There is More Than One Way to Treat Your Pet's Pain

This article originally appeared on Dr. Mahaney’s The Daily Vet column on PetMD as There is More Than One Way to Treat Your Pet's Pain There are many modalities available to pet owners to better manage the pain experienced by a companion canine or feline. Which options to use, how frequently they should be employed, and concerns for side effects are some of the main considerations that may govern the availability of such treatments for a pet's pain management. In my veterinary practice, the goal in treating my patients’ pain is to always improve their comfort, mobility, and quality of life while reducing risks for mild to life-threatening side effects from medications or other prescribed treatments (radiation for cancer, etc.). This approach is termed multimodal pain management and I use it frequently and effectively for my canine and feline patients’ arthritis and other health problems that cause pain (intervertebral disc disease [IVDD], trauma, surgery, muscle and ligament damage, etc.). The multimodal pain management protocols I recommend involve combinations of the following therapeutics tailored specifically to my patients’ needs. Veterinary Prescription Drugs When pets suffer from pain, owners must provide immediate relief so that secondary health (decreased appetite, difficulty resting, etc.) and behavior concerns (lethargy, aggression, etc.) do not emerge on a short or long-term basis. My first line of treatment is to use veterinary prescription pain-relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs), including Carprofen (Rimadyl), Meloxicam (Metacam), and others. When prescribed and used appropriately, such medications can safely benefit arthritis pain. Of course the goal of multimodal pain management is to reduce the dose and frequency of such drugs by making the body healthier and modifying a patient’s lifestyle to decrease the further likelihood of creating additional discomfort. Cats are very sensitive to the use of NSAIDs, so I highly prioritize other means of reducing pain and inflammation to help protect feline kidneys and other organ systems. I always evaluate my patients’ blood and urine status before prescribing such drugs, as the kidneys and liver are the primary means of drug metabolism and the digestive tract. Blood clotting mechanisms and organ systems can be negatively affected by non-judicious use. Human Prescription Pain Medications There are many human pain medications that can be used to relieve discomfort in our companion canines and felines. These drugs don't have animal-specific versions, so veterinarians dispense them from their hospital supply, human pharmacies, or veterinary pharmacies. Some examples include opioid pain relievers (those derived from the poppy plant but synthetically produced) like Tramadol and Buprenorphine and GABA analogues (Gabapentin, which mimics a neurotransmitter called GABA and modifies calcium channels). Since side effects of these drugs include sedation, difficulty standing or walking, anorexia (decreased appetite), nausea, and others it’s crucial to use such drugs at a dose and frequency that provides a desired result but minimizes adverse responses. I must stress the importance that such medications are used under the guidance of your veterinarian and frequent communication about your pet’s response occurs so that any appropriate modifications in the pain management protocol can be made. Joint Supporting Nutraceuticals Nutraceuticals are food-derived substances having a medicinal effect. Nutraceuticals geared to promote joint health are termed chondroprotectants (i.e., cartilage protectors). Chondroprotectant nutraceuticals commonly include glucosamine, MSM, vitamins (C, E, etc.), minerals (Calcium, Manganese, etc.), antioxidants (Selenium, Alpha Lipoic Acid, etc.), anti-inflammatory substances (turmeric, omega fatty acids, etc.), and more. I’ve seen favorable responses to ActivPhy for may canine patients, as it contains a novel blend of the above ingredients plus phycyocyanin, which is a blue-green algae extract that has been scientifically proven to reduce production of the cyclooxygenase-2 (COX-2) enzyme associated with arthritis in dogs. I also strongly recommend the use of fish-oil based omega 3 fatty acids to naturally reduce inflammation in the joints, skin, internal organs, and nervous system. The primary product I use in my practice is Nordic Naturals Omega 3 Pet, which is free from heavy metals, pesticides, and radiation, has minimal odor or flavor, and comes in either easily-administered liquid or capsules. (I’ve taken Nordic Naturals fish oil for years to help my own arthritis pain and skin issues.) Cartilage Rebuilding Medications Besides nutraceuticals, there are veterinary medications that are given by injection to benefit joint health and rebuild cartilage, including Polysulfated Glycosaminoglycan (PSGAG, like Adequan) and Sodium Pentosyn Sulfate (Cartrophen). Since these products are given as an injection, they bypass the digestive tract and readily travel from the injection site through the bloodstream to all joints. Such medications are ideal for a dog having digestive tract problems caused by disease (food intolerance, inflammatory bowel disease, etc.) or medications (NSAIDs, chemotherapy, etc.). Home Environment and Lifestyle Modification When dogs suffer from arthritis pain, modifying their home environment and lifestyle is crucial so that affected joints experience less stress and potential for injury is reduced. This means lowering the height of a bed and using a step or stairs next to the couch to provide safe passage onto and off of elevated surfaces. Carpeting, runner rugs, or yoga mats should cover slippery floors. Foot and nail covers (Pawz, ToeGrips, etc.) provide additional traction on slick surfaces. Access points to stairs can be blocked by gates to prevent a dog from slipping, falling, and injuring himself while attempting to ascend or descend. Ramps can provide safer access to the backseat of hatchback of cars. Dogs engaging in high-impact activities (running, ball playing, etc.) must transition to low-impact exercise, such as walking, hiking, swimming, or physical rehabilitation. Weight Management Over 54% of cats and dogs (approximately 98 million pets) in the U.S. are overweight or obese according to the Association for Pet Obesity Prevention (APOP). Besides arthritis, other ailments like heart and lung problems, glandular disorders (diabetes, etc.) digestive problems (constipation, etc.), and cancer can be avoided or minimized if pets maintain a normal body condition score (BCS) on a lifelong basis. Dogs in need of weight loss should have an examination by a veterinarian and any recommended diagnostic testing to determine if there’s an underlying endocrine problem (hypothyroidism, hyperadrenocorticism, etc.) contributing to an elevated BCS and higher number on the scale. Veterinarians can calculate a dog’s daily caloric needs and recommend the exact amount of commercially-available or home-prepared diets to feed each day to safely promote weight loss. Complementary and Alternative Medicine (CAM) A variety of treatments for arthritis pain have emerged that are considered complementary and alternative medicine (CAM). CAM is becoming better-accepted as means of treating many canine ailments. Options include: Acupuncture — Insertion of needles into acupuncture points to promote the release of the body's own pain-relieving and anti-inflammatory hormones. Manual pressure (acupressure), heat (moxibustion), electricity (electrostimulation), injection of liquids (aquapuncture), or laser can also be used to stimulate acupuncture points. Herbs — There are a variety of plant-derived products that help promote blood flow and reduce inflammation in body tissues. I always recommend veterinary-prescribed, U.S.-made products like those made by Dr. Xie’s Jing Tang Herbal, Standard Process, and others. Laser — Low power (“cold”) lasers can be used to safely and painlessly promote tissue repair, blood flow, oxygen and nutrient delivery, and the removal of metabolic wastes. I commonly use a MultiRadiance MR4 Activet4 Laser on my patients' painful spots and acupuncture points. Pulsed Electromagnetic Frequency (PEMF) — PEMF is a non-invasive means of modulating canine OA pain. In my practice, I treat patients with the Assisi Loop, which is simple to lay over or around affected joints. (To read more about it, click here) Physical Rehabilitation — Specially-trained veterinarians and human physical therapists can provide physical rehabilitation to animal patients. Besides the above-mentioned modalities, dogs can swim in a pool, walk on an above-ground or underwater treadmill, have their bodies thoroughly stretched and massaged, receive range of motion (ROM) therapy, and more. Some treatments need to be done in a veterinary physical rehabilitation facility, but in many cases dog owners can be instructed on how to safely provide therapy at home. As there are so many options to help lessen your pet’s pain, dog and cat owners now have the ability to make choices that can minimize undesirable side effects from treatment while still maintaining a pet’s comfortable quality of life.Thank you for reading this article.  Your questions and comments are completely welcome (I’ll respond).