Page 132 - Veterinary Laser Therapy in Small Animal Practice

118 Veterinary Laser Therapy in Small Animal Practice

Table 9.2 Examples of recommended parameters for chronic joint disorders.
Area Patient Dose (J/cm ) Power (W) Power density (W/cm )
2
2
Carpus, tarsus Cat, small dog 4–8 3–4 0.5–1
Elbow, stifle Mid-sized dog 6–12 5–8 1–2
Spine, hip Large dog 8–20 8–15 1.5–3

2
So there are well-established grounds for the use of dogs. Start treating hips with 8–10 J/cm , but if after a
LT in different forms of arthritis. But the question once couple of sessions there is no noticeable improvement,
again is, can these results somehow be transposed to increase the dose – up to 18–20 J/cm . Table 9.2 is just a
2
clinical cases? A large and growing number of clinical starting point for you to work with. In a cat or a smaller
trials in humans seem to answer “yes” to that question. dog, for instance, the initial dose for a carpus would be
2
4–6 J/cm , and only 3–4 W would be used.
• In women with OA of the hand, LT was able to Consider increasing power, especially for obese or
decrease pain and interphalangeal joint perimeter large patients. Since you will be working with higher
after five and seven twice weekly treatments, respec- settings and in contact, proper hand speed has to be
tively. In this study, adding three more treatments maintained to avoid thermal saturation (see section 9.1
did not bring a significant benefit, and the improve- “General treatment considerations”).
ment achieved was maintained for 8 weeks. [335] Patients with multiple affected joints are going to
• In other clinical trials, LT was able to decrease syn- need longer appointments; plan the time and place
ovial thickness of the knee (as measured by ultra- to perform it in a proper and comfortable way for
sound) in male patients with OA, [336] as well as pain everyone (Fig. 9.6). Whenever possible, treat every 48 h
and MMPs levels. [337] Actually most trials concern- or three times a week until you see a clinical response,
ing LT and OA refer to knee OA, and it has been and do not decrease the frequency of sessions until
proposed that LT should be included in standard then. Explain to owners that they may have to come
conservative care, since the clinical improvement quite often for the first 2–3 weeks, but if after 2 weeks
can delay the need for surgical intervention. [338] of intensive treatment you see no improvement, recon-
• Adding LT to stretching exercises for people with sider your diagnosis and treatment (see section 9.7,
ankylosing spondylitis can improve pain and func- “How to improve results”).
tion scores. [339]
• In temporomandibular OA and pain, LT improves 9.6 How to assess clinical progression
pain and function – even more than ibuprofen
according to one study. [340] Part of improving results is assessing your patients and
• A review of the use of LT to treat rheumatoid keeping good track of clinical changes and treatment
arthritis concluded that treated patients experience
reduced pain and stiffness and improved joint flex-
ibility. [341]

To the authors’ knowledge, there are still no pub-
lished clinical trials on the use of LT to treat arthritis
in dogs or cats, but without a doubt this is among the
top five uses of the therapy in small animal practice, so
hopefully some will come to light sooner rather than
later.
While acute arthritis may respond to lower power
and doses, chronic forms often need 10–15 J/cm ,
2
2
10–15 W, and 2–3 W/cm , especially to treat deeper
tissues, for example in spondylosis or the hips in large Figure 9.6 Multiple joint treatment in an elderly patient.

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