What Can Be Done?

Anti Inflammatory Medications

Anti-inflammatory medications, known as nonsteroidal anti-inflammatory drugs (NSAIDs), are frequently used to manage your dog’s condition and can offer a dramatic improvement in mobility and quality of life. There are many licenced drugs available that come in different formulations and are given in different ways and generally they are very well tolerated. However, as with all medications, side-effects can happen, so following advised dosing, as well as keeping a close eye on your dog’s appetite, toileting and thirst.

NSAIDs reduce the production of prostaglandins which drive inflammation associated with arthritis. They do this by blocking an enzyme called cyclooxygenase. However, there are at least two forms of this enzyme cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), and it is cox-2 which is believed to be the chief culprit for creating these inflammatory prostaglandins. COX-1 is recognised to produce prostaglandins that are beneficial within the body as they protect the stomach lining, aid in kidney function and help in clotting. Developments in NSAIDs in the last decade have created more COX-2 selective drugs which should reduce the side effects seen, however adverse reactions can still happen.

Owners are often hesitant to use NSAIDs due to publicity regarding potential side-effects, and will seek alternative options for pain control. CAM fully supports their choice as long as the treatment chosen offers effective pain control to that dog. We strongly suggest using a means of measuring pain before the treatment and after to ensure the goals of using it are met. Leaving a dog in pain for whatever reason is not acceptable, and will lead to the condition worsening rapidly. Combining a number of treatments  is recognised as the most effective way of controlling pain with minimum side-effects.

CAMs tips to using an NSAID effectively
  1. Always use an NSAID with the guidance of your vet.
  2. Do not use medication designed for humans as these can be fatal to dogs.
  3. Follow your label instructions regarding dosing, and check that it is compatible with any other medication being used. (A recent study of 29 severe side-effects seen in dogs showed the majority were due to inappropriate dosing, or combining unsuitable medications).
  4. Follow advice on how to give it, such as with food.
  5. Don’t give a dose if your dog is behaving strangely, reluctant to eat, has vomited or has diarrhoea. Contact your vet to discuss further.
  6. Initially plan to give the NSAID for 2-3 weeks to see the best effect. Reassess his pain status then and plan further management. Providing just a few days NSAID will not be effective in controlling chronic pain and will lead you to feeling they have been ineffective.
  7. If prescribed for long-term dosing, observe your dog’s chronic pain indicators to attempt to reduce the daily dose of the NSAID. Especially as you and your dog change your lifestyle.
  8. NSAIDs have been found to be more effective and safe for chronic pain if given regularly as prescribed, however they can be stopped and restarted. So if your dog’s pain status and mobility has improved significantly, and you have reduced the dose with no deterioration, stop the NSAID and continue to monitor. It can always be restarted.
  9. It is well recognised that a dog’s response to an NSAID is individual. An otherwise healthy dog may not tolerate one NSAID but have no side-effects with another. If your dog needs anti-inflammatory support, but has reacted to one NSAID, it does not mean they can’t be effectively treated with a different one.
  10. If changing from one NSAID to another, wait at least 48 hours after stopping one before starting the new one.
  11. Have regular blood samples (6-monthly) taken to ensure other conditions have not developed which could mean an NSAID should no longer be given.
In addition to licenced NSAIDs, other anti-inflammatories are often used in managing the pain of arthritis.

This everyday drug has been found to have minimal anti-inflammatory effect so is not suited to be used alone for management of arthritis (and should never be given to a cat). It is sometimes used as an additional treatment alongside an NSAID, or in combination with codeine as a veterinary licenced compound called Pardale-V, which can also be used alongside the NSAID.

This easily accessible anti-inflammatory was historically used a lot in cats and dogs, but it is associated with significant vomiting and diarrhoea episodes, and COX -2 selective NSAIDs are now more popular.

It must never be used alongside another nsaid.

These are very powerful anti-inflammatories, and are used to manage immune-mediated arthritis. However, they have significant side-effects on the body and after a short term initial improvement can lead to the condition worsening due to steroid-induced weakening of muscle and soft tissues that support the joint. They can also affect your dog’s hormone balance which will encourage them to eat and drink more, urinate more, gain weight and often excessively pant. They are occasionally used to buy time in a terminally ill patient.

This injectable treatment is considered to have anti-inflammatory properties, as well as disease modifying capabilities. It is generally given weekly for 4 consecutive weeks and can be repeated up to twice more in a year.

There is good evidence it can be beneficial in managing arthritis, but often the response is unique to the dog so it must be used alongside good observational skills looking for improvement.