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I see it all the time. it might be a yellow Lab cursed with crunchy, stiff elbows; a Rottweiler with knees that refuse to bend; or a German Shepherd who circles forever before daring to lie down. Degenerative arthritis in our canine companions is a common, debilitating and frustrating problem, especially for older dogs. Though some dog owners opt for surgical solutions like joint replacement, others think twice about the merits of major surgery, particularly in the later stages of a dog’s life. Thus the questions: Are there alternative ways to effectively manage my dog’s pain? Can I restore quality of life and, given these tough economic times, not break the bank? My colleague at Boston’s Angell Animal Medical Center, Lisa Moses, VMD, DACVIM, CVMA, heads up the center’s specialty Pain Medicine Service, and I turned to her for insights, which she generously provided.
“We almost always use a multimodal approach, combining different techniques and/or types of drugs to target the different ways in which pain is produced. It’s not about adding more and more, it’s about treatments complementing and enhancing one another.”
Like me, the first thing Dr. Moses focuses on is weight. Studies have shown that an 11 to 18 percent reduction in body weight significantly decreases the severity of hind-limb lameness. It’s not easy, but weight loss has huge potential to reduce arthritis-associated pain. When recommending supplements, Dr. Moses is a fan of the omega-3 (n-3) fatty acids. “You need to make sure you get the right dose for your dog. Check with your vet, use a dog-specific preparation and choose a supplement that separates the fatty acid from vitamin D,” she cautions. Then there are glucosamine and chondroitin sulphate.
In broad terms, these compounds are thought to target some of the destructive enzymes that cause arthritic pain. Dr. Moses uses an injectable supplement, Adequan (polysulfated glycosaminoglycan), but remains cautious about all the unregulated products for oral administration, regardless of how much anecdotal success they claim. “Sometimes we are so desperate to help our best friends that we’re willing to believe anything will work. We’re the ones susceptible to the placebo effect, not our dogs,” she says.
Non-steroidal anti-inf lammatory drugs (NSAIDs) are the mainstays of pain management, especially for canine arthritis. According to Dr. Moses, “Regardless of what you read on the Internet, NSAIDs such as Rimadyl, Metacam and Deramaxx remain the best class of drugs. We know the risks, we know how to monitor our patients and we know how to minimize side effects.”
Both Dr. Moses and I strive to use the smallest effective dose to restore function. As she notes, “Clearly, in older dogs, use of NSAIDs depends on kidney and liver function, but [all things being equal] I often use them in conjunction with other drugs.”
Amitriptyline, amantadine and gabapentin may also enhance pain relief in combination with other analgesics. Every dog’s pain is individual and needs to be addressed as such.
It’s not all about drugs, however. Acupuncture, another useful modality, has no side effects, though, as Dr. Moses says, it’s important for owners to understand that the response to acupuncture is not as immediate as the response to drugs: “It’s a cumulative change in the way pain is signaling.” Typically, Dr. Moses (who is also certified in veterinary medical acupuncture) treats dogs weekly for up to two months. “Very few cases show no improvement on acupuncture, though some owners feel the improvement is insufficient.”
Physical therapy is another option. Dr. Moses advocates aquatherapy, provided by a trained physical therapist in a controlled environment and heated water, with the dog wearing a floatation device. I agree; letting your arthritic Labrador dive into the local pond on the weekend doesn’t have the same effect. The goal of aquatherapy is to carefully build muscle strength and boost a dog’s quality of life, not pound away on sore joints while chasing ducks or tripping over rocks.
Then there’s transcutaneous electrical nerve stimulation and laser therapy. When I asked her if she was sold on these, she replied that the jury’s still out. “I think these treatments hold promise, but as far as I know, there’s no peer-reviewed evidence that proves they’re effective.”
The proverbial bottom line? It takes time to make changes in the nervous system. The owner has to have faith and not keep jumping from one option to another. Dr. Moses generally uses a treatment plan for four to eight weeks before trying something else. “Think about it — the way your dog shows discomfort often waxes and wanes. If you change the treatment plan too frequently, it’s hard to know whether it’s working or not.”
And how do you know a treatment’s working? Look for markers of normalcy, says Dr. Moses. “It might be your dog’s ability to once again get up on your bed. It might be a male dog once more cocking his leg to pee. My favorite comes from an owner who said he knew his Miniature Poodle was responding to treatment when the dog tried to hump his wife’s leg!”
Photograph by Ellen Soohoo