To this day, “How frequently should we treat?” remains one of the common questions from operators in the field. This is an important facet of laser therapy, as the operator can induce a quicker response as well as a more sustained response long term when being flexible in treatment session frequency. Laser therapy provides the leeway for the operator to be creative and responsive to a patient’s “glide path” of response to the modality as we initiate laser therapy.
In the past, the “3-2-1″ protocol was a popular treatment approach. In this scenario, the patient would receive three treatments the first week, two the next week, and a single treatment on the third week. Although this is not an ineffective protocol per se, we have since come to see the value in treating patients with a more individualized approach to the frequency of treatment.
If a patient is in pain, we need to address that pain and treat for it. Thus, a daily treatment schedule is recommended here. However, when a patient remains in intractable pain despite standard of care, such as FLUTD cats / pancreatitis / severe degloving injuries / snake bites, a more frequent approach may be indicated. For these patients, it may be advantageous to treat twice or even three times daily. These patients are usually hospitalized, so the opportunity is there for the patient to receive treatment as often as needed in a non-invasive manner. Here, we will provide an overview of some of the common approaches in choosing a treatment frequency. Specific approaches to acute conditions and chronic conditions will be discussed separately.
Once we have attained a significant clinical improvement, it is at that time that we should consider reducing the frequency of treatments. Depending on the specifics of the case and our goals, the patient will undergo either a short course of treatments or continued long term treatment phases. When we have an acute condition such as a laceration or hot spot, our goal is resolution, and a short course is recommended. In this instance, we expect complete resolution. However, when dealing with an incurable condition such as arthritis, our goal is to prevent an active decline while minimizing debilitating symptoms and inducing significant clinical improvement. In this instance, we will begin with an induction phase of frequent treatments until a peak plateau effect is noted. Once we have attained this, we can initiate a less frequent transition phase of treatments. As long as the patient continues to thrive, we can continue to taper this treatment frequency to a long term maintenance phase. These long term maintenance treatments may need to be done as frequently as weekly, or may only be needed every few months. The timeframe of these treatments is individual to the case and the laser operator will need to be flexible, observant, and realistic, as we often see our patients suffering from arthritis having a harder time seasonally (some may be worse in summer vs. winter months).
The client needs to understand our approach with treatment frequency and be open to our setting realistic goals as well. Because therapy laser treatments have a cumulative effect, we can continue to move treatment sessions further apart into a maintenance phase as long as the patient does not have any setbacks. The plan is only the plan – it is crucial for the client to understand that if there is a setback prior to the next scheduled treatment, they need to return as soon as possible to address any decline. Depending on the individual patient, some may be prone to overdoing it due to the fact that we are accelerating their healing while minimizing pain.
It is important to remember that the laser is best applied as an adjunct to standard of care, it is not meant to be a replacement for NSAID, opioid, etc. as per the case specifics, but works best as part of a multimodal approach for pain management. The adept laser operator will be able to design and deliver an optimal treatment frequency as per the patient’s presentation and ensuing glide path of response to laser therapy. Laser therapy as a modality offers the operator the leeway to be flexible in treatment frequency, and this is useful as no two patients are exactly the same in their presentation and physical ability to respond to laser therapy. For example, a young and otherwise healthy patient is expected to have a quicker and more pronounced response than a geriatric patient with a chronic condition and concomitant disease. The young adult field trial dog with a laceration needs to be approached differently than the geriatric Cushingoid patient dealing with arthritis. The addition of laser therapy will enable a quicker return to function while minimizing pain or discomfort during the convalescence period.
As we continue to treat an increasingly wide variety of species and conditions, it is clear that we must be flexible in our approach so as to best address the individual needs of each case.