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:
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
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:
Chronic Inflammatory Bowel Disease (CIBD)
Feline Skin-Spinal Reflex, Feline Neurodermatitis, Endocrine Alopecia, Milliary Eczema
Kidney Disease, FUS, FLUTD
Canine Hip Dysplasia Syndrome
Canine Idiopathic Epilepsy
Chronic Inflammatory Bowel Disease
Canine Wobbler’s Disease
Progressive Degenerative Myelopathy
Arthritis, (General or Focal) Sore Back etc.
Bleeder (exercise induced naso-pharyngeal hemorrhage) Elevated Blood Pressure
Bronchitis, Bronchopneumonia, Pneumonitis
Bruising, Subcutaneous Hemorrhage, Wound Reorganization
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
Heart and Heart Related Conditions
Focal or General Inflammation
Lack of Focus in Training
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.
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