September is pet pain management awareness month — so I feel the need to discuss arthritis and how it is important to diagnose and manage chronic pain.
It’s Not “Just Arthritis”
Arthritis is typically thought to be a disease of old dogs but it is currently thought that up to 35% of dogs of all ages and 80% of dogs over the age of eight suffer from effects of the disease.
Arthritis means “inflammation of the joint” but the disease is much more complex than the definition implies. If left unmanaged it can cause complete failure of the joint. Additionally throughout the degenerative process the nerve receptors in the joint and surrounding tissues are sending pain messages to the brain. As the inflammatory process continues these receptors increase in number and send more pain messages to the brain. If this process is left unchecked a complex pain syndrome called wind up will develop. When this occurs the brain becomes increasingly aware of the pain messages sent and amplifies the messages. This can cause pain to be caused by stimuli that would not normally cause pain (like touching another area of the body). This process is very difficult to interrupt and in turn makes pain management more difficult.
There are numerous ways to support a pet who suffers from arthritis. I will list some out below. The best resource for questions regarding your pet is your veterinarian. If you are worried your pet maybe painful I would encourage you to make an appointment with your regular veterinarian to discussed diagnostic and treatment options.
Weight Loss
This is probably the single most important part of helping maintain a pets comfort but is also the recommendation I get the most push back on. Preventing obesity is much easier than treating it, especially if the obesity is diagnosed when arthritis is being diagnosed. Prevention is best! A really good resource for body condition scoring is the Body Composition Score chart from WSAVA (World Small Animal Veterinary Association).
Joint Supplements
There are many supplements that can be found for any number of ailments. Since there is no federal oversight taking recommendations from your veterinarian is best. Adequan and Flexidin Advanced with UC-II are two of my favorites.
Non-Steroidal Anti-Inflammatories
These medications are a corner stone in the treatment of pain (acute or chronic) that is associated with inflammation. There are several types of these medications allowing for a custom treatment plan for each patient. They all have pro’s and con’s so discussing response to treatment and side effects with your veterinarian are important. When on these medications long term it is ideal to monitor lab work to be sure that the medication is being tolerated well.
Adjunctive Pain Management Medication
These medications have been used but information is still lacking when it comes to when to add these medication and how much benefit they offer. Gabapentin, Amantadine, and Ketamine are a few medications you may come across.
Kiba is a 14 year old mixed breed dog who is currently being treated for elbow arthritis, hypothyroidism, chronic pancreatitis, and heart disease. She is seen here sleeping on her Big Barker Bed
Localized Treatment
Intrarticular injections are hugely helpful and there are so many to choose from depending on the patient needs. Steroids and hyaluronic acid, platelet rich plasma, poyacrylaide hydrogel, and low level radiation have all been successively used in a variety of cases to improve pain management. The really nice benefit of this treatment is that it is placed directly into the painful joint and the effects are local so we worry less about side effect like oral medications. As with all other therapies they all have pros and cons and selecting the right injection will be based on the diagnosis and other patient specific factors. These types of treatments are generally offered at speciality practices like surgical centers or rehabilitation centers.
Monoclonal Antibody Therapy
This is a long anticipated therapy in the USA. We have had the feline equivalent for approximately one year and the results are amazing. This product has recently been approved in the USA for the canine patient and should be available this fall. This injection is given under the skin once monthly and is specifically for pain related to osteoarthritis.
Non-Pharmaceutical Therapies
Acupuncture, photobiomodulation, shockwave, and pulsed electromagnetic therapy are all amazing modalities that can be used to treat pain. Additionally it is important to be sure your pet has a supportive bed to sleep on. The only orthopedic dog bed that has research to support that it is helpful and has a 10 year guarantee is the Big Barker bed.
As you can see “just arthritis” is very complex and can be challenging to manage. It is important that when treatments are started objective measures are use to determine if the treatments offered are working. There are several outcome measures that can be used. The Canine Brief Pain Inventory, Canine Osteoarthritis Staging Tool, and Liverpool Osteoarthritis in Dogs are all great tools to use. Ideally we would use one of the above tools to score the dog prior to starting a new therapy and after a period of time when we expect to see results.
Since even young dogs can suffer from arthritis regular check up’s and analysis of your pets gait is critical.
