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-

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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.

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75 Responses to Cold Laser Therapy

  1. Art Malernee Dvm says:

    So I went to get my 2 hr required by law CE last night along with two glasses of wine sponsored by a cold laser company. The topic was cold laser but the speaker seems to like LED light also and the unit (14000 dollars) that he uses can do both. I ask some questions about the difference between cold laser classes and LED light. I think they said that the law requires you to wear goggles with laser but not LED. The speaker said the pet insurance company will pay for cold laser treatment as long as you do it in your office. Human medicine we were told is behind the times because the federal government will not pay for cold laser treatment for humans. So I guess there will not be any photos of nicu nurses wearing goggles lasering newborns anytime soon.

  2. v.t. says:

    Sounds a lot like the hyperbaric oxygen chamber promotions – not approved, nor proven for safety and efficacy, but as long as performed by a vet, all is good. UGH!

  3. Jason Neman says:

    Very interesting post. I never thought that cold laser may cause harm because it was being approves by the law. Thanks for sharing your insights.

  4. Art Malernee Dvm says:

    Very interesting post. I never thought that cold laser may cause harm because it was being approves by the law. Thanks for sharing your insights.>>>>

    The interesting thing about the glasses at the CE meeting was that someone in the audience had to bring it up and the speaker Dvm had to ask one of the cold laser reps about what the laws wearing glasses were. I guess if you just ignore the theft by deception laws your not going to give safety laws much attention either at required by law CE courses.

  5. SJS says:

    Thanks – my enthusiastic friend (DVM) was busy doing my dog and me. I as a skeptic kinda doubted that it would do much, and today, one day later, am not compelled that much has changed.

    Now here’s one for you… do I gently dissuade my DVM friend (who has parted with considerable dollars to buy this device) by sending him this link, or just leave well enough alone?? Interesting conundrum.

  6. skeptvet says:

    Yes, it’s always difficult to decide whether to share information with someone when that information contradicts their beliefs. It rarely has any direct effect on what they believe, since we all tend to spin any information we get so that it supports what we already think, or discount it alltogether if we can’t. There’s nothing wrong with sharing if you have a good relationship and you think your friend is open to other points of view, but since you aren’t likely to change his/her mind anyway, it probably isn’t worth creating any conflict or awkwardness. If you do share, let me know how it goes. 🙂

  7. Art Malernee Dvm says:

    http://search.yahoo.com/search?fr=ipad&p=laser+cartoon&pcarrier=&pmcc=&pmnc=

    Sometimes a little humor can help.
    Art Malernee Dvm

  8. skeptvet says:

    Your logical fallacy here is Appeal to Authority. The fact that someone believes something, regardless of who that person is, is not itself evidence that belief is correct.

    I like and respect Narda, and she and I agree on many things, but not yet on the quality of evidence for laser therapy. Her article puts a positive spin on the existing evidence. The far more comprehensive reviews I cite, and that you reject out of hand because you disagree with their conclusion, show a less positive balance of evidence.There is room for disagreement here, but you prove nothing, and add nothing constructive to the discussion, but suggesting that my conclusions are wrong simply because someone else has come to a different conclusion.

    And Narda admits there is almost no evidence in veterinary patients. The only study she refers to is the UFL study which you also cite. If the only evidence so far is one small unpublished study is the sum total of the evidence in companion animals, that’s not very impressive.

    The UFL link discusses a study that has only been presented at a conference, not published, so it is difficult to assess the quality or validity of the results. The proceedings from the ACVIM meeting indicate it was not randomized (alternate allocation was used), not blinded, and included no placebo control. Given it was supported by the manufacturer specifically to generate support for their marketing (as is stated in the article you link to), there is significant risk of bias, so without these controls the results or not very reliable.

    Interestingly. there was another similar study presented by a different researcher at the same conference. There are few methodological details for this one also, so it’s impossible to know if it was controlled any better than the study you refer to. In any case the results were negative.

    So now we have two studies, both small, at least one (and probably both) at high risk of bias. That is most consistent with the conclusion in my original article that laser is promising but by no means proven. I’m not sure why my refusal to make a confident judgment on this therapy until there is adequate evidence to support one bugs you so much, but the facts at this point simply aren’t definitive, whatever you choose to believe.

    C.C. Williams; G. Barone. Is Low Level Laser Therapy an Effective Adjunctive Treatment to Hemilaminectomy in Dogs with Acute Onset Parapleglia Secondary to Intervertebral Disc Disease?

    Results of the study revealed that treatment with LLLT of 635nm wavelength did not shorten or improve recovery times for dogs with acute onset paraplegia secondary to IVDD after hemilaminectomy procedures. Dogs that showed recovery to ambulation at the two week recheck were consistently dogs that were deep pain positive on presentation. A lengthened recovery time or no recovery was seen in the majority of those dogs with absent deep pain on presentation as has been revealed historically in past studies. LLLT did not appear to have an effect on this result.

  9. Art Malernee Dvm says:

    As an evidence based medicine preacher ( the discipline that insist on proof that traditional medical practices really work) I wish the FDA would require at least in humans two prospective randomized trials that show a long term benefit for hemilaminectomys. I did the surgery for years on dogs but stopped because I cannot even find a human study where surgeons can use results of an MRI to predict which cases will benefit from surgery and which ones will not. Even the artificial disc approved by the FDA did not need to prove benefit beyond placebo they just had to show that artificial disc worked as well as traditional back surgery.

  10. Hugh French says:

    This article presents the conclusions of insurance companies who interpreted the studies so there is a conflict of interest (but that doesn’t mean they are wrong).

  11. skeptvet says:

    Well, it presents the studies collected by the insurance companies and other sources. While every source has its bias, the research itself contains varying levels of control for such biases. And, of course, we have to ask what the alternative sources of information are and what biases they contain. It is certainly never a simple matter of accepting uncritically any particular bit of evidence or point of view, but neither can we ignore the evidence we have. In the case of cold laser, “promising but unproven” still seems an appropriate global assessment.

  12. catnipVet says:

    there are several studies out there, not just the ones mentioned here. I have a list of at least a 90 papers. Not all of these studies are great, but i think some are pretty decent. To me most reliable ones can be found on the journal of sports medicine, rheumatology, surgery, and orthopedics. All these human medicine, most articles are from Laser Sur Med and Photomed Surg.
    And these last ones do have a lot of bias. I also agree that there is a lack of studies in animals(cat/dog/horse), where most applications of LLLT have been used. There are plenty of studies in mice and rats, but those are not the animals we usually use laser as therapy.
    In the other hand, just because something hasn’t been proved to work yet, it doenst mean that it can work.
    I am not absolutely convinced either way. But I do give laser some credibility because there is science behind it. Physics and biophysics are very real, although sometimes abstract. As One cannot see an object absorbing energy when a force is applied to it and counter interacting with a force in a different reaction. However we all know that its real and it happens just like that.
    So I am still giving laser a chance until proven or unproven otherwise.

  13. skeptvet says:

    1. The studies mentioned here are systematic reviews, not clinical trials. This means they incorporate and summarize the results of clinical studies done on cold laser such as the ones you mention, so these studies haven’t been overlooked.

    2. I think you summarize pretty much my view on cold laser. There is good scientific plausibility to suggest it might work, and some weak inconclusive clinical trial evidence, which adds up to “maybe.” The problem is not with testing or even using laser but with the strong positive claims made for it that go well beyond anything supported by the evidence, and by the widespread adoption of it in the veterinary profession as a revenue source before we know whether it actually helps in any particular situation. People are paying for this therapy, and they deserve to know what the evidence says, and does not say, about it.

  14. catnipVet says:

    Skeptvet

    Thanks for your input. I agree that we have jumped in band wagon a little to fast as usual. I also agree that it doesn’t really stimulate any company to perform any studies when the veterinary community seems already convinced. It is unfair to the clients and patients to pay for something without a strong scientific background. In the other hand, clients are often demanding the same type of care they have for their pets. That includes all the alternative options out there. What I mean is simply, they are not concerned about research, science based medicine. For all I know some people can careless for science based medicine. As you have already mentioned, many folks still make therapeutic decisions based on personal experience. Unfortunately, no mater what you say, for these clients miracles and stories are way more important. Its sad and frustrating when you have spent many years in school and still spend hours studying and reading studies (like I do). In the end of the day, you are only a successful vet if you make your clients happy. Thats the sad reality. So many vets are using technologies without understanding them. I could just blame the DVMs, but I won’t. If you have to pay your loans, your bills, and thus keep your clients, you may brake some oaths and even go against some of your own believes. Anyhow, I hope we have some good studies in actual pets in the following years. And I also hope all the leap of faith about laser were right.

    excellent article

  15. Art says:

    In the end of the day, you are only a successful vet if you make your clients happy. Thats the sad reality. So many vets are using technologies without understanding them. I could just blame the DVMs, but I won’t. If you have to pay your loans, your bills, and thus keep your clients, you may brake some oaths and even go against some of your own believes. >>>>
    Is there a name for that rationalization in medicine?

  16. Blake says:

    Thank you for doing the sound legwork on debunking this bollox. It’s obscene that so called medical professionals of any type are deluding themselves and their clients with this fraud.

  17. Pingback: Cold Laser Therapy For ArthritisTinySide.com | TinySide.com

  18. Pingback: Evidence Update: Cold Laser Therapy for Dogs & Cats | The SkeptVet

  19. christie says:

    Do you think this is a topic worth revisiting? Technological advances and the newest research should be looked into. This article is from 2010 and I know there is more current research and case studies out there. The key to laser therapy seems to be the wavelength.

  20. skeptvet says:

    I’m actually working on an update of this article, which should be out in the Spring. Unfortunately, I’m not finding much new research evidence. People still make a lot of claims about laser therapy based almost entirely on theory or personal experience. One major problem with relying on anecdotes is that you don’t feel any need to do the research that will really uncover the truth.

  21. Art Eldridge PhD says:

    Vets, Cold Laser treatments is snake oil 2016.
    Health payers, such Cigna, consider Low-level laser therapy (LLLT) to be experimental/investigational for all indications. While LLLT may be safe, its clinical utility has not been definitively determined. Several randomized controlled trials involving patients with venous ulcers, rheumatoid arthritis, and other musculoskeletal disorders have failed to demonstrate any significant benefits of low-level laser therapy when compared to standard treatment methods or placebos for these conditions.

    Just say no.

  22. Tom D says:

    SkeptVet,

    My vet is suggesting we try cold laser treatment, in addition to other treatments, on our dog that appears to have an inflamed nerve in his neck that is causing him discomfort in his front right leg. He is not able to put full pressure on that leg. Your last comment on this topic indicated that you were hoping to present additional information on laser therapy in the spring of 2016. Do you have any updates?

  23. skeptvet says:

    My presentation on cold laser can be found HERE. Unfortunately, it is still in the category of promising but unproven. There are few risks if done properly, so as long as it isn’t substituted for established treatments, I don’t think it is wrong to try, but we don’t yet know how much it will help and in what conditions.

    Good luck!

  24. art malernee dvm says:

    Vets, Cold Laser treatments is snake oil 2016.>>>

    thanks for the 2017 update skepvet. Another promising year goes by.

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