CAM conversation WITH CAM Gwen Covey-Crump ABOUT NSAIDs versus Neutraceuticals

25th November 2018

What is your veterinary background?

I qualified as a veterinary surgeon from the Royal Veterinary College in 2001 and spent the next 3 years in small animal general practice. Between 2004 and 2008 I completed a senior clinical training scholarship in veterinary anaesthesia and analgesia at the University of Bristol, gaining the RCVS certificate in Veterinary Anaesthesia, before going on to work as a veterinary anaesthetist at the University of Cambridge Queens Veterinary Hospital. Returning to Bristol in December 2009 I took the team lead role for Langford Veterinary Services(LVS). I received the Diploma of the European College of Veterinary Anaesthesia and Analgesia in 2012.

As the lead clinical Specialist of the Small Animal Rehabilitation and Pain Management Service at Langford Vets, I now focus my energies working alongside physiotherapists and collaborating with specialist colleagues in surgery, neurology and medicine. I maintain my clinical anaesthesia work as part of a growing team of anaesthetists as we broaden our influence within the clinical service of LVS and it’s clients and collaborate with the Bristol Anaesthesia and Analgesia Research Group.

What does the literature say about NSAIDs and their effect on cartilage?

My understanding is that the literature is fairly equivocal but that there is evidence that COX-2 selective NSAIDs actually improve cartilage quality where non-selective COX-inhibitors may be deleterious. In vitro studies have shown meloxicam not to affect the quality of cartilage from dogs with naturally occurring arthritis (cartilage taken at hip arthroplasty and treated in vitro) – this doesn’t necessarily translate to a clinical effect but may be the best evidence we have.

What does the literature say about glucosamine/chondroitin?

Numerous clinical studies about supplements have either been too underpowered to demonstrate clinical effect of glucosamine/chondroitin or have not given a positive conclusion. The overall impression is that many supplements are very likely to be helpful if given in advance of OA formation. So they are useful for athletes as prevention and if supplemented as soon as an injury occurs they seem to delay progression of arthritis in humans. I’m not sure we have this data in dogs. So in other words if your patient receives an injury they should be supplemented long-term with chondroitin/glucosamine before OA takes hold though studies in dogs are lacking in this context.

Are there any problems with assessing the effects of neutraceuticals?

One of the difficulties we have with evaluating the clinical effect of supplements is that the industry is unregulated since they are not considered drugs. Many companies use references from studies extrapolating the data from other species and often pre-clinical studies – it is rare for studies to look at naturally occurring disease. There is a great barrier to high quality in vivo research – which has to be surmounted by pharmaceutical companies in order to licence their product..

Is there any evidence of the benefits of neutraceuticals?

The best evidence we have for any supplement is for marine-based omega 3 oils. Studies have demonstrated anti-inflammatory and even cartilage benefiting effects in research animals with naturally occurring disease, and improved mobility in pet dogs with clinical disease. Other supplements with some evidence of efficacy for OA in dogs include avocado-soybean unsaponifiables for example (you can find more information on this in the conversation with CAM Shona)

Can human studies be used for making decisions in dogs?

As I’m not in orthopaedics I’m not sure on the absolute definition of OA for research but for clinical trials generally radiographic diagnosis and clinical exam is sufficient. It is important to remember that we need to be careful extrapolating data from humans, it’s not that data can’t be extrapolated, more that we can’t assume efficacy in dogs/cats based on human data. There are various reasons including mechanical differences in joints/joint loading, differences in oral bioavailability etc and extrapolation is much abused.

Would YOU recommend use of an NSAID or a neutraceutical?

Before you consider a medicine you should address the animal’s environment – type of exercise, environmental hazards such as slips, trips and falls (including jumping out of the car, running down stairs, chasing balls, micro-slips on laminate floors). Small environmental adjustments (such as putting non-slip mats down and stopping the dog from jumping out of the car) can make a huge difference even without medication. See the CAM home assessment checklist

When would YOU use an NSAID?

I think NSAIDs are a first line therapy for osteoarthritis primarily for their role in pain reduction. Dogs adapt their gait to cope with painful joints and this results in a vicious cycle of disuse atrophy, increased joint laxity, weakness, pain and increased disuse. Further pain medications become necessary as the disease progresses and other options include paracetamol, amantadine and gabapentin.

When would YOU use a Neutraceutical?

Supplements come 3rd if the client is short of cash but if they can afford it/have insurance then get them onto a high-quality marine-based fish oil supplement such as Yumove. Some reasonable evidence also exists for avocado-soybean unsaponifiables (Dasuquin).

What else would YOU use?

Other therapies such as physiotherapy and hydrotherapy can be extremely useful to build muscle/prevent atrophy, relieve pain and spasm and increase joint range of motion but much harm can be done by well-meaning but inexperienced/poorly trained therapists. I suggest finding a chartered physiotherapist who has done a veterinary physiotherapy conversion degree, or a vet with a physiotherapy qualification. The term physiotherapy is abused in veterinary medicine (it is protected in human medicine). Acupuncture is also frequently helpful.

CAM conversation WITH CAM Gwen Covey-Crump ABOUT NSAIDs versus Neutraceuticals

CAM conversation WITH CAM Gwen Covey-Crump ABOUT NSAIDs versus Neutraceuticals

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