Welcome back for the second part of this two-part series exploring how laser therapy, also known as photobiomodulation (PBM), can be used for pain relief and healing after surgery. Click here to read part one.
In this section, we will dive deeper into how laser therapy can be beneficial for post-operative pain relief, incisional healing, wound healing, and post-procedure recovery.
Post-Operative Pain Relief
PBM has been shown in studies to be highly effective in reducing patient pain and enhancing recovery when added to a multimodal post-operative pain control protocol. This drug-free pain control option may reduce the need for rescue analgesia medications and can encourage an earlier return to eating after surgery and anesthesia.
A recent study by Alves et al.1 looked at post-operative pain control with PBM in a working dog population undergoing elective gastropexy. The dogs were randomly divided into a control group and a PBM treatment group (PBMT), with all dogs receiving standard peri-operative pain medications. An incisional gastropexy was performed in all animals, with the PBMT group receiving a single on-contact deep tissue abdominal treatment immediately after surgery, dosed at 8.6 J/cm2. The researcher scoring the dogs was blinded as to which patients were in the control group and which were in the PBMT group. Patients were evaluated on the need for post-operative rescue analgesia, whether the animal had eaten by the evaluation moment, and their pain level was examined using the Glasgow Composite Measure Pain Scale – Short Form at nine different time points from 1-24 hours post-extubation. They found that no rescue analgesia was needed for either group and that medical pain control protocols were effective. However, the PBMT group had better pain scores between 1-4 hours post-extubation and had a higher proportion of patients who ate when food was offered up to eight hours post-extubation. These findings support decreased pain and increased comfort occurring almost immediately after laser treatment for the PBMT group after a single post-operative treatment.
Laser Therapy for Incision Healing
Almost any incision can benefit from improved healing and improved cosmetic appearance. Routine surgical incisions can receive a single, short treatment, applied off-contact, while the patient is being monitored before extubation. When applied directly over and around a surgical incision, PBM reduces local inflammation and pain and encourages tissue healing along with hair regrowth. This treatment is easily added into post-operative recovery protocols, with post-operative incision treatments applied off-contact, treating over the incision and several inches of healthy tissue margin around the incision at a dose of 4-5 J/cm2. Clinics using post-operative incision treatments have reported seeing a visible difference between those patients treated with laser therapy after surgery versus those not treated. Overall, patient comfort is improved, and pet owners appreciate the faster return to a normal appearance after surgery.
In evaluating whether PBM influences surgical incision healing, Wardlaw et al.2 looked at incision healing in Dachshunds after hemilaminectomy surgery. Researchers monitored the normal healing process of three dogs after hemilaminectomy surgery using digital pictures taken at specific time points after surgery to establish a baseline scale for routine incision healing. Nine additional dogs were randomly divided into a laser treatment group and a control group. The laser treatment group was treated daily for seven days at a dose of 8 J/cm2, with both groups having digital pictures taken at the same time after surgery as the scale group. Those resulting pictures were arranged randomly, and the incisions were scored by blinded clinicians using the baseline scale pictures for consistency of incision scoring. The results showed the laser treatment group had an increased scar scale with improved cosmetic healing by day seven and showed significant differences again at day 21. Laser therapy accelerated the healing of these incisions and improved the appearance of the incisions while they were healing.
Laser Therapy for Wound Healing
When treating wounds where surgical closure is not an ideal or a viable option, PBM treatments are of great benefit to increase patient comfort while improving and accelerating wound healing. Laser therapy and its benefits in wound healing are well documented, with healing accelerated through increased activity of fibroblasts, neovascularization, and collagen synthesis. Increased elastic fibers in the wound result in reduced scar tissue formation and better patient comfort and movement after the wound is fully healed. Epithelial growth is encouraged, and PBM may also enhance macrophage functions along with modulating the immune response in an infected wound.
Wound treatments using PBM can be performed daily along with standard medical care, decreasing the laser treatment frequency as the wound heals. Laser treatment is dosed at 2-5 J/cm2 and is performed off-contact to avoid any contamination of the wound or of the treatment head. The area of treatment should include the wound along with several inches of healthy tissue surrounding the wound. When treating over any compromised tissue, more of the treatment is focused on the surrounding healthy tissue to help establish better blood flow to the area. PBM is performed after the wound has been cleaned and prior to any topical medications or bandaging, as light will not penetrate through bandages.
PBM in Post-Procedure Recovery
Adding PBM into post-operative pain management and healing protocols is beneficial to both patients and the veterinary team. PBM contributes to pain relief without additional medications and without any side effects. The reduced inflammation and edema, along with accelerated healing, can increase patient comfort rapidly. This may decrease the length of a hospital stay due to less need for any medication-based rescue analgesia, and a quicker return to eating.
The treatments are quick, stress-free, and are a non-invasive treatment performed while the patient is recovering from anesthesia, which allows it to easily fit into the existing clinic workflow. A faster return to eating after surgery counteracts any post-operative ileus and provides better nutrition for recovery and healing. Pet owners are reassured by drug-free and high-tech care along with an increased peace of mind that their beloved pet’s comfort is prioritized, leading to fewer owner concerns after surgery with a better cosmetic appearance of the incision.
References
1Alves, J., Filipe, A. & Santos, A. Post-surgical photobiomodulation therapy improves outcomes following elective gastropexy in dogs. Lasers Med Sci 39, 211 (2024).
2Wardlaw JL, Gazzola KM, Wagoner A, Brinkman E, Burt J, Butler R, Gunter JM and Senter LH (2019) Laser Therapy for Incision Healing in 9 Dogs. Front. Vet. Sci. 5:349.