The following was a question & answer on the Spectravet Laser Discussion Group, that I requested to be allowed to use on FourLeg. Thank you to Peter Jenkins (again!) for this fabulous answer!
Question: How long should I wait to laser following a local cortisone injection?
There's a commonly-held belief that laser therapy should not be used in conjunction with, or applied at the same time as, corticosteroid injection, ingestion or topical application.
However, to my knowledge, there have been no studies specifically performed investigate the effects – detrimental or otherwise – of laser on tissues treated with corticosteroids, nor to determine a withholding or washout period.
Some studies (e.g. Gál, 2009; Lacjaková et al, 2010) have shown that laser therapy does not improve wound healing in animals treated with steroids, whilst another (Marchionni et al, 2010) found that it does; the answer to these contradictory observations is likely in the specific parameters – wavelength, power, intensity, dose, time, etc. – of the laser devices used in the various studies.
However, even those studies in which laser did not accelerate wound healing in steroid-treated animals, it was found that other factors, such as edema, inflammation and pain, were beneficially affected by laser.
Other work has demonstrated the safety and potential benefit of combining laser therapy with corticosteroids.
For example, Konstantinovic et al (1997) investigated the use of laser therapy combined with local infiltration of corticosteroids in the treatment of radial-humeral epicondylitis, and found that, on day seven of treatment, the combined therapy demonstrated a significantly higher analgesic effect than either therapy alone.
Yamada et al (1995) looked at the clinical effects of laser therapy and corticosteroid therapy in the treatment of facial palsy, comparing both interventions alone and in combination. Those patients who had received laser therapy showed a very similar overall recovery from the palsy when compared to those treated with corticosteroid, however those patients who had received the combination therapy showed the best recovery in the shortest period. Importantly, no clinically significant adverse effects resulted from using laser in combination with the corticosteroid.
In oral//dental medicine, Markovic & Todorovic (2007) found that laser irradiation after lower third molar surgery minimizes swelling, and that "the effect is enhanced by simultaneous local intramuscular use of dexamethasone", and Aboushelib & Elsafi (2016) determined that "active lichen planus should be managed with oral corticosteroids and soft tissue laser irradiation before insertion of dental implants.".
de Souza et al (2018) analyzed the effect of laser photobiomodulation and dexamethasone (Dex), alone and in combination, on nerve regeneration in a sciatic nerve crushing model, with results evaluated using the Sciatic Functional Index (SFI) and Sciatic Static Index (SSI), finding that the group treated with laser alone obtained better results when compared to the other groups for the SSF, and that the group treated with laser+Dex obtained better results for the SSI in the intergroup comparison. These results indicate that the application of both laser and dexamethasone is effective in the regeneration and early functional recovery of the sciatic nerve of mice, and was more effective when laser was combined with dexamethasone.
Peter A Jenkins
Peter A. Jenkins, MBA, began his exciting and ongoing adventure in the world of laser therapy & photobiomodulation in Australia in 1996. His technical background includes the specification and development of laser devices for safety, reliability, affordability and efficacy, and he is driven to create technologies that enable practitioners to optimize their patients’ clinical outcomes. A passionate educator, and co-author of a number of peer-reviewed articles, Peter sees market education as the key to improving standards in the laser therapy/photobiomodulation industry and holding manufacturers and marketers accountable for the claims they make.
•Spectra-Medics Pty Ltd (Founder, Managing Director)
•SpectraVET, Inc. (Co-Founder, Dir. Education & Technology)
•Immunophotonics, Inc. (Co-Founder, Technology Advisor)
•Co-Founder & Council Member, Australian Medical Laser Association Inc
•Co-Founder, Co-Editor, The Annals of Laser Therapy Research
•Committee Member, Standards Australia HE3-12/003 (Medical Laser Safety)
•Peer Reviewer, Photomedicine & Laser Surgery
•Peer Reviewer, Lasers in Surgery & Medicine
•Peer Reviewer, Photochemistry & Photobiology
•Peer Reviewer, Dose-Response
•Past President (1998-9), Hornsby and District Chamber of Commerce & Industry Inc
•Master of Business Administration (University of Western Sydney) 1997
•Avionics Technician (Royal Australian Air Force) 1992
•Instrument Fitter (Royal Australian Air Force) 1984