Whilst starting with natural, holistic and often simple lifestyle changes is always preferred, there are inevitably times where some degree of further veterinary intervention is required, particularly in severe cases or later in the progression of the disease.
Disease modifying osteoarthritic agents
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.
This intramuscular injectable treatment slows the disease process through inhibiting some of the destructive process within the joint, as well as some anti-inflammatory effect. It is of most benefit early in the disease and involves commitment to 2 injections a week for 4 weeks
Additional pain relief
CAM’s experience with adding further ‘chronic pain drugs’ to a dog’s regime is very varied. There needs to be strict monitoring of chronic pain indicators; by this stage both vet and owner are desperate to find something effective at controlling the dog’s discomfort, and caregiver placebo effect is very likely.
This oral medication has gained in popularity in the last 5 years, as it is considered part opioid which strongly hints at significant pain control and it is affordable and easy to give. However, there is very little statistical evidence available on how effective it is. It is a recognised treatment strategy, especially combining it with an NSAID with the view of using it for an acute flare episode of pain from arthritis, however the benefits are believed to be marginal, and the side-effects can be significant, causing drowsiness, lack of co-ordination and diarrhoea. It is known to break down in the dog’s body very quickly meaning that potentially high and regular dosing of up to every 4 hours is necessary to get good effect.
Is an opioid available in a veterinary licenced product called Pardale-V. It can be added to an NSAID to offer additional pain relief.
These are very powerful government controlled pain relieving drugs and are generally not used on an outpatient basis, but may be used in a practice to control acute pain of an arthritic flare up.
This oral medication has shown to be an effective additional medication to NSAIDs to control chronic pain of arthritis, and can be used intermittently for 1-3 weeks to get effect and then stopped.
Rare side effects are agitation and diarrhoea.
Originally an anti-epilepsy drug, gabapentin has gained great popularity recently for managing chronic pain, and nerve induced pain. However, it has not proven itself in strict clinical trials. It is used in addition to a NSAID and potentially an opioid.
The dose range is wide, starting low at 2.5mg/kg but potentially going very much higher, ideally 2 or 3 times per day which suggests that good observational skills are required to assess its effectiveness, and adjust the dose accordingly. It is advised it is trialled for 4 weeks before discounting it as ineffective.
Side-effects are sleepiness, muscle weakness and weight gain. The first side-effect can be counteracted by starting on once daily dosing at night to allow the body to accommodate it. Gabapentin should not be stopped suddenly, but weaned off over a couple of weeks.
Is very similar to gabapentin, with differing dose rates but same frequency of administration.
Laser therapy has recently become very popular, with many veterinary practices using it for chronic pain management.
It aims to stimulate the body’s own healing mechanisms through photobiomodulation. It is considered to offer a reduction in pain sensitivity, reduce inflammation and promote healing.
A recent surge in interest in rehabilitation therapies for post orthopaedic surgery recovery, musculoskeletal disease and osteoarthritis management has led to a significant number of practices incorporating either a hydrotherapy pool or treadmill into their facilities.
Some small animal practices have taken rehabilitation a step further, employing a qualified physiotherapist to run an in-house rehabilitation centre which often allows a carefully constructed target-driven therapeutic plan to be created using different treatments such as ultrasound therapy, shockwave therapy, TENS therapy, as well as well-respected hands-on techniques.
Combining physical rehabilitation techniques alongside the foundation treatments is very effective at controlling pain as well as improving musculoskeletal health, which has been shown to over time decrease the needs for medical intervention with NSAIDS etc.
This joint injection has multiple beneficial effects within the joint. It:
- improves the properties of the joint fluid which is generally poor due to arthritis. This cushions the joint.
- encourages improved joint health, slowing the disease process
- has anti-inflammatory properties
- Offers pain relief. This effect has been reported to last for up to 6 months.
This is a very exciting new field in arthritis management in dogs, and becoming more widely available. However it is still in its infancy in this species with many questions still not answered.
Surgery plays a strong role in managing some cases of arthritis and falls into 3 main categories:
- Potentially preventative
- stabilising to slow progression
- excision to potentially resolve
It is a huge field that requires good communication with your vet to ensure the suitability of the patient is considered, realistic expectations are put in place, costs are clearly discussed, and rehabilitation is planned and accounted for.