merely vitalist, mystical speculation, which does not, of course, limit in any way the certainty and authority with which the fantasy is presented as scientific fact. This is yet another example of how chiropractic is fundamentally a pseudoscience based on imaginary “energy” and fake abnormalities like the “subluxation.” As such, it is open to any similar sounding nonsense, and any benefits it might have in practice are accidental and unrelated to the irrational and bogus underlying principles.

Like most pseudoscientific therapies, cold laser not only addresses the one true underlying cause of disease, it can also be applied in almost any way. Directly over diseased organs, in the general area of a symptom, even on acupuncture points associated with the meridians connected to the problem area. And since the proponents here are chiropractors, we should not be surprised to find that the use of lasers “is particularly effective in rehabilitating the effects of vertebral subluxation complex and their effects on the myofascial tissues affected by these subluxations.”

What else do these folks claim cold laser can do?

These protocols are designed to enhance a particular disease therapy or can be used in a general sense as the sole treatment of choice.

If a practitioner were to master only these protocols and use only these, he would be still far more effective than any of his colleagues to date using methods other than cold laser.

They list a number of general protocols first:

 Arthritis/Spondylitis/Myelopathy Protocol
Neuropathy Protocol
Immune Protocol
Lymphatic Drainage Protocol
Pre and Post Surgical Protocol
Liver Detox Protocol
Hormone Balance Protocol
Acute Pain-Injury Protocol
Sympathetic-Parasympathetic (S-PS) Balance Protocol
Acupuncture Meridian Balance Protocol
Infection Protocol
Allergy Protocol (Specific or General)

If one prefers a slightly more specific indication for the treatment, they can also provide protocols for laser treatment of:

Feline-

Abscesses
Chronic Inflammatory Bowel Disease (CIBD)
Feline Hyperthyroidism,
Feline Skin-Spinal Reflex, Feline Neurodermatitis, Endocrine Alopecia, Milliary Eczema
Kidney Disease, FUS, FLUTD
Megacolon
Pyorrhea

Canine-

Canine Hip Dysplasia Syndrome
Canine Idiopathic Epilepsy
Chronic Inflammatory Bowel Disease
Cushing’s Disease
Canine Wobbler’s Disease
Hypothyroid
Progressive Degenerative Myelopathy
Urinary Incontinence

Equine-

Arthritis, (General or Focal) Sore Back etc.
Bleeder (exercise induced naso-pharyngeal hemorrhage) Elevated Blood Pressure
Bronchitis, Bronchopneumonia, Pneumonitis
Bruising, Subcutaneous Hemorrhage, Wound Reorganization
Bursitis
Colic (all kinds), Bloat
Bone Injury, (splint bone and acute boney injuries)
Dermatosis, Urticaria, Hives, Rain Scald
Ear and Guttoral Pouch Disease
Edema, (general, hypostatic, ventral, extremities)
Equine Protozoal Myelitis (EPM)(see also Neurotropic Herpes)
Facial Nerve Paralysis, Lip Paralysis
Fear, Terrors, Miss-emotion, Training Problems
Hepatitis, Hepatosis
Hock Distension
Heart and Heart Related Conditions
Focal or General Inflammation
Lacerations
Lack of Focus in Training
Laryngeal Hemiplegia
Kidney Disease
Malignant Hyperthermia
Navicular Disease and Laminitis
Neurotropic Herpes (West Nile Virus?)
Proud Flesh, Excessive Granulation Tissue
Sepsis, (General or Focal)

So what is the truth behind all of these claims? Despite the nonsense of the underlying theory, is there any evidence cold laser therapy might have real benefits?

The answer for the vast majority of conditions is “No!” For a few conditions, the answer is more appropriately a “Maybe, but probably not much.”

Extensive reviews of the human literature have been done by the Cochrane Collaboration and the insurance companies Aetna and Cigna. These have found mixed but generally poor evidence for benefit as follows. A review of the veterinary literature on the subject can be found in Ramey 2004.

1. Cochrane Review for rheumatoid arthritis: 6 studies with a  total of 660 people were examined. There was limited evidence for a small benefit, with an improvement in self-reported pain of 1.1 points on a 10 point scale. The studies were short term and methodologically weak and inconsistent, and the conclusion was, as usual for Cochrane reviews, that no firm conclusion can be drawn and more research is needed.

2. Cochrane Review for osteoarthritis: This examined 6 studies, three of which found no effect and three of which found a benefit. The studies were methodologically weak and inconsistent and more research was recommended. The review has since been withdrawn pending analysis of additional evidence and correction of some statistical errors.

3. Cochrane Review for nonspecific low back pain: 7 studies of 384 people. Three studies (168 people) showed very small improvement in pain compared with fake laser. Three studies (102 people) found no difference. All the studies used different treatment protocols and short-term evaluation, so no firm conclusions could be made.

4. Cochrane Review for tuberculosis: One poor quality study from India was available and did not meet even basic methodological standards, so no conclusion could be drawn.

5. CIGNA Review: References 1-36

            A. Musculoskeletal Conditions: A number of studies and reviews in addition to the Cochran Reviews were examined. Generally, they showed no effect from most treatments for most measures but small benefits for a few measures in some trials. Overall, the evidence was weak and of poor quality, and it suggested some small  benefit for discomfort and range of motion might be possible.

            B. Wound Healing: Several systematic reviews were discussed, none of which showed convincing evidence of benefits for wound healing.

            C. Oral Mucositis: Two small studies were reviewed, one of which showed a benefit to laser therapy and the other of which did not.

            D. Other Medical Conditions: Reviews of laser use for temperomandibular joint disease and acute and chronic Achilles tendinitis found no clear evidence of benefit.

Summary: Low-level laser therapy (LLLT) has been proposed for a wide variety of uses, including wound healing, tuberculosis, and musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia and carpal tunnel syndrome. There is insufficient evidence in the published, peer-reviewed scientific literature to demonstrate that LLLT is effective for these conditions or other medical conditions.

6. Aetna Review: References 37-81 (duplicates with CIGNA deleted)

” Although the results from large, uncontrolled, open trials of low-energy lasers in inducing wound healing have shown benefit, controlled trials have shown little or no benefit. The analgesic effects of low-energy lasers have been most intensely studied in rheumatoid arthritis. Recent well-designed, controlled studies have found no benefit from low energy lasers in relieving pain in rheumatoid arthritis or other musculoskeletal conditions. Furthermore, although positive effects were found in some earlier studies, it was not clear that the pain relief achieved was large enough to have either clinical significance or to replace conventional therapies.”

Published reviews indicate a lack of evidence for effectiveness for the following conditions:
chronic wounds, arthritis, tuberculosis, tinnitus, pain, smoking cessation, epicondylitis, Achilles tendinitis, plantar heel pain, back pain, and carpal tunnel syndrome.

Some evidence of benefit was found for the following conditions:
Raynaud’s phenomenon, pain following endodontic procedures, palpation sensitivity and passive extension in patients with shoulder pain (but not other measures), swelling following dental extraction when used in combination with steroids, tennis elbow pain in combination with plyometric exercise

Most of these studies were small and had methodological weaknesses, an most of their authors conclded that the treatment was promising but more research was needed to conclusively demonstrate a benefit.

7. Ramey 2004: References 82-100

Some studies have found evidence of improved wound healing in diabetic mice, dairy cattle, and laboratory rats. Other studies in rats and rabbits find small but clinically insignificant effects, and several studies have found no evidence of any effect on wounds in rats, guinea pigs, pigs, beagle dogs, and horses. A couple of poor quality studies of tendon and ligament injuries in horses have had conflicting results, one showing benefit and the other not. Other unblinded or uncontrolled studies in horses have suggested benefit for a variety of conditions. “Laser acupuncture” has been examined in uncontrolled and unblinded studies in horses, with the expected claims of benefit. Overall, there is weak evidence to suggest possible benefit in wound healing (though this conflicts with the results of higher quality studies in humans), and many claims made based on studies so poorly designed as to be no different from mere anecdotes. There is no good quality clinical research on which to base firm conclusions, or to support the dramatic claims of laser therapy proponents.

Overall, then, the theoretical foundations for low power laser therapy range from questionable to completely nonsensical pseudoscience. The in vitro research does suggest some real effects on living cells, but it does not indicate that such effects would be achievable or beneficial in actual patients. The human clinical research is extensive but of generally poor quality with no consistency to the laser treatment methods investigated, and it provides only very weak evidence of any clinically meaningful effects. The veterinary research is even more limited and of poor quality, ad it to is mixed with little convincing demonstration of real clinical benefits. All of this suggests an appropriate stance towards this therapy would be neutral to somewhat pessimistic, though certainly better quality research could identify some meaningful clinical benefits. The evidence does not support, and in some cases directly contradicts the claims made by the chiropratic organization website and much of the marketing materials on cold laser therapy veterinarians receive.

References-

1. Arora H, Pai KM, Maiya A, Vidyasagar MS, Rajeev A. Efficacy of He-Ne Laser in the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Feb;105(2):180-6.

2. Bingol U, Altan L, Yurtkuran M. Low-power laser treatment for shoulder pain. Photomed Laser Surg. 2005 Oct;23(5):459-64.

3. Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008 May 29;9:75.

4. Bjordal JM, Lopes-Martins RA, Iversen VV. A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med. 2006 Jan;40(1):76-80.

5. Bjordal JM, Couppe C, Chow RT, Tuner J, Ljunggren EA. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother. 2003;49(2):107-16.

6. Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskelet Disord. 2007 Jun 22;8:51.

7. Brosseau L, Gam A, Harman K, Morin M, Robinson VA, Shea BJ, et al. Low level laser therapy (Classes I, II and III) for treating osteoarthritis (Cochrane Review). In: The Cochrane Library, Issue 3, 2004.

8. Brosseau L, Robinson V, Wells G, Debie R, Gam A, Harman K, et al. Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002049.

9. Brosseau L, Wells G, Marchand S, Gaboury I, Stokes B, Morin M, et al. Randomized controlled trial on low level laser therapy (LLLT) in the treatment of osteoarthritis (OA) of the hand. Lasers Surg Med. 2005

Mar;36(3):210-9.

10. California Technology Assessment Forum (CTAF). Low-energy laser therapy for the treatment of carpal tunnel syndrome. Technology Assessment. San Francisco, CA: CTAF; February 15, 2006. Accessed

June 7, 2009. Available at URL address: http://ctaf.org/content/general/detail/499

11. Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic

therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504.

12. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.

13. Crossley K, Bennell K, Green S, McConnell J. A systematic review of physical interventions for patellofemoral pain syndrome. Clin J Sport Med. 2001 Apr;11(2):103-10.

14. Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 2001;5(9):1-221.

15. Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial. Aust J Physiother. 2007;53(3):155-60.

16. Ekim A, Armagan O, Tascioglu F, Oner C, Colak M. Effect of low level laser therapy in rheumatoid arthritis patients with carpal tunnel syndrome. Swiss Med Wkly. 2007 Jun 16;137(23-24):347-52

17. Emshoff R, Bösch R, Pümpel E, Schöning H, Strobl H. Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Apr;105(4):452-6.

18. Fikácková H, Dostálová T, Navrátil L, Klaschka J. Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study. Photomed Laser Surg. 2007 Aug;25(4):297-303.

19. Flemming K, Cullum N . Laser therapy for venous leg ulcers (Cochrane Review). In: The Cochrane Library, Issue 3,2004 .

20. Genot MT, Klastersky J. Low-level laser for prevention and therapy of oral mucositis induced by chemotherapy or radiotherapy. Curr Opin Oncol. 2005 May;17(3):236-40.

21. Gerritsen AA, de Krom MC, Struijs MA, Scholten RJ, de Vet HC, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. J Neurol. 2002 Mar;249(3):272-80.

22. Gur A, Karakoc M, Nas K, Cevik R, Sarac J, Demir E. Efficacy of low power laser therapy in fibromyalgia: a single-blind, placebo-controlled trial. Lasers Med Sci. 2002;17(1):57-61.

23. Gur A, Sarac AJ, Cevik R, Altindag O, Sarac S. Efficacy of 904 nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck: a double-blind and randomized controlled trial. Lasers Surg Med. 2004;35(3):229-35.

24. Low Level Laser Therapy (LLLT) Technology Assessment. Washington State Department of Labor and Industries. May 3, 2004. Accessed June 7, 2009. Available at URL address:

http://www.lni.wa.gov/ClaimsIns/Files/OMD/LLLTTechAssessMay032004.pdf

25. Lucas C, van Gemert MJ, de Haan RJ. Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomised clinical trial. Lasers Med Sci. 2003;18(2):72-7.

26. Mazzetto MO, Carrasco TG, Bidinelo EF, de Andrade Pizzo RC, Mazzetto RG. Low intensity laser application in temporomandibular disorders: a phase I double-blind study. Cranio. 2007 Jul;25(3):186-92.

27. McLauchlan GJ, Handoll HH. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Database Syst Rev. 2001;(2):CD000232.

28. McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006 May;86(5):710-25.

29. O’Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;(1):CD003219.

30. Oken O, Kahraman Y, Ayhan F, Canpolat S, Yorgancioglu ZR, Oken OF. The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial. J Hand Ther. 2008 Jan-Mar;21(1):63-7.

31. Ottawa Panel. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Electrotherapy and Thermotherapy Interventions in the Management of Rheumatoid Arthritis in Adults. Phys Ther. 2004 Nov;84(11):1016-43.

32. Samson DJ, Lefevre F, Aronson N. Wound-Healing Technologies: Low-Level Laser and Vacuum-Assisted Closure. Evidence Report/Technology Assessment No. 111. AHRQ Publication No. 05-E005-2. Rockville, MD: Agency for Healthcare Research and Quality. December 2004. Accessed June 7, 2009. Available at URL address: http://www.ahrq.gov/downloads/pub/evidence/pdf/woundtech/woundtech.pdf

33. Simon A. Technology Assessment. Low level laser therapy for wound healing: an update. Alberta Heritage Foundation for Medical Research, 2004. Accessed June 8, 2009. Available at URL address: http://www.ihe.ca/publications/library/archived/low-level-laser-therapy-for-wound-healing/

34. Vlassov VV, MacLehose HG. Low level laser therapy for treating tuberculosis. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD003490.

35. White AR, Rampes H, Campbell JL. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000009.

36. Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V , Akbari-Kamrani M, et al. Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005107.

37. Basford JR. Low-energy laser therapy: Controversies and new research findings. Lasers Surg Med. 1989;9(1):1-5.

38. Wheeland RG. Clinical uses of lasers in dermatology. Lasers Surg Med. 1995;16(1):2-23.

39. Basford JR. Physical agents. In: Rehabilitation Medicine: Principles and Practice. 2nd ed. JA De Lisa, ed. Philadelphia, PA: J.B. Lippincott Co.; 1993: 404-424.

40. Johannsen F, Hauschild B, Remvig L, et al. Low energy laser therapy in rheumatoid arthritis. Scand J Rheumatol. 1994;23(3):145-147.

41. Heussler JK, Hinchey G, Margiotta E, et al. A double blind randomised trial of low power laser treatment in rheumatoid arthritis. Ann Rheum Dis. 1993;52(10):703-706.

42. Bulow PM, Jensen H, Denneskiold-Samsoe B. Low-power Ga-Al-As laser treatment of painful osteoarthritis of the knee: A double-blind placebo-controlled study. Scand J Rehab Med. 1994;26(3):155-159.

43. Krasheninnikoff M, Ellitsgaard N, Rogvi-Hansen B, et al. No effect of low power laser in lateral epicondylitis. Scand J Rheumatol. 1994;23(5):260-263.

44. Snyder-Mackler L, Bork CE. Effect of helium-neon laser irradiation on peripheral sensory nerve latency. Phys Ther. 1988;68:223-225.

45. Hirschl M, Katzenschlager R, Ammer K, et al. Double-blind, randomised, placebo controlled low level laser therapy study in patients with primary Raynaud’s phenomenon. Vasa. 2002;31(2):91-94.

46. Flemming K, Cullum N. Systematic reviews of wound care management (7): Low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. Health Technol Assess. 2001;5(9):137-221.

47. Schneider W L, Hailey D. Low level laser therapy for wound healing. Health Technology Assessment. HTA 19. Edmonton, AB: Alberta Heritage Foundation for Medical Research (AHFMR); 1999:1-23.

48. de Bie RA, de Vet HC, Lenssen AF, et al. Low-level laser therapy in ankle sprains: A randomized clinical trial. Arch Phys Med Rehabil. 1998;79(11):1415-1420.

49. Marks R, de Palma F. Clinical efficacy of low power laser therapy in osteoarthritis. Physiother Res Int. 1999;4(2):141-157.

50. Gross AR, Aker PD, Goldsmith CH, et al. Physical medicine modalities for mechanical neck disorders. Cochrane Database Syst Rev. 1998;(2):CD000961.

51. van der Heijden GJ, van der Windt DA, de Winter AF. Physiotherapy for patients with soft tissue shoulder disorders: A systematic review of randomised clinical trials. Br Med J. 1997;315:25-30.

52. Puett DW, Griffin MR. Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis. Ann Intern Med. 1994;121(2):133-140.

53. Waddell A. Tinnitus. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; December 2004.

54. Binder A. Neck pain. In: Clinical Evidence, Issue 7. Tavistock Square, UK; BMJ Publishing Group; June 2002.

55. Landorf KB, Menz HB. Plantar heel pain and plantar fasciitis. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; November 2007.

56.  C. Shoulder pain. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; February 2006.

57. Cullum N, Petherick E. Pressure ulcers. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; February 2007.

58. Abdulwadud O. Does laser therapy improve healing and function in patients with tendinitis compared to no treatment? Evidence Centre Evidence Report. Clayton, VIC: Centre for Clinical Effectiveness (CCE); 2001.

59. Alberta Heritage Foundation for Medical Research (AHFMR), Institute of Health Economics. The use of low level laser therapy in wound care in Alberta, Canada: Results of a survey of physical therapists involved in rehabilitation, long term care and home care. Edmonton, AB: AHFMR; 2001.

60. Chapell R, Turkelson CM, Coates V, et al. Diagnosis and treatment of worker-related musculoskeletal disorders of the upper extremity. Evidence Report/Technology Assessment 62. Rockville, MD: AHRQ; 2002.

61. Hirschl M, Katzenschlager R, Francesconi C, Kundi M. Low level laser therapy in primary Raynaud’s phenomenon–results of a placebo controlled, double blind intervention study. J Rheumatol. 2004;31(12):2408-2412.

62. Kreisler MB, Haj HA, Noroozi N, Willershausen B. Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery — a randomized double blind clinical study. Int J Oral Maxillofac Surg. 2004;33(1):38-41.

63. Ohio Bureau of Workers’ Compensation (BWC). Position paper on low level laser therapy (LLLT). Medical Position Papers. Columbus. OH: Ohio BWC; September 2004.

64. Wang G. Low level laser therapy (LLLT). Technology Assessment. Olympia, WA: Washington State Department of Labor and Industries, Office of the Medical Director; May 3, 2004. Available at: http://www.lni.wa.gov/ClaimsIns/Providers/Treatment/TechAssess/default.asp. Accessed June 8, 2005.

65. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;(2):CD004258.

66. Nelson EA, Jones J. Venous leg ulcers. In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; September 2007.

67. Altan L, Bingol U, Aykac M, Yurtkuran M. Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int. 2005;25(1):23-27.

68. Posten W, Wrone DA, Dover JS, et al. Low-level laser therapy for wound healing: mechanism and efficacy. Dermatol Surg. 2005;31(3):334-340.

69. White AR, Rampes H, Campbell JL. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2006;(1):CD000009.

70. Markovic A, Todorovic Lj. Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: A clinical trial. Int J Oral Maxillofac Surg. 2007;36(3):226-229.

71. Ziganshina L, Garner  P. Tuberculosis (HIV negative people). In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; July 2008. 

72. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev. 2003;(3):CD000416.

73. Brosseau L, Robinson V, Wells G, et al.  Low level laser therapy (Classes III) for treating osteoarthritis. Cochrane Database Syst Rev. 2007;(1):CD002046.

74. Vlassov VV, MacLehose HG. Low level laser therapy for treating tuberculosis. Cochrane Database Syst Rev. 2006;(2):CD003490.

75. BC Cancer Agency. Lymphedema. Patient/Public Information. Vancouver, BC: BC Cancer Agency; revised November 2007.

76. Kaviani A, Fateh M, Yousefi Nooraie R, et al. Low-level laser therapy in management of postmastectomy lymphedema. Lasers Med Sci. 2006;21(2):90-94.

77. Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: A double blind, placebo-controlled trial. Cancer. 2003; 98(6):1114-1122. 

78. Moseley AL, Carati CJ, Piller NB. A systematic review of common conservative therapies for arm lymphoedema secondary to breast cancer treatment. Ann Oncol. 2007;18(4):639-646.

79.  L, Mouraux A. EEG and laser stimulation as tools for pain research. Curr Opin Investig Drugs. 2005;6(1):58-64.

80. Stergioulas A. Effects of low-level laser and plyometric exercises in the treatment of lateral epicondylitis. Photomed Laser Surg. 2007;25(3):205-213.

81. Reddy M, Gill SS, Kalkar SR, et al. Treatment of pressure ulcers: A systematic review. JAMA. 2008;300(22):2647-266282. Ramey DW, Rollin BE. Complementary and alternative veterinary medicine considered. Ames (IA), USA: Iowa State Press; 2004. p. 156-163.

83. Yu W, Naim JO, Lanzafame RJ. Effects of photostimulation on wound healing in diabetic mice. Lasers Surg Med. 1997;20(1):56-63.

84. Ghamsari SM, Taguchi K, Abe N, Acorda JA, Sato M, Yamada H. Evaluation of low level laser therapy on primary healing of experimentally induced full thickness teat wounds in dairy cattle. Vet Surg. 1997 Mar-Apr;26(2):114-20.

85. Kami T. The experimental effect of low-energy laser on skin flap survival. Plast Reconstr Surg. 1992 Dec;90(6):1127-8.

86. Medrado AR, Pugliese LS, Reis SR, Andrade ZA. Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg Med. 2003;32(3):239-44.

87. Braverman B, McCarthy RJ, Ivankovich AD, Forde DE, Overfield M, Bapna MS. Effect of helium-neon and infrared laser irradiation on wound healing in rabbits. Lasers Surg Med. 1989;9(1):50-8.

88. Surinchak JS, Alago ML, Bellamy RF, Stuck BE, Belkin M. Effects of low-level energy lasers on the healing of full-thickness skin defects. Lasers Surg Med. 1983;2(3):267-74.

89. Becker J. Biostimulation of wound healing in rats by combined soft and middle power lasers. Biomed Tech (berl) 1990;35(5):98-101 [in German]

90. Hutschenreiter G, Haina D, Paulini K, Schumacher G. [Wound healing after laser and red light irradiation] Z Exp Chir. 1980 Apr;13(2):75-85. [in German]

91. McCaughan JS Jr, Bethel BH, Johnston T, Janssen W. Effect of low-dose argon irradiation on rate of wound closure. Lasers Surg Med. 1985;5(6):607-14.

92. Basford JR, Hallman HO, Sheffield CG, Mackey GL. Comparison of cold-quartz ultraviolet, low-energy laser, and occlusion in wound healing in a swine model. Arch Phys Med Rehabil. 1986 Mar;67(3):151-4.

93. In de Braekt MM. et al. Effect of low level laser therapy on wound healing after palatal surgery in beagle dogs. Lasers Surg Med 1991;11(5):462-70.

94. Peteson SL, et al. The effect of low level laser therapy (LLLT) on wound healing in horses. Equine Vet J 1999;31(3):228-31.

95. Kaneps AJ, Hultgren BD, Riebold TW, Shires GM. Laser therapy in the horse: histopathologic response. Am J Vet Res. 1984 Mar;45(3):581-2.

96. Marr CM, Love S, Boyd JS, McKellar Q. Factors affecting the clinical outcome of injuries to the superficial digital flexor tendon in National Hunt and point-to-point racehorses. Vet Rec. 1993 May 8;132(19):476-9.

97. Gomez-Villamandos RJ, et al. He-Ne laser therapy by fibroendoscopy in the mucosa of the equine upper airway. Lasers Surg med 19995;16(2):184-88. 

98. McKibbin LS, Paraschak D. Use of laser light to treat certain lesions in standardbreds. Mod Vet Pract. 1984 Mar;65(3):210-3.

99. Martin BB Jr, Klide AM. Treatment of chronic back pain in horses. Stimulation of acupuncture points with a low powered infrared laser. Vet Surg. 1987 Jan-Feb;16(1):106-10.

100. Klide AM, Martin BB Jr. Methods of stimulating acupuncture points for treatment of chronic back pain in horses. J Am Vet Med Assoc. 1989 Nov 15;195(10):1375-9.

This entry was posted in Miscellaneous CAVM. Bookmark the permalink.

75 Responses to Cold Laser Therapy

  1. Alison says:

    I was highly amused to see in the ‘equine’ list that such things as fear, emotional problems and training problems are considered suitable for treatment with these lasers. Where would they shine the beams for that, then? Especially as in these cases it is generally the owner rather than the horse that needs the treatment.

  2. Ceridwen says:

    My boyfriend’s mother (a massage therapist at his father’s chiropractic office) uses one of these. She refers to it as “the healing light of Jesus” when she offers it to her patients.

    Thankfully we don’t visit them often, it’s very hard to keep from losing it when they start spouting off about stuff like this.

  3. skeptvet says:

    Wow, can’t get a much clearer example of faith-based medicine than that!

  4. Ceridwen says:

    You wouldn’t happen to have any fun stuff on crystal healing in vet medicine would you?

    As woo-ful as his family is, they did actually stumble across a vet who was too far gone into woo even for them. They brought in a cat with a urinary condition and the vet pulled out some kind of crystal (or multiple crystals, been a bit since they told me this story) and waved it over the cat and picked medicines based off of whether the crystal “pulled toward certain areas of the body” or something like that.

    They payed for these medicines (why?!?!) but never administered them, choosing to go to a real vet shortly thereafter. For which I’m sure the cat was quite grateful.

    I was quite disturbed by the whole thing, since urinary problems can so quickly become life threatening (my family lost a cat to a urinary blockage that went unnoticed for too long) and the woo-vet failed to prescribe any real medicine at all.

  5. skeptvet says:

    Sadly, it’s pretty easy to find “veterinary crystal healing” with a quick web search. I sort of though of it like pet pyschics, as something so patently ridiculous I wouldn’t need to bother with it, but it looks like I may have to come up with something on the subject.

  6. Cold Laser or Low Level Laser Therapy / LLLT (a MeSH term on pubmed) has been hijacked by the esoteric new age quacks and it is right that you point that out.

    You reference many positive clinical papers but do not refer to them in your conclusion and somehow you missed out the biggest and most recent review published in The Lancet.

    The fact that 30% of clinical research papers are inconclusive or negative does not mean LLLT does not work.

    LLLT has a power density and a dose specific effect which when applied to the correct anatomical location has a good anti-inflammatory effect equal to NSAID’s but without side effects, some tissue repair and analgesic action also.

    See the the Harvard Medical School review available here

    http://thorlaser.com/downloads/research/Biphasic-Dose-Response-in-Low-Level-Light-Therapy-Harvard.pdf

    The Lancet review
    http://www.ncbi.nlm.nih.gov/pubmed?term=19913903&cmd=DetailsSearch

  7. skeptvet says:

    Mr. Carroll,

    Thank you for your comment and the references. I am waiting to comment on the Lancet article until I can get a copy of the complete paper.

    The other review you linked to is not especially convincing. It acknowledges that “LLLT remains controversial in mainstream
    medicine,” yet it reviews only positive research findings and ignores the negative findings. It attributes studies which fail to show efficacy,

    “to several factors including dosimetry (inadequate or too much energy delivered, inadequate or too much irradiance, inappropriate pulse structure, irradiation of insufficient area of the pathology), inappropriate anatomical treatment location and concurrent patient medication (such as steroidal and non-steroidal anti-inflammatories which can inhibit healing).”

    I cannot help but notice the omission of the possibility that lack of efficacy could be due to lack of efficacy. The article is certainly biased, and it is published in a journal for the International Dose Response Society, a group devoted entirely to the promoting the concept of hormesis as an important phenomenon of great potential therapeutic value. This is even more controversial than the concept of LLLT, so I do not consider this an entirely reliable source. The plethora of alternative medicine journals devoted to publishing material not acceptable for mainstrea medical journals is ample evidence that there mere existence of a positive literature review is not conclusive evidence for the claim being made.

    As for the conclusions of my post, I did acknowledge that there is evidence for efficacy of LLLT in humans. I merely pointed out that it is “generally poor quality with no consistency to the laser treatment methods investigated, and it provides only very weak evidence of any clinically meaningful effects.” I stand by this conclusion based on reviewing the literature.

    This is not meant to categorically deny that LLLT might have clinical utility, only to point out that we are nowhere near the point where we are justified in making comments like, “‘cold laser therapy’ is on track to become one of the most important developments in life sciences since the discovery of penicillin” as your company does on its web site. If people such as yourself selling this therapy were more circumspect in the marketing of it and limited yourselves to claims that were at all reasonable in light of the existing evidence, I shouldn’t be writing posts such as this one in the first place.

  8. Rich says:

    Your cold laser link is to a website of a veterinarian whose license to practice was suspended for significant negligence and fraud (falsified lab tests) in Washington State (VT00002687) in 1996 and he does not hold a valid license to practice ANYWHERE.

  9. skeptvet says:

    Rich,

    Thanks, that is an important detail.

  10. skeptvet says:

    So, I had a look at the Lancet review. It does provide some support for the claim that cold laser may have some benefit for pain, but it is also riddled with biases and weakness. The authors, of course, practice laser therapy and clearly deisgned the review to prove the benefit. The appropriate goal of a scientific study is to disprove the hypothesis being examined, since it is all too easy to confirm our beliefs but much harder, and more meaningful, to disconfirm them.

    The authors included non-English language journals and journals devoted to alternative medicine, both of which are often excluded from Cochrane reviews due to concerns about publication bias.

    They included only studies in which no “specific pathological changes could be identified,” which tends to select a population with less precisely defined disease, the very population that seeks out and believes in CAM and for whom it is most likley to appear to work.

    They also included in their search terms nomenclature such as “trigger points,” a somewhat controversial term that suggests an alternative bias.

    There was inconsistent reporting of concurrent therapies, and it was impossible to know in 6 of the 16 studies included what concurrent therapy was used in each of the groups.

    And, of course, all the results were ultimately self-reported pain scores or comfort surveys, which are notoriously unreliable and likely to suggest a benefit to almost any therapy one applies.

    There are quite a few of such weakness, and while they do not invalidate the results, they suggest pretty strongly that the authors set out with an agenda to prove an a priori position and did so. Ultimately, that is likely to lead to false positive results, which is why consistency and replication is required and the best conclusions come from considering the preponderence of the evidence. The preoponderence of the evidence at this point is still weak, with reasonable suggestions that LLLT might lead to subjective improvements in pain scores but no consistent, strong evidence that it has tangible benefit and no justification for extreme claims concerning it. Further research is certainly warranted, but widespread clinical application with florid promises are inappropriate.

  11. Tracey says:

    I’ve been treating patients with cold laser for more than ten years and when you treat a paraplegic patient with a chronic wound of more than 2 years which heals with laser in 15 sessions, i don’t care what research has been done the evidence is in the results. I have had amazing results with acute tendinitis, sometimes only 1 session required. I’ve treated canine and equine wounds with success, actually, my woundcare patients have had the best results. I used my laser following a c section and i was even impressed at how quickly i healed and how faint my scar is.

    There has been extensive research carried out over the past 40 years and NASA have some very interesting results. sometimes things just work, backed up by good research or not, its like BOBATH approach to treating stroke patients and CP, it works but the research is not good. It is the best treatment to prevent abnormal tone and movement. It’s so easy to knock something that doesn’t make full sense. But when you use it on a daily basis and see results you will never be able to tell me it doesn’t work because frankly it’s just not true.

  12. skeptvet says:

    Tracey,

    I understand why personal experiences are so compelling. I also understand wy they are often not reliable. George Washington’s doctors had seen many respiratory infections cured by bloodletting, and they truly believed they were helping him when they bled him to death. Every homeopath believes they are curing diseases with their magic water. The reason medical care, and the length and quality of our lives have improved more in the last 200 years than all the rest of human history is because we have better methods of deciding what is true and what isn’t than what looks like it works. The hardest thing about practicing science-based medicine is accepting that things may not be what they seem, and that takes a level of humilty and open-mindedness that is sometimes painful and hard to achieve.

  13. Light or photon energy with the unique property of being able to penetrate up to two inches below the skin surface causing an increase in cellular metabolism with no tissue damage whatsoever

  14. skeptvet says:

    So chiropractors often claim. Unfortunately, there is no solid evidence that this theory is true, as the numerous references cited above illustrate. Such claims are, for the moment, only unsubstantiated opinion.

  15. We are seeing more positive studies and I believe this will continue. In the future, I believe the research will focus on the specific parameters of low level laser therapy for specific conditions.

  16. skeptvet says:

    Would you care to share any of these studies so I and my readers can evaluate their significance for ourselves?

  17. Sharon Barker says:

    I used cold laser as an adjunct to hypnotherapy for chronic insomnia and pain. This cost me approximately $1500. Three words: MASSIVE RIP OFF.

    After my 3rd treatment I honestly felt like a bit of a lunatic for allowing this assistant to “laser” my wrists while we all wore sunglasses. I so wanted it to work but to say the results were ZERO would be overstating the efficacy of the cold laser. I know that the placebo effect should have had some positive effects on the pain and sleeplessness. And the doctor who was administering the hypnotherapy kept going on and on about what a great patient I was. I guess I was a great patient for parting w/ 1500 bucks!

  18. skeptvet says:

    Thanks for sharing your experience. All too often, people who believe they are helped trumpet it to the world, and those who don’t experience a benefit quietly move on to something else, which contibutes to the false impressio of real efficacy.

  19. jeff brown says:

    I have been looking for studies to support laser usage for arthritis in dogs. A lot of believers out there. No real evidence, so far. I will continue following your blog and hold off on purchasing a “miracle laser” for now. Thanks.

  20. Keith says:

    There are numerous studies showing efficacy of low level laser for inflammatory conditions. Arthritis in dogs is an inflammatory condition. Look for yourself at http://www.pubmed.gov

    Lasers Med Sci. 2011 Apr 12. [Epub ahead of print]
    Infrared (810-nm) low-level laser therapy on rat experimental knee inflammation.
    Pallotta RC, Bjordal JM, Frigo L, Leal Junior EC, Teixeira S, Marcos RL, Ramos L, de Moura Messias F, Lopes-Martins RA.
    Source
    Laboratory of Pharmacology and Experimental Therapeutics, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil, 05508-900.
    Abstract
    Arthritis of the knee is the most common type of joint inflammatory disorder and it is associated with pain and inflammation of the joint capsule. Few studies address the effects of the 810-nm laser in such conditions. Here we investigated the effects of low-level laser therapy (LLLT; infrared, 810-nm) in experimentally induced rat knee inflammation. Thirty male Wistar rats (230-250 g) were anesthetized and injected with carrageenan by an intra-articular route. After 6 and 12 h, all animals were killed by CO(2) inhalation and the articular cavity was washed for cellular and biochemical analysis. Articular tissue was carefully removed for real-time PCR analysis in order to evaluate COX-1 and COX-2 expression. LLLT was able to significantly inhibit the total number of leukocytes, as well as the myeloperoxidase activity with 1, 3, and 6 J (Joules) of energy. This result was corroborated by cell counting showing the reduction of polymorphonuclear cells at the inflammatory site. Vascular extravasation was significantly inhibited at the higher dose of energy of 10 J. Both COX-1 and 2 gene expression were significantly enhanced by laser irradiation while PGE(2) production was inhibited. Low-level laser therapy operating at 810 nm markedly reduced inflammatory signs of inflammation but increased COX-1 and 2 gene expression. Further studies are necessary to investigate the possible production of antiinflammatory mediators by COX enzymes induced by laser irradiation in knee inflammation. PMID: 21484455 [PubMed – as supplied by publisher]

    Photomed Laser Surg. 2009 Aug;27(4):577-84.
    The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial.
    Hegedus B, Viharos L, Gervain M, Gálfi M.
    Source
    Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. arthrodent@freemail.hu
    Abstract
    INTRODUCTION:
    Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).

    MATERIALS AND METHODS:
    Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.

    RESULTS:
    In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature–and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.

    CONCLUSION:
    Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area. PMID: 19530911 [PubMed – indexed for MEDLINE]

  21. skeptvet says:

    We’ve been through this, ut you don’t seem to be hearing me. There are lab animal studies that show some effects on artificially induced inflammation. That means it is plausible that there might be clinical benefit in naturally occurring disease in dogs, but it is NOT definitive proof that this is true. Many things which show promise during in vitro or lab animal studies don’t really work once put into clinical practice, and without controlled clinical trials we can’t justify definitive statements either way. So it is still the case that laser might have benefits but the question remains open. If you sell it to patients by telling them it might have benefits or it might not, fair enough. But if you are selling this as a scientifically proven treatment, that isn’t accurate.

  22. Jon Covey says:

    Both heat and cold are used for therapy, and so is ultrasound. Arthritic people use heat on their pain, and it helps. Cold helps too, but the therapy should end with heat. The heat (but not cold) and ultrasound are part of the electromagnetic spectrum, as is light, including low level laser. We know heat and cold therapy works, and we know ultrasound works. (Cold is not part of spectrum because cold is the lack of heat.).

    Massage is also used to help with pain, because like heat & cold, and ultrasound, it causes increased circulation and provides relief. If laser seems to be providing horses and other animals some help, great. I hope it helps my arthritic cat. I’m thinking about shaving his hip joint and giving him some ultrasound therapy. It’s helped me with my knee. I’ve treated my knee with LLLT only one time, so I can’t say anything about that.

  23. skeptvet says:

    Apart from the personal anecdote (“I’ve tried it and I think it works”), which doesn’t have much value in deciding which therapies work and which don’t, this comment doesn’t really make a lot of sense. Heat is not electromagnetic radiation, it is a function of the amount of motion of the atoms in the material. Ultrasound is not electromagnetic either, it is sound, which is wave energy passing through matter. Laser, as a form of light, is electromagnetic radiation. None of these things has, at the fundamental level of physics, anything to do with the others, so the point you’re trying to make is inaccurate and demonstrates the danger of trying to make medical decisions based onfundamental misunderstandings about science.

    As for whether any of these things “help,” that depends both on what you mean and what your evidence is. Subjective pain relief, slowing of progression of disease, healing of arthritic joints, changes in inflammatory mediators withing joints, and many other measures can be looked at to see whether or not a therapy has benefits, so whether these things “work” depends on what you’re measuring. And it cannot be said often enough that personal experiences and anecdotes have been used to justify every medical therapy in history. So either bloodletting and ritual sacrifice have to be accepted as effective treatments, or we have to acknowledge that such anecdotes are unreliable.

  24. Jim Boult says:

    I have a friend whose heart condition was so bad that doctors told him there was nothing they could do for him. He’s had three heart surgeries and was told that his arteries were so blocked they could not perform another operation. He was virtually immobile and suffered serious angina attacks. In desperation he tried laser therapy and has had a remarkable recovery. You can get the whole story with videos at heartattacklaser[dot]com.

  25. skeptvet says:

    Maybe true, maybe not. The same exact stories can be told for Lourdes water and the intervention of Apollo and every other method anyone has ever tried to heal a serious disease. the reality is that stories like these are how we decided which treatments worked for thousands of years, and we did a lousy job of healing. The improvements of the last few centuries come from recognizing that such stories can’t be trusted.

  26. Thanks for the in-depth, scientific discussion of this topic.
    I’ve been suffering with hip-joint pains for years, and so far nothing has helped. The pain sometimes eases up and sometimes increases, for no apparent reason. My orthopedist said home-use of the B-Cure contraption might help, but it’s expensive and I should try to get it free of charge for a trial period. If I can swing that, I’ll try it. Who knows — I might be among those for whom it affords some relief. I do realize, thought, that this would not constitute any firm scientific proof.
    To be clear: I am a skeptic and do not believe in homeopathy, acupuncture, crystals, or any other such rubbish/pseudoscience. (The name of my blog refers to matters of translation and other aspects of language; long story, not relevant here.)

  27. Albert Day says:

    I was recently bilked out of 90 bucks at a local vet when my dog was bitten by another dog then required treatment. The cold laser was brought out (rather than the pain reliever or antibiotics) and held over my pooch’s wounds for a few minutes. This was done 3 times over 2 plus days with no visible result I could see. I was told to bring the dog back for more treatments which I did not do (thank goodness). The bill indicated charges of $30 for each laser treatment. I had enough of this non-sense. I took the dog home, irrigated the wounds, used some anti-biotic I had on hand and basically held my poor dogs paw while he healed. To me the shear number of claimed benefits make me think the entire process stinks to high heaven. It kind of reminds me of snake oil sales. Cure-alls are generally a sign of scam medicine. I asked specifics about the process while at the vets but no real answers were forthcoming. And for me that is a red flag. I have found old-fashioned common-sense is the best guideline in all matters. A red light-bulb in a chrome fixture doesn’t make for good medicine. I think the fact that most are emotional and therefore vulnerable when their beloved pet is affected is for some vets a sign that the money is about to flow. Weasels!! All who bilk loving pet owners are below human.

  28. SChrist82 says:

    First my personal experience with cold laser, then a question:
    I work at a veterinary hospital, have been for 7 years. around the time I started working there we got a cold laser. I was told it works well for a variety of things, but a few of our staff had some doubts. Others swear by it, they say ‘ I notice an immediate difference in the patient’ . SO i say ‘well what difference do you notice’. The response, that the patient is much happier when brought back to the owner after a treatment than before treatment. (FYI in the world of Veterinary medicine, 99% of patients are happier after being brought back to the owner than when taken away (duh), no matter what the reason for the visit).
    Anyway, our laser came with a little booklet with protocols for treating various symptoms including joint pain, inflammation , wound healing etc. It has a few settings F1, F2, F3, F4, F5 and F6. F6 was for use if the target area was deep: like for joint pain, while F1 was for the most superficial targets. The rest of the settings were for in between (setting I think refers to frequency, but not sure). Then as our physical therapist would attend lectures about the latest laser info, the rules would change. we were told that setting doesn’t matter always use F4 (or in the case of the ‘Ultra Wide’ laser head use F6). so we threw the booklet away. we usually gave the patient 4 or 6 joules per cm squared (as instructed based on experts in the field) per treatment. Then we got a new updated booklet. Now it said to increase/decrease the amount of Joules based on the patient’s size. a large dog requires twice as many joules (8 to 12) and a cat or small dog requires half (2-3). So i questioned our PT staff (one PT, one CVT, and one DVM) and usage instructions varied among the three. They all used either 4 or 6 Joules/cm squared regardless of patient size (said they never heard of basing dosage on patient size), some used F6 setting for ultra wide, others used F4 for the ultra wide, etc, etc. Lack of consistency.
    Now the laser I have been referring to is a class 3B laser (see Wikipedia ‘laser safety’ article), which is for the most part harmless, except to the eyes. But the latest thing in the world of cold laser is the hot laser. a class 4 laser. within the past year many laser companies have been sending reps to us trying to sell us a class 4 laser and eventually (and unfortunately) we bought one. They claimed the class 3b doesn’t affect deep targets, due to skin blocking/absorbing most of the energy and now these class 4 lasers are necessary. one rep said a study done on rabbit joints showed that rabbit skin absorbed most of the energy ( i think between 3/4 and 2/3 of the energy) directed at the joint from a class 3B. (and for those who don’t know, rabbits have paper thin skin). Also, it was found that hemoglobin blocks a significant portion of the energy, so we are supposed to press to the laser firmly onto the patient to temporarily cut off capillary blood flow, minimizing hemoglobin interference (doesn’t work out so well when you have to press firmly on a painful joint by the way). each rep cautioned that unlike a class 3B laser a 4 laser can cause burns to the patient, however one called it a ‘warm laser’ because it was just barely above the class 3B range and the risk for damage is low. The point is: I’ve been fed promises about this laser for years, but it doesn’t seems like anyone knows the correct way to use it. All the painful patients I used it on were still painful, it still took a few days for their issues to resolve, and even the biggest supporters of laser at my job still performed physical therapy and treated pain with ACTUAL PAIN MEDICATION. No one is confident enough to use it on its own (and for good reason).
    So Anyway after many years of usage it turns out it was useless for all but the most superficial targets (post surgical incisions, surface wounds), if it even works at all. Even the top laser companies are acknowledging the limitations and are marketing more powerful lasers. One thing obvious to the naked eye about these new lasers are all the bells and whistles. Touch screen monitors, different shaped laser head attachments, pre set protocols based on location (example you select Knee, or Hip then Large vs Medium vs Small Dog and a computer chooses the settings instead of manually picking F4 or whatever: I guess settings matter again). Just seems like very dishonest business. IF it works its taking a long time to Iron out the kinks, and all the while clients are being charged money for it.
    And now for my question : how likely are these class 4 therapeutic lasers to cause burns, or to actually reach the target? IF these class 4s are like the class 3B lasers where most of the energy is absorbed by the skin, are we putting skin at risk to treat joint pain. and does enough energy even reach the joint (if it even works in the first place that is) to warrant risking burns to skin. Or are the class 4 therapeutic lasers barely across the threshold, and only slightly more powerful than 3B lasers. Im not allowed to use the class 4 only our PT staff is (it must have been very expensive), so I dont know much else about it. Anyone know?

    PS one thing i forgot to mention. In patients with a history of cancer or suspected of cancer: Laser treatment is not recommended. If it actually works It will stimulated cancer cells to divide more rapidly like it (allegedly) does in normal cells. Also it is not recommended for patients taking steroids (not the baseball player kind, put meds like prednisone.), I dont remember why though. There may be other risks but im not sure. So there are a few things to worry about other than protecting your eyes.

  29. skeptvet says:

    I think you’ve hit on an important problem with lasers, and also stem cell therapies and a number of other new interventions. While there is some biologic plausibility (unlike, say, homeopathy, they might actually work), they are rushed to market before adequate reearch is done to know if they actually are safe and effective. Then evryone tries to guess based on individual case experiences whether or not they work. And individual case anecdotes almost always make a therapy look effective due to confirmation bias, regression to the mean, and all the other factors that make uncontrolled observations unreliable for evaluating medical treatments (http://www.skeptvet.com/index.php?p=1_13_Why-We-re-Often-Wrong). In this case, the same reps who told you your old laser would work are now telling you it probably didn’t in order to sell you the new one. But with no greater basis in controlled clinical research than the old laser had, there’s not much reason to have greater faith in the new one.

    The answer, of course, is properly designed and conducted clinical trials. And I personally think companies who want to sell products like these should be responsible for paying for them. But that’s a political question more than a scientific one.

    Here is a recent evidence summary on lasers, both IIB and IV: http://www.aetna.com/cpb/medical/data/300_399/0363.html

    Nothing about veterinary use, of course, and no quantification of the incidence of burns. The bottom line is that since no one has done the necessary research, we still don’t know if these are truly helpful or how often they cause problems. Extrapolation from basic in vitro and lab animal research is a starting point, but it doesn’t replace clinical trials and doesn’t justify selling expensive pieces of equipment to use on patients when we don’t really know if they are safe or effective. Supposedly more research is coming (http://www.veterinarypracticenews.com/vet-practice-news-columns/complementary-medicine/why-laser-therapy-is-evidence-based-medicine.aspx), but it has yet to appear in the literature, so we’re still largely guessing based on basic physiology and clinical experience.

  30. SChrist82 says:

    Thanks for the info. I followed the Aetna link and the article by Dr Narda Robinson. Seems like both articles talk about the same thing, there is conflicing information, but each draws a different conclusion. One says basically as this point its not worth it (Aetna), the other says there is still hope for the technology and garuantees it will be eventually accepted. (Light at the end of a tunnel, nyuck, nycuk, nyuck). From Dr Narda Robinson: “As more veterinary schools adopt laser therapy and teach its basic science to students, growing numbers of practitioners will recognize that laser therapy, when properly applied and appropriately dosed, provides clinically significant benefits and expands our options for delivering compassionate veterinary care with fewer drugs and less surgery.”
    The Dr Narda Robinson article says (in part 1) that every possible parameter of the laser treatment has to be perfect such as wavelength, fluence, irradiance, pulsing, timing of treatment and repitition of treatment. But what are the correct parameters? In part 3 of the article it is implied that lasers can be ovepriced and/or inadequate, and the evidence presented can be misleading. So how do we know right from wrong, what the good info is vs hype. What are the correct settings and parameters. I followed the link to the World Association of Laser Therapy (WALT) under part 6, (click on footnote 16). And it brought me to ThorLaser.com a website that sells lasers, told me that the article was removed. Id be willing to bet each laser company has there own set of optimal paramaters. However footnote 3 does bring you to the WALT guidlines, but they are not guidlines for usage for Laser, just how to conduct a propper study on Laser. So even though each parameter has to be correct for the patient to respond we still dont know what those parametes should be. The more I ‘learn’ about this the more confused I get. Anyway, I like how in part 8 it says ‘With enthusiasm for Class IV lasers growing at a rapid pace, more research is expected in the near future’. I think the research should lead to enthusiasm, not the other way around.

  31. skeptvet says:

    I think the research should lead to enthusiasm, not the other way around.

    I couldn’t agree more! I appreciate that Narda takes a more scientific, evidence-based approach to such therapies than most vets who use them, but I am not yet convinced the evidence is strong enough to justify using laser. The costs to the client and the risks seem great enough to more than balance the “potential,” which is still only theoretical.

  32. SChrist82 says:

    Just an update on some stuff i found out about class 4 theraputic laser. Apparently the potential for burns to skin is a concern. THe PT staff told me you ‘have to keep it moving, always keep it moving’. With the class 3b laser, we would hold the laser head over the area until a certain number of joules (dose) was given. each 2 seconds was one joule. if the area was larger that the probe head we would do x amount of seconds here, then x amount of seconds to the spot next to it and on and on until the whole area was covered. with class 4 you set the computer to deliver x amount of joules and continuosly sweep the head back and forth for a certain amount of time (the computer stops it automatically after x joules are given). The PT staff cautions against keeping the head over one spot for more than a second due to potential for burns. SO far no dog has received any burns that i am aware of. also the need for eyeware is stressed alot more for 4 vs the 3b. with 3b protective eyeware was recommended, but we never used it, the odds of the 3b beam reflecting off of something and going back into your eye with enough energy to do damage is slim ( or maybe impossible). But they make a REAL big deal about eyeware with class 4, the chances of a dangerous reflection are apparently significant. In people they found that dark skinned people are MUCH more likely to get burns, but according to the reps treatment is still worthwhile (how? i dont know, im no laser expert but if they tend to get burns with dark skin that must mean most of the dose is getting absorbed by the skin AND causing damage, the only way to get more energy THROUGH the skin will also cause more damage TO the skin) Also very fair skinned people get burns more easily as well (i.e. people – like me – who get terrible sunburn for being outside more than 10 minutes). The PT staff actually all have stories with the OLDER, WEAKER class 3B where black haired dogs had their hairs start to smolder from higher doses (ie more joules). the higher doses were used back then for deep targets like joints and spine, and now we have class 4 which has MORE POWER that is used for those types on targets. Regardless of hair color, dogs tend to have pale skin (under all the hair), sometimes with patches of hyperpigmented areas. there doesnt seem to be an in between skin tone for dogs, like there is for people. so a dog seems to be more likely to be burned than a person would. And if black hair absorbs light, other colors of hair must at least block SOME of the light. Who knows…..
    Anyway, the latest laser stuff (that our staff is exposed to anyway) says that only a select few wavelengths ‘work’ however these wavelengths are also easily absorbed by hemoglobin in red blood cells (according to the sales reps). I think i mentioned this already in an older post, but this is why we are now supposed to put enough pressure on the patient with the laser head to cut off capilary blood flow, minimizing hemoglobin interference. SO……. IF laser works, and if it can penetrate the skin, despite interference from pigmentation, despite interference from hemoglobin, despite interference from hair (esp dark hair), and IF it doesnt cause burns while doing so…………[it is a safe and effective therapy! I highly reccomend for hairless anemic dogs with medium skin tones who dont mind a strange object being firmly pressed against painful areas of thier bodies to cut off capilary flow!

    Idea: maybe we should bring back bloodletting, it would really help with laser therapy by removing all those pesty hemoglobin molecules. ]

    Note: Please read above text within brackets in sarcastic tone of voice.

  33. Adam Mohr says:

    Spektvet – I am curious what your thoughts are about the fact that the majority of medical procedures used in medicine today have little to no evidence to support their efficacy. Isn’t it appropriate for us to continue to try new treatments and procedures in order to find ones that work. Since most medical procedures lack great supporting evidence, LLLT is just one other option for people to try. The US is behind in the research to support LLLT, however, research out of Europe is a bit better.

  34. skeptvet says:

    I don’t accpet the contention that “the majority of medical procedures used in medicine today have little to no evidence to support their efficacy,” so it’s not a compelling argument. That isn’t to say that we aren’t always seeking better evidence, or that the evidence is less than ideal for many interventions. But in fact, the evidence suggests that there is good research evidence to support a large portion of conventional medicine.

    This article, for example, reviews the literature and concludes that there is strong evidence for many interventions:

    96.7% of anesthetic interventions (32% by RCT, UK)[13]

    approximately 77% of dermatologic out-patient therapy (38% by RCT, Denmark)[14]

    64.8% of ‘major therapeutic interventions’ in an internal medicine clinic (57% by RCT, Canada)[15]

    95% of surgical interventions in one practice (24% by RCT, UK)[16]

    77% of pediatric surgical interventions (11% by RCT, UK)[17]

    65% of psychiatric interventions (65% by RCT, UK)[18]

    81% of interventions in general practice (25.5% by RCT, UK)[19]

    82% of general medical interventions (53% by RCT, UK)[20]

    55% of general practice interventions (38% by RCT, Spain)[21]

    78% of laparoscopic procedures (50% by RCT, France)[22]

    45% of primary hematology-oncology interventions (24% by RCT, USA)[23]

    84% of internal medicine interventions (50% by RCT, Sweden)[24]

    97% of pediatric surgical interventions (26% by RCT, UK)11

    70% of primary therapeutic decisions in a clinical hematology practice (22% by RCT, UK)[25]

    72.5% of interventions in a community pediatric practice (39.9% by RCT, UK)[26]

    This article also provides a strong response to the idea that most modern medicine isn’t based on good evidence.

    In any case, even though there are unarguable deficiencies in the evidence for many interventions, this says nothing about the appropriateness of choosing a specific therapy that does not have good supporting evidence, or of ignoring the evidence in favor of anecdotes. There is always a balance to be struck between the amount of uncertainty about an intervention and the urgency of intervening. Given the uncertainty associated with the value of cold laser therapy, it is not appropriate to make strong positive claims for its efficacy. Qualified claims about the possibility of benefits, and use in situations where more thoroughly studied interventions are not available, are certainly appropriate.

  35. Bodil says:

    Thank you.
    You’ve just saved me from hundreds of dollars spent on a VetroLaser supposed to relieve my dogs pain from cancer. (Sarcoma) He had one “treatment” which sure enough seemed to have amazingly positive effects,but reading these posts make me realize I’m simply so desperate to find a positive in this very miserable situation I could actually have caused him more damage and pain.
    While I’ll readily admit I did see a remarkably improvement from that treatment I also failed to analyze all the variables present,and although the situation is sad,it certainly would not benefit the dog if I end up spending funds on a useless and very expensive laser-pointer. Sad as I am to realize nothing will or can change the fact that I’m losing my wonderful companion over the past seven years,I am also somewhat relieved I can now concentrate on enjoying my last few weeks with this beautiful dog and not waste valuable (to me..) time researching pseudo science online.
    Thank you.

  36. SChrist82 says:

    Hi Bodil

    just curious who recommended using cold laser on a dog with cancer?
    I dont believe laser does anything, but IF it does work the way they say it does, then patients with cancer or suspected cancer should not receive treatment for risk of making the tumor grow. (at least thats what our sales rep says). Anyway sorry to hear about your dog, I had to go through it in the past……….its rough.

  37. RumpyDog! says:

    DeDe Dog, a lab mix, has been diagnosed with arthritis. One of the recommended treatments by our vet was cold laser therapy. She was given her first treatment for free. It consisted of the vet tech sitting on the floor with her and rubbing a light-emitting “wand” over the affected joints. I wondered if it was effective, and that’s how I found you. As a single treatment can cost $30, I was wondering what scientific studies had to say about the treatment.

  38. Pingback: Words on Wednesday- Cold Laser Treatment | Rumpydog

  39. Kgearh says:

    I am sorry to say I completely disagree with you. I have seen nothing but positive results from the laser therapy treatments I have done. Not only do I use it for my horses and dogs pain and wounds, I use it on myself for my pain and wounds. I have seen first-hand black and blue marks that I know would have taken over a week to disappear completely gone in days. While my animals may not be able to tell me how they are feeling after their treatments, I can tell you it has worked wonders for me. I’ve used it on my shoulder that was in so much pain I could not even move it up and down and after one treatment and some rest I was almost back to normal in less than 12hours. While the research may be lacking I say you should not completely dismiss a treatment just because it is new. I predict in another 10 years the research will be there and it will prove the benefits of the therapy. Just give it time. Like with any advances in medical history you will always have people who don’t believe, I suggest you at least give it a try and make up your own mind rather than getting your information from the intranet. And YES it does take multiple treatments to see results. In my experience you should give it at least 5 treatments within 14 days to note a clinical response.

  40. Annk says:

    hi, is there any gap on the laser when you treat a patients?

  41. Kathi says:

    Interesting article, I particularly like the inclusion of study data.

    As an anecdote: I decided to try it with my limping senior dog with an arthritic wrist. The dog went from regularly limping to not limping at all, almost immediately and after only one treatment. I’m pretty encouraged and plan to continue treatment. I do wish I could try it on myself to feel the difference personally.

    I think it is important to recognize that bad advertising from … erm, ah… “over-eager providers” … yeah, that works… does not negate the health benefits of a technology. To suggest that is so is a logic fallacy. There is always going to be someone who over-reaches but that doesn’t mean lasers are useless: it means to advertiser is full of shit.

  42. skeptvet says:

    I think it is important to recognize that bad advertising from … erm, ah… “over-eager providers” … yeah, that works… does not negate the health benefits of a technology. To suggest that is so is a logic fallacy. There is always going to be someone who over-reaches but that doesn’t mean lasers are useless: it means to advertiser is full of shit.

    You are quite right. The problem is that in the absence of an explicit, detailed, and critical review of the research evidence, treatment decisions are made on the basis of these kinds of claims. And even you appear to be strongly influenced by the appearance of an effect and convinced that a personal experience with the treatment would help you decide if it works or not. These kinds of eveidence, unfortunately, are very likely to lead us astray. So while I agree we cannot say the therapy does not work on the basis of unsupported claims and weak anecdotal evidence, we also cannot say it does, which many people seem willing to do. The best we can say is we don’t know and that better evidence is needed. But people almost always choose the most hopeful and positive interpretation of even poor evidence as their default, and this is why such claims are so dangerous–they are likely to be believed out of proportion to their actual validity.

  43. Jim Tew says:

    Fascinating discussion! Years ago, I had a grad school professor who had been a missionary in China probably 50 years ago. Having tea one day with a group of Chinese medical doctors, the subject of acupuncture came up. The consensus was:

    “None of us think acupuncture is ‘better’. But we have no access to the marvelous pharmacology that you in the west have—we do not have those drugs. So, we make do with what we have. We stick a needle in a nerve bundle and it ‘seems’ to provide some pain relief. Who knows.”

    Anecdotally, my 13 year old Chinook, with two “repaired” stifles seemed to genuinely benefit from her twice a week laser therapy. When we stopped it, she seemed less mobile.

    BUT! Now I have a 6 year old Dane with bone spurs, severe arthritis, stifle issues, myleopathy and so on. If we start him on laser (just did, two treatments), the cost for both will approach $8,000 a year. I also have a ten year old Weimaraner with significant arthritis in his front feet. Add him? $12,000/year.

    Now. He is a little better (the Dane)—but he is also on NSAIDs, Tramadol and Gabapentin. Not to mention bed rest and massage.

    SO! I decided it might be time to buy my own laser. What a cluster quark! There is so much bogus info out there that it is mind numbing.

    All for a technology that “seems” to have some science behind it, but…

    I can easily afford to buy that laser. BUT! Maybe it is useless? Or maybe the $600 one works, or even the $3,000 one…oh damn.

    Dogs are more responsive to placebo than people. I’ve taken dogs to the vet to be sent to the rainbow bridge and magically they perk up in the vet’s parking lot.

    BUT that 13 year old girl positively scampers after her therapy laser and declines without very markedly.

    NOT ready to join any camp. NOT sure what I will do.

  44. Skepvet,

    I always appreciate the in-depth reviews that you provide. There is so much quakery in both human & veterinary medicine, and a lot of equivocal treatments that sometimes work. I provide laser therapy using a Class-IV 15 W laser. It does not qualify as LLLT, which are <0.5 W in power. Thus, a 15W laser is 30 times more powerful, allowing deeper penetration and shorter treatments to achieve the same delivery of a given energy. So, while the majority of the studies referenced are from the earlier generations of "cold lasers", they had such low power output that results are difficult to compare to the deep-penetrating lasers now available.

    Also, since 2008, there have been over 1800 scientific papers published on the benefits and cellular & biological effects of photobiomodulation. I've no doubt that many need better designs or follow-up, but the data is mounting that demonstrate the actual effects of the photon interactions within tissues, from Nitric oxide interactions to increased ATP production to acceleration of cellular metabolism.

    My own experiences with patients and personal use are just anectdotal, so hardly worth mentioning. I never propose to clients that laser therapy is a cure-all, but simply a new tool in the armamentarium for promoting healing and comfort. I inform clients that if their pet's condition is chronic, the laser will only provide temporary and periodic relief, and may take several treatments to be significantly noticeable. I also warn them that response to therapy is individual and some pets respond dramatically, while others hardly at all. That does not mean that this is placebo effect in those that do respond, just that we don't fully understand what may be blocking the effect in others. I, like others, have noticed a more rapid healing response in acute injuries & surgeries, but I let clients know that those things are going to heal anyway, but just may heal faster with the laser. I certainly don't want to be lumped in with the quacks promoting "energized water" and homeopathy, but I certainly want clients to know that I am a hopeful skeptic trying to offer as many options to help their pets with their pain. I have found more response to laser therapy for arthritis than I have with a full series of Adequan injections, in spite of all the good studies documenting those benefits.

  45. skeptvet says:

    Thanks for the comment. I find nothing to disagree with, and I like to think of myself as a “hopeful skeptic” with regard to laser therapies as well.

    I’m a little frustrated, though, that laser and stem cell therapies are so widely used and promoted and yet there has been so little effort to generate clinical trial evidence to evaluate them. It seems that companies selling such products have some ethical responsibility to demonstrate efficacy with more than animal model and in vitro studies and extrapolations from human clinical trials (which are still somewhat equivocal for laser). Certainly, there is some good reason to think the therapy ought to have efficacy, but as you say we have mostly anecdote to show that it actually does, and that’s pretty weak evidence. Of course, there’s no financial incentive for companies to do so since vets will buy and use these systems without such evidence, and unlike pharmaceuticals there is no government requirement to demonstrate safety and efficacy in target-species clinical trials.

    hopefully, the benefits you appear to be seeing will someday be shown in such trials, and then you can teach the rest of us hoepful skeptics how to use the therapy! 🙂

  46. Art Malernee Dvm says:

    I have with a full series of Adequan injections, in spite of all the good studies documenting those benefits>>>>

    Any idea why people are not “getting full series of adequan injections” if they really clinically work ?
    I seem to be the only vet I can find around me that does not offer laser therapy. I’m not sure if the specialty practice I refer to has one but we have 2 hr of CE this week on lasers so I will ask. My wife is a nicu nurse and she has not mentioned that they now laser premies where she works.

  47. v.t. says:

    What’s the cost to benefit ratio between repeat laser therapies and a series of Adequan injections that may also need to be repeated at some point? Pet owners are also looking at costs, and looking for the best long-term results.

  48. Diane says:

    Art–Are clients in your practice declining Adequan? If so, what is your take on why?

    I’m a big fan of Adequan so I’ve talked with quite a few people about it, and my sense is that some folks are concerned about injections hurting their pet, and some are concerned about possible side effects, as it is technically a drug and many people are concerned about potential risks of any drug. Laser therapy is a lot less threatening, I think.

    But I’m shocked to read some of the costs mentioned by posters here–I had no idea laser therapy could be so expensive. For thousands of dollars a year I’d want a miracle cure.

  49. Art Malernee Dvm says:

    Read this from ponydoc

    PSGAG is made up mostly of chondroitin sulfate (CS), which is sometimes fed orally to horses (in any number of oral supplements), and like CS, the product is made, and then modified, from the lung and tracheal tissue of cows. There are two forms of Adequan®: one is for injection into the joint, and the other is for injection into the muscle. Even though the product has been approved by the US Food and Drug Administration, it’s not at all clear how well – or even whether – the products are effective, especially when injected into the muscle (the most common route of administration).

    It’s not like people haven’t studied the stuff. Early test tube studies on the effects of PSGAG were somewhat contradictory. Some studies conducted in test tubes on cartilage cells showed positive effects on cartilage, while others showed no effects; some even showed effects that could be construed as harmful. The thing about test tube studies is that the results can’t necessarily be carried over to a living animal – putting drugs into test tubes is a lot different than putting drugs into a horse, mostly because the horse’s body does things to the drug that don’t occur in the test tube (it’s called metabolism). Horses don’t live in glass houses – or glass vials, either.

    Results from studies on living horses don’t provide much in the way of support, either. So, for example, even though one study conducted in a surgical model of osteoarthritis concluded that Adequan®, given in the joint, reduced joint inflammation and subsequent damage to cartilage caused by chemical injury, the substance absolutely did not help heal damage caused by the surgical procedure. A more recent study, in 2011, conducted at Colorado State University, found that Adequan® had no measurable effects on any of the measures used in an experimental arthritis model. Under any circumstances, there’s no study that has shown that PSGAG helps heal cartilage damage that is already present. That means that if your horse has an arthritic joint, you shouldn’t expect that by giving it Adequan® you are going to reverse any of the damage.

    Adequan® given in the muscle seems to be a very popular treatment among horse owners. It’s pretty easy to understand why – people have the idea that it helps prevent joint problems; owners and trainers don’t want their horses to have joint problems. It has two other things going for it, that, I think, help explain its popularity:

    1. It’s easy to give (just a shot in the muscle)

    2. It’s a lot cheaper than Legend®.

    Even so, there is some expense associated with PSGAG, which has led to the curious dosing regimen whereby people give their horses Adequan® once a month. To me, this makes very little sense. The label says that you’re supposed to give the injection every four days – I’m not sure how giving it every once in a while is supposed to help anything. It is cheaper, of course, to give it monthly, instead of all the darn time, but under that rationale, and given the relative lack of supporting evidence, if saving money were the real issue, I’d suggest that you not use it at all!

    PSGAG does appear to be very safe. Then again, a saline injection would be safe, too (although pointless).

    Adequan® can be injected directly into the joint; you’re not going to do this, of course, but the product is out there. Given in the joint, it seems to have a more reliable anti-inflammatory effect, but not obviously anything else. When it first came out, the company recommended giving weekly injections for five weeks, but, unfortunately, many horse joints weren’t happy with that recommendation, and problems with acute inflammation occurred (joint “flare”) sort of doused people’s enthusiasm for that route of administration. In addition, when compared to other things that get injected into horse joints, such as corticosteroids and hyaluronan, there’s a slightly greater risk of infection with PSGAG; understandably, people might not be inclined to use a product if there’s a significant risk of harm.

    The risk of problems from injections of PSGAG into the joint can be greatly reduced by combining it with an antibiotic. Of course, injecting any substance into a joint is something that should be done by your veterinarian. Still, you kind of have to wonder if it’s worth the fuss, particularly since other substances, such as corticosteroids, are demonstrably as effective, more consistently effective in research studies, and a lot cheaper.

    Oh, one other thing. There’s also some weak support for using PSGAG injections to treat horses that have injured tendons or ligaments. So, if your horse hurts his tendon, or strains a suspensory ligament, you can always shoot him with some PSGAG. But, it’s certainly not something that is going to be critical for a full recovery.

    What do I think (how did I know you’d ask)? Well, more than anything else, when it comes to Adequan® I think that you’re probably paying for your own peace of mind, and putting a price on your good intentions, rather than paying for much of a therapeutic effect. Although PSGAG can be injected into joints with some reasonable expectation of an anti-inflammatory effect (but not much else), giving it in the muscle is probably not something that’s going to do your horse much good. And it’s certainly not something that’s going to keep your horse from developing arthritis, that is, if he was ever going to get arthritis in the first place.

    If you’re concerned about your horse’s joints, there are a few things that you can do. Keep your horse at a good weight, don’t ride him too hard, and take care of him. There’s nothing that prevents joint problems that you can buy in a bottle, can, or plastic tub.

  50. Art Malernee Dvm says:

    Ponydoc is David Ramey. My bottles of Adequan went expired after he and some physcians posted about it on quackwatch ten years ago. He also had something to say about cold lasers back in the day. I just do not see a lot of science out there for fixing any joints other than replacing them, moderate exercise and weight loss.
    See
    Compendium Continuing education for veterinarians
    Journal site on the Web
    Veterinary Learning Systems (Published since 1979)
    eISSN: 1940-8315; pISSN: 1940-8307; uISSN: 0193-1903; Monthly
    Volume 22 | Issue 3 (March 2000)

    Laser Therapy in Horses
    Compend Contin Educ Vet. March 2000;22(3):263-271. 65 Refs
    David W Ramey1; Jeffrey R. Basford
    1* Ramey Equine, Glendale, CA
    Article Abstract

    Since its introduction in the late 1960s, low-intensity laser therapy has been investigated as a treatment modality with a variety of applications. Despite some evidence of in vitro effects, low-intensity laser therapy has yet to move beyond the level of marginal or no evidence of clinical effect. This article reviews findings from numerous studies investigating the efficacy of low-power laser therapy. [abstract]

Leave a Reply

Your email address will not be published. Required fields are marked *

This blog is kept spam free by WP-SpamFree.