Page 189 - Veterinary Laser Therapy in Small Animal Practice

Implementation of laser therapy in practice 175

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Dose: most studies use a dose of 1–50 J/cm . Some distance from the skin is going to be very little or 0, it
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have proposed the use of low doses (0.5–2 J/cm ) to could be too much (especially in contact mode or with
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stimulate the acupoint, and higher ones (8–20 J/cm ) to prolonged treatment time).
sedate it, but this has not been proven, and some clini- Whatever device you have, decide the dose you want
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cal studies use 20 J/cm and more and still achieve stim- (e.g. 10 J/cm ), check the area of the tip (e.g. 0.5 cm ,
ulation. On the other hand, different doses/times of which makes a dose of 5 J/point), decide the power you
exposure can have different effects according to some can and want to work with (probably lower if the animal
studies. In He’s paper on needle laser acupuncture, [428] is very sensitive; imagine 100 mW) and work out the
red light from the needle had a physiological effect after treatment time this takes (5 J divided by 0.1 W is 50 s).
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20 min of stimulation (total of 300 J, 600 J/cm ) but not I usually work with 100–400 mW, at a distance of
after 10 or 30 min (both time and dose were different). 0–10 mm from the point, for 10–50 seconds/point, to
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Now note that when we deal with acupoints or laser give a dose of 2 J/cm (e.g. 100 mW for 10 s) to 20 J/cm
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acupuncture, the treatment area, our target point, or (e.g. 400 mW for 25 s).
the tip of the hand-piece/laser device can differ from 1
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cm . So, for instance, if the tip of your laser is 0.5 cm Acupoint selection
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and you apply a total of 4 J to a point, you would be using The selection of points to stimulate can be the same as
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8 J/cm . If the tip is 0.25 cm , you would be applying 16 with conventional acupuncture, and laser also offers
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J/cm . The World Association of Photobiomodulation you the possibility of stimulating some points that
Therapy recommends a minimum dose of 1–6 J/point because of their location are less commonly used, or
in its guidelines for class 3B lasers, [454, 455] which could very sensitive points that you feel the patient will not
mean a minimum of 2–12 J/cm . It makes sense to tolerate: you can combine needle stimulation of some
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use a lower dose for more superficial acupoints, and a points and laser for others.
higher one for deeper points. For instance, the points Even at the risk of disappointing you, TCVM offers no
Tai-Yang and SP-6 could be treated with 2–4 J/cm , cookbook of points, but these are some very commonly
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while for the deeper points such as Jian-jiao, BL-23, or used ones that have also been proven, in a scientific way,
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GB-21, I would use 10–20 J/cm . to have an effect. Please note: these points are usually
Power: the authors recommend using 0.1 to 0.5 W, stimulated in combination with others. The described
so 100–500 mW, although some studies achieve results effects are just examples, and their use is much broader.
with lower-powered devices, even 5 mW, but for a 5 I recommend Xie’s Veterinary Acupuncture [456] and
mW device it would take more than half an hour to Schoen’s Veterinary Acupuncture [457] if you want an
deliver 10 J. More power will reduce the treatment time acupuncture atlas (and more).
and increase the density of photons that penetrate to the
desired depth. Working at 0.2 W (200 mW) of average • LI-4 (He-gu): located in the forelimb, between the
power (remember the difference between average and second and third metacarpal bones, in the middle
peak power!), applying 2 J takes 10 seconds. Applying of the length of this space (Fig. 11.7). It is reached
10 J would take 50 seconds at that same power, but by from the dorsal surface toward the palmar, aiming
increasing it to 0.4 W the time would be cut in half. On at the third metacarpal. Very commonly used for
the other hand, a very low-powered device working at immune regulation, nasal discharge, and general
10 mW (0.01 W) would take more than 16 minutes to pain/inflammation – especially over the head and
produce 10 J. mouth.
Also, power density can affect the biochemical • PC-6 (Nei-guan): in the medial side of the forelimb
response to laser acupuncture. [429] When selecting how (Fig. 11.8). Find the distance from the transverse
high a power to use, consider very well the resulting carpal crease to the elbow, and the point is one
power density. Laser acupuncture is usually performed quarter of that distance from the carpus, over the
with tips or probes that are narrow and concentrate interosseous space, between the flexor carpi radialis
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the energy. If your tip is 0.5 cm (on the broad side of and the superficial digital flexor muscles. This point
tips for acupuncture), working at 1 W would give you has an anti-nausea, anti-vomiting effect, reduces
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2 W/cm of power density. Since the tip is not going to anxiety, and modulates cardiac rhythm, among
move during treatment (unlike scanning in LT) and the others.

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