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Wednesday, 3 June 2020

Veterinary Laser Therapy

Laser Therapy for Beginners
Companion Animal Health®
Photobiomodulation Therapy (PBM)
You may have heard the terms “Cold Laser” or “Low-Level Laser Therapy (LLLT)” before. In general, such terms refer to “treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat.”Many of the terms used to commonly describe this process do not ideally reflect the mechanisms of action involved. They also don’t adequately distinguish this type of therapy from the other laser-based thera- pies that rely on heating tissue to achieve an effect. This lack of clarity has led to significant confusion and a need for better nomenclature.
In September 2014, the North American Association for Light Therapy (NAALT) and the World Association for Laser Therapy (WALT) convened to discuss this issue, and as a result of their efforts, the term “Photobiomodulation Therapy” was added to the MeSH database. This term more accurately reflects the process and better distinguishes it “from the popular use of light- based devices for simple heating of tissues...or other applications of light energy that rely on thermal effects for all or part of their mechanism of action.”2
professional and collegiate athletics? LightForce Therapy Lasers (the human
counterpart to Companion) are utilized by over 100 professional and collegiate tea
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What is Photobiomodulation Therapy?
drives cellular metabolism. As light is absorbed, cytochrome
c is stimulated, leading to increased production of ad- enosine triphosphate (ATP), the molecule that facilitates energy transfer within the cell. In ad- dition to ATP, laser stimulation also produces free nitric oxide and reactive oxygen species. Nitric oxide is a powerful vaso- dilator and an important cellular signaling molecule involved

in many physiological pro- cesses. Reactive oxygen spe- cies have been shown to affect many important physiological signaling pathways including the inflammatory response.
In concert, the production of these signaling molecules has been shown to induce growth factor production, to increase cell proliferation and motility, and to promote extracellular matrix deposition and pro- survival pathways. Outside the cell, nitric oxide signaling drives vasodilation which improves microcirculation in the damaged tissue, delivering oxygen, vital sugars, proteins, and salts while removing wastes.
Watch this short animation to see how laser therapy targets damaged areas located deep within tissue to accelerate healing on a cellular level.
Photobiomodulation therapy is defined as a form of light therapy that utilizes non-ion- izing light sources, including lasers, light emitting diodes, and/or broadband light, in the visible (400 – 700 nm) and near-infrared (700 – 1100 nm) electromagnetic spectrum.
It is a nonthermal process in- volving endogenous chromo- phores eliciting photophysi- cal (i.e., linear and nonlinear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes includ- ing but not limited to the al- leviation of pain or inflamma- tion, immunomodulation, and promotion of wound healing and tissue regeneration.1
The term photobiomodula- tion (PBM) therapy is now being used by researchers and practitioners instead of terms such as low level laser
therapy (LLLT), cold laser, or laser therapy.2
The fundamental principles that underpin photobio- modulation (PBM) therapy, as currently understood in the scientific literature, are relatively straightforward. There is consensus that the application of a therapeutic dose of light to impaired or dysfunctional tissue leads to a cellular response mediated by mitochondrial mecha- nisms that reduce pain and inflammation and speed healing.3
The primary target (chro- mophore) for the process is the cytochrome c complex which is found in the inner membrane of the cell mi- tochondria. Cytochrome c
is a vital component of the electron transport chain that
1. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy. Photomedicine and Laser Surgery. 2015; 33(4): 183-184. 2. Frydrych. The Evolution of Photobiomodulation link
3. Karu TI. Low power laser therapy. In: Vo-Dinh T, editor. Biomedical Photonics Handbook. Boca Raton (FL) CRC Press; 2003: 48-1-48-25.
4. Hamblin MR, Demidova TN. Mechanisms of low level light therapy. Proc. of SPIE. 2006; 6140: 612001-1-12.
See Photobiomodulation in Action
Protocols for use
Appropriate dose selection is critical to the safety and effectiveness of photobio- modulation therapy. To get clinical results, sufficient light must reach
the target tissue. There are various parameters to consider when calculating dose, including power density or irradiance, treatment time, wavelength, pulsing, and application technique.6
The therapeutic dose is measured in joules (J) delivered per square inch of surface area.Much of the research conducted in the field has involved cell or small animal studies in which low power and small beam size were sufficient to treat the cells or muscles.
A recent study published by Anders, et al., reported the successful trans- lation of in vitro results obtained in the petri dish by using those parameters to treat surgically repaired peripheral nerves in vivo.The researchers found an optimal dose for nerve repair in vitro to be 97.5 percent less than that required when delivered on the surface
FDA approved the first Class 4 laser (greater than 0.5 watts) for the relief
of minor muscle and joint pain. The higher powered lasers make it possible to not only apply the benefits of photobiomodulation superficially, but also to treat a greatly expanded range of conditions by delivering a clinically effective dose to target areas below the skin (e.g., hamstring muscles), and in a shorter period of time.
Optimal wavelength
For light to produce beneficial thera- peutic outcomes, it must be delivered at an appropriate wavelength and of sufficient intensity to the target tissue. One range of wavelengths has been referred to as the “optical window” for photobiomodulation therapy, where there is minimal absorption from different substances (e.g., water, hemoglobin, and melanin).
The current understanding is that light in the visible range (600 to 800 nanometers) is absorbed more by hemoglobin and melanin, so these visible wavelengths are better suited for superficial areas. To effectively treat deeper musculoskeletal conditions,
evidence is needed.
When the laser is used in gated

mode, it is cycling its CW power on and off and consequently delivering a lower average output power. In general, the use of pulsing decreases light delivered to the target. On the other hand, in instances where there is a concern about heating tissue, such as in treatment of the brain, pulsing can be used to further control the output power of the laser. In a recent paper that looked at human cadaver brain tissue, there were no differences observed in light penetration between pulsed and CW laser light.11
Implementation and application
As with any complicated technology, even if you don’t understand exactly how it works, you should have a basic grasp of the mechanisms involved. If you are using a laser that has prepro- grammed protocols, understand the differences between treatments when your patient’s skin color is light or dark, or their body size is small or large. For example, if the laser has a mix of 980 and 810 nanometer light for treatment of light skin, it may switch to only 980 nanometer light to treat dark skin. 

TOP 10 Uses
Laser therapy reduces inflammation with vasodilation, activation of the lymphatic drainage system, and reduction of pro-inflammatory mediators. As a result, inflammation, erythema, bruising, and edema are reduced.
Analgesic Effect
Laser therapy of diseased and damaged tissue produces a suppression of hypersensitive nociceptors, normalization of the membrane firing threshold, and an increased release of tissue endorphins. The result is a decreased patient perception of pain.
Accelerated Tissue Repair and Cell Growth
Photons of light from lasers penetrate deeply into tissue and accelerate cellular reproduction and growth. Laser light increases the energy available to the cells so that they can take on nutrients and get rid of waste products more quickly.
Improved Vascular Activity
Laser light significantly increases the formation of new capillaries in damaged tissue. This speeds the healing process, resulting in more rapid wound closure.
Increased Metabolic Activity
Laser therapy of diseased and damaged tissue produces a suppression of hypersensitive nociceptors, normalization of the membrane firing threshold, and an increased release of tissue endorphins. The result is a decreased patient perception of pain.
Trigger Points and Acupuncture Points
Laser therapy stimulates muscle trigger and acupuncture points without mechanical invasion to pro- vide musculoskeletal pain relief.
Reduced Fibrous Tissue Formation
Laser therapy reduces the formation of scar tissue.
Improved Nerve Function
Slow recovery of nerve functions in damaged tissue may result in numbness and impaired limbs. La- ser therapy accelerates nerve cell regeneration.
Therapy laser photons have an effect on the immune system’s status through stimulation of immuno- globins, neutrophils, and lymphocytes.
Faster Wound Healing
Laser light stimulates fibroblast development. Fibroblasts produce collagen, which is predominant in wound healing in damaged tissue. Collagen is the essential protein required to replace old tissue or to repair tissue injuries. As a result, laser therapy is effective on open wounds and burns.
Biological Effects of Laser Therapy
There are many different types veterinary la- ser therapy devices. Class IV, Class IIIB, Class III, and even Class II lasers may be used for therapy. One parameter that separates these lasers from one another is its available power. What role does power play in achieving clinical results for pet pain?
Power impacts the functional depth of pen- etration of the laser light. The combination
of treatment time and power determines the therapeutic dose of energy that is received
by tissues at depth. If a therapy laser has low power, the total number of Joules it can deliver to relevant depths for treating most musculo- skeletal conditions in a realistic treatment time is very low.

For example, to treat the lumbar spine for arthritis on a large dog with a treatment area of 300 cm2, since it is a deep condition, an effective target dose of 10 Joules/cmis 3,000 Joules (300cmx 10 J/cm= 3,000 J). Below is an example of how long it would take to deliver 3,000 J of therapeutic energy with 4 different lasers of varying power capabilities:
• 5mW Laser = 10,000 minutes (166.7 hours)• 500mW Laser = 100 minutes (1 hour 40 min.) • 3W Laser = 16.7 minutes• 10W Laser = 5 minutes
Therefore, treating with a low-powered laser will deliver less than the identified therapeutic dose of 3,000 Joules simply because the treat- ment time is unrealistic. Companion Therapy lasers enable you to deliver power from 500mW up to 15 Watts giving you the flexibility you need to give every condition the appropriate therapeutic dose. Understand the difference between class IV laser therapy and other therapy devices before you invest.

What Role Does Power Play in Dosing?
What is Your Time Worth?
Your time is valuable – and providing your patients with the best care in the most efficient amount of time is a priority. Class IV therapy lasers are a great resource to maximize your staff’s efficiency in treating your patients.
Class IV laser therapy enables you to deliver a therapeutic dose of Joules (J) to a larger area of target tissue in a shorter period of time: ultimately resulting in positive, consistent, clinical results. Higher power and the op- tion to deliver treatment in continuous wave give the clinician the flexibil- ity to deliver the therapeutic dose of energy in less time than with other lower-powered devices. This technology is very effective at reducing pet pain and speed healing.
Class IV laser therapy is often able to provide pain relief to pets suffering from a variety of conditions such as arthritis and otitis. Flexibility of treat- ment delivery gives the clinician the power to deliver therapy in either contact or non-contact mode to maximize results based on the presenting condition.
Provide your patients with a quick, medication-free solution to their pain while maximizing staff efficiency in the clinic with a Companion therapy laser.
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What Can Laser Therapy Treat?
Common Acute Conditons That Benefit from Laser Therapy
Common Chronic Conditons That Benefit from Laser Therapy
Laser Therapy: A Powerful Adjunct
Due to the drug-free, non-invasive nature of laser therapy it is often used as a powerful adjunct to existing treatment protocols. It can be used before, during, or after surgical procedures, alongside pharmacological management of certain conditions, and in conjunction with rehabilitation programs. Since laser therapy has a broad spectrum of physiological effects, mainly surrounding the reduction of pain and inflammation and increasing the speed of healing, it is a versatile tool as part of a multi- modal approach to treating MANY common conditions in veterinary medicine.
  • Arthritis
  • Bursitis
  • Chronic Pain
  • Degenerative Joint Disease
  • Feline Asthma
  • Geriatric Disorders
  • Gout
  • IVDD
• • • • • • • • • •
Acral Lick Dermatitis Acute Nephritis Acute Pain
Bacterial Infections Burns
Fungal Infections Mastitis

  • Neurological Disorders
  • Orthopedic Disorders
  • Otitis
  • Pyoderma
  • Respiratory Disorders
  • Stomatitis
  • Urinary Tract Disorders
  • And More...
• Otitis• Post Surgical Pain Relief • Post-Operative Healing • Pyotraumatic Dermatitis • Skin Grafts• Snake Bites• Soft Tissue Trauma• Sprains & Strains• And More...

Why Choose Companion®?
The Company
Whether you are considering adding laser therapy, regenerative medicine, or another Companion rehabilitation product - Companion allows you to practice reliable, innovative medicine.
You can elevate your standard of care with con- fidence. Keep a finger on the pulse of the most innovative therapeutic solutions with Compan- ion.
You don’t just purchase a product with Companion - you gain a clinical and business partner. Leverage the Companion CORE business consulting program to realize success with any Companion Product.
Never be left behind - Companion provides you with the most current research and applications through a multi-channel education program.
Effectively treat a wide variety of clinical conditions with a Companion product.
Realize synergy by leveraging multiple Companion products to achieve the best clinical outcomes for every patient. Every time.
The Therapy Lasers
Backed by scientific evidence and on-going research you can achieve the best results with a Companion Therapy Laser. On-going software updates ensure you are always practicing the most current medicine.
Achieve results on acute and chronic conditions alike. Treat with ease with the most species- specific protocols available on any therapy laser on the market.
Clinical Support
Veterinarians are on staff and available to an- swer your clinical questions. Receive on-going clinical training with monthly webinars and other Companion University educational op- portunities.
Realize ROI with the Companion CORE imple- mentation program. The program includes one-on-one consulting.
Attend live events or monthly webinars for the latest applications.
Customer Support
Never spend a day without your most versatile tool. Customer support and a loaner program ensures you are always up-and-running.

For more information about how a therapy laser can transform your clinic call 087 2503629 to set up your in-office demonstration.