A hot topic in veterinary medicine these days is cold laser therapy. I’ve been reviewing the theory and research evidence for this treatment regularly from my first review in 2010 to my most recent look at the evidence in 2016. Overall, my conclusions have largely remained the same:
Lasers have significant measurable effects on living tissues in laboratory experiments, so it is plausible that they might have clinical benefits. The extensive research done in humans, however, has so far only found limited evidence to support the use of lasers in a few conditions, and high-quality controlled studies often contradict the positive findings of initial, small and poorly controlled trials.
The experimental evidence in veterinary species is mixed and low quality, and there are no high-quality published clinical trials validating laser therapy for specific indications. It is possible that high-quality research may one day validate some of the claimed benefits for laser therapy. However, at present the best that can be said about this intervention is that it appears promising for some conditions, such as wounds and musculoskeletal pain.
The growing popularity of lasers is based largely on anecdotal evidence and economic factors. Laser units are being aggressively marketed to veterinarians, often using unsubstantiated claims of clinical benefits. Laser therapy represents a potential source of income for practitioners and, of course, for laser device manufacturers. It appears likely that this profit potential contributes to an enthusiasm for laser therapy not matched by the quality of scientific evidence for its benefits to patients.
Veterinary therapies often lack robust high-quality clinical trial evidence to support their use, and this is not itself a reason to avoid these therapies. However, when employing interventions that have not yet been rigorously demonstrated to be safe and effective, we have a duty to acknowledge the limitations of the evidence. Clients should be fully informed about the uncertainties concerning the effectiveness of laser therapy and the potential for unforeseen effects. Established therapies with stronger evidence identifying their risks and benefits should take precedence over promising but unproven therapies like laser treatment. And those interested in promoting low-level laser, particularly those marketing laser equipment and training, should proportion their claims to the available evidence and assume some responsibility for developing the evidence base further so that practitioners and animal owners can make better-informed decisions about this practice.
Today I came across a new study looking at the use of cold laser in dogs having back surgery for intervertebral disk disease (IVDD). I have previously reviewed two other studies of laser for this purpose, one of which appeared to show some benefit and the other showed no effect. The new study is very similar in terms of the small sample size and the methodology, though it is generally stronger than the other two in terms of mechanisms that control for various types of bias and error.
Bennaim M, Porato M, Jarleton A, et al. Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease. AJVR 2017;78(2):195-206.
Briefly, the study classified dogs with severe neurologic symptoms caused by IVDD into groups based on the level of dysfunction. All dogs had surgical and standard medical treatment. Some also had laser therapy, some had physical therapy and fake laser treatment, and some had only standard care and fake laser treatment. The time to reach various stages of functional recovery and the amount of post-surgical intravenous pain medication each dog required were measured and compared between the groups. There were no differences in any of these measures between any of the groups. This indicates that neither laser treatment nor physical therapy added to surgery appeared to have any benefits above standard care.
The authors list a number of reasons why this negative result might have occurred even if laser therapy does actually have some benefit. The most plausible of these was the small sample size. A very large improvement due to laser could be seen even when evaluating only a relatively small number of patients, as in this study. However, if laser has some benefit and it is fairly small, it might not be possible to detect it in such a small study. Of course, the most likely explanation for the failure to find any benefit is simply that there is none.
Overall, these three studies do not provide much encouragement for using laser in dogs with IVDD. Only one of the three appeared to show any benefits, and that study lacked most standard controls for bias. The negative findings of the other two studies, especially the current study, which was the strongest of the three in terms of methodology, strengthens the view that laser therapy is not helpful for dogs having surgery for IVDD.
Of course, it is always possible that different laser treatment (different doses, duration of treatment, equipment, etc.) could be helpful, or that laser is useful for other conditions. We can, as always, only make provisional conclusions based on existing and imperfect evidence. With the evidence we have now, however, it seems likely that laser will not be helpful for dogs with IVDD that are severely affected enough to need surgery.
Would love to hear your thoughts on this product since it’s supposedly coming from veterinary research (I’m not convinced):
https://calmz.com/pages/how-it-works-1
see
https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html?_r=1
Sad to say Knees and Backs are creating a group of doctors who want to do something other than their job practicing what has proven to work. When these non proven treatments started doctors at least talked wondered if the non proven treatments work. Now they produce a study that does not rule out the placebo effect and cry about the difficulty of producing the proof.
I’m on the fence with this article. Our dog has a spine issue and I feel like we see results on the same day she has treatments. My dog went from a paralyzed state to now walking almost normal in less than two months. So I will continue to get the laser therapy for my dog as long as I feel I see results. On a side note, a lot of the women at the vet hospital all tell us the same story. Many of them use the machine on themselves. At one point, a pregnant employee that couldn’t take meds had back issues and used it on herself. She said it was almost an immediate relief. I really feel these women are trust worthy.
Hmmm…I notice my dogs usually feel much better during and after pretty much any visit to the vet, even when nothing much is done. I chalk that up to adrenaline, since the dog is stressed by visiting the vet’s office. Also, their happiness to be home once we get back may mask discomfort. My dog has disc disease and when having an “attack” screams in pain if I move her slightly, yet the vet is able to manipulate her without a single yelp. You really need a serious long-term study with a large control group that tests lasers against a placebo. And so far I don’t see that anywhere.
Thanks for covering this topic, Skeptvet. It’s been suggested for my dog, but I hadn’t seen much about whether it’s useful or not.
Hi there!
I noticed your article said, “…however, it seems likely that laser will not be helpful for dogs with IVDD that are severely affected enough to need SURGERY.” Well what about dogs that have mild IVDD and aren’t surgery bound? In your opinion do you think laser treatments would be beneficial to dogs that aren’t recovering or will need surgery (any time soon)? I’m curious to know your thoughts.
Thank you for covering this topic!
Unfortunately, we have to wait until studies are done looking at this. The value of laser generally is still a very open question in veterinary medicine, and we know little about its use in specific conditions.
As a practicing small animal veterinarian, I witness the aggressive marketing of these ‘instruments’. These companies use paid lectors, spend huge sums at conferences, have reps visit practices pushing these products. All have one thing in common, their pitch begins with “make more money with laser”. Every single time this is their top pitch… make money. Without any supportive scientific study to show benefit, except to their pocket books. Laswer is a profit center, that is all.
I’m curious too about non surgically treated ivdd and success of laser therapy.
I am not aware of any studies using laser in dogs not also treated with surgery. Since there Is clear data that dogs with progressive neurologic symptoms have worse outcomes if not treated surgically, I doubt people would take the ethically questionable risk of trying laser instead of surgery in these dogs. And since dogs with only pain but with no neurologic effects almost always recover with current therapy (~ 80%), it would be hard to show that laser was helping these dogs without a study comparing dogs treated identical except for using or not using laser, and any benefit would be small since it could only increase the success rate from the baseline of 80%.
when the fda approved artificial intervertebral disc for humans i was excited because i thought finally there would be a good prospective randomized controlled trial or two showing long term results from a back surgery is better than no treatment using a good placebo surgery like they do for human clean out knee surgery and Parkinson brain surgery.. I went to read the study and the fda only made them show the artificial disc was as good as traditional back surgery. Surgery is a powerful placebo. The argument is that you do not need a good prospective randomized controlled placebo surgery trial for every surgery treatment. This belief , often called the parachute argument, that no such trial is needed to advise you ware a parachute jumping out of a plane. If someone has a growing lipoma next to a spinal cord and symptoms are in that spot i would use the parachute argument and remove it. If a doxie comes in with no deep pain in its back legs and your treatment is to remove some disk material in the spinal canal from one of the lumbar vertebrae that you see on mri i think its fair to question if that will do any good long term vs a placebo surgery. If people are willing to let doctors drill a fake surgical placebo hole in their head I bet enough of these doxie owners would allow a placebo surgical trial on their dog.
not everyone is on board requiring ‘sham surgery that harms” so that we can regulate surgery the same way the fda regulates drugs. If human and pet insurance is going to be cost effective medical care i think this is needed.
see
https://pubmed.ncbi.nlm.nih.gov/12357587/