Non-steroidal anti-inflammatory agents, (NSAID)
Nonsteroidal anti-inflammatory drugs are a corner stone in the treatment of osteoarthritis in dogs and cats. These medications are very effective and acts by blocking inflammatory pathways that lead to the production of destructive molecules (prostaglandins) and subsequent pain. Many studies have documented the usefulness of these medications. Currently, there are six of these drugs approved for use in dogs, although we recommend only four: Rimadyl, Deramaxx, Metacam, and Zubrin. There are no NSAIDs approved for use in cats in the US, but we frequently use Metacam based on clinical experience and approval status in other countries. Although these medications are very effective in dogs and cats, they also have side effects which can preclude their use in some cases. It is very important that use of these medications be under the direction of a veterinarian. Additionally, the use of these medications in conjunction with other types of medications (e.g. aspirin, ibuprofen, corticosteroids) can lead to serious illness and should be avoided completely. Patients who cannot take prescription NSAIDs may be dispensed Duralactin as an alternative. Side Effects of NSAIDs are uncommon, but please watch carefully for the following: vomiting, diarrhea, blood in the stool, not eating or drinking, lethargy, inactivity, mental dullness, or nausea. If you observe any of these please contact us and discontinue the NSAID. (Aragon C. et al. Systemic review of clinical trials of treatments for osteoarthritis in dogs. J Am Vet Med Assoc. 2007 Feb 15;230(4)514-21. Mansa S. et al. Long-term treatment with carprofen of 805 dogs with osteoarthritis. Vet Rec. 2007 Mar 31;160(13)427-30. ).
Opioids and Opiod-like Drugs
These drugs are primary pain relievers, which act directly on pain pathways in the spinal cord or inhibit perception of pain in the brain. They are very effective adjuncts to nonsteroidal anti-inflammatory drug (NSAID) therapy. Dogs and cats are frequently administered tramadol, an opioid like drug for mild to moderate pain. Less commonly, oxycodone, morphine or a similar drug may be dispensed for short or long term administration. There is a high degree of individual variation in effect with these medications. We always try to choose the dose, which is likely to induce pain control without side effects. We may need to alter the dose or dosing interval to accommodate the onset of side effects (most likely drowsiness) or inadequate pain relief.
OTHER ANALGESIC MEDICATIONS
There are a number of other medications that can be used intermittently for more severe pain. Please check with your primary care veterinarian or us as to which other medications are possible.
AMANTADINE This drug acts to modulate the pain response by antagonizing the N-methyl-d-aspartate (NMDA) receptor and the role they play in central neuronal hyperexcitability (wind up). These receptors are found throughout the central nervous systems of humans and non-human animals, and play an important role in pain pathways. Amantidine is considered an adjunct to the analgesic drugs as amantidine does not induce pain control directly, but resets spinal cord receptors so that other analgesics can work more effectively. Amantadine has been studied well in humans and has demonstrated good efficacy in prospective studies involving patients with chronic neurogenic and orthopedic pain. Recently, this drug has been studied in dogs with chronic and refractory pain relating to osteoarthritis. Results have shown that using amantadine in conjunction with traditional anti-inflammatory drugs can improve comfort significantly. (Pud D, et al. The NMDA receptor antagonist amantadine reduces surgical neuropathic pain in cancer patients a double blind, randomized, placebo controlled trial. Pain. 1998 Apr;75 (2-3)349-54.Kleinbohl D, et al. Amantadine sulfate reduces experimental sensitization and pain in chronic back pain patients. Anesth Analg. 2006 Mar;102(3)840-7. Lascelles B.D.X. Gaynor J.S et al. Evaluation of Amantadine as part of a multimodal analgesic regimen for the alleviation of refractory canine osteoarthritis pain world small animal veterinary association world congress proceedings, 2007.)
These are supplements that have been shown in some cases to be effective at preserving and healing damaged joint cartilage. Unfortunately, these supplements are not regulated by the FDA, which makes evaluating their quality difficult. Nutraceuticals which we recommend include Cosequin, Dasuquin and Welactin. GLUCOSAMINE/CHONDROITIN CONTAINING AGENTS This is a category of nutraceuticals that may improve the health of cartilage and joint fluid as well as decrease the pain associated with arthritis. The products which have research indicating beneficial effects are Cosequin and Dasuquin. Many other brands are available. Caution should be used when selecting these other brands as they may not have the labeled amounts of glucosamine, chondroitin, and manganese.
CHRONIC ARTHRITIS TREATMENT
Chronic arthritis can be a very debilitating and painful disease in dogs and cats. Traditionally, reversing the disease process has not been possible. However, some newer interventions may allow reversal of early arthritis or at least slowing of the disease process. We can use various modalities to slow the disease progress and modify the pain associated with arthritis. The four corner stones of arthritis treatment are physical rehabilitation, weight loss, non-steroidal anti-inflammatory drugs, and nutraceuticals. Most patients respond well to these treatments. However, in some cases, additional treatments are indicated. It is important to remember that regular follow up is necessary, not only to gauge the success of therapy but to reevaluate and add in other therapies as indicated by the specific needs of individual patients.
We do not recommend aspirin for pain relief in dogs or cats. One hundred percent of dogs receiving only a single dose of aspirin bleed into their gastrointestinal tracts. Some dogs develop severe ulcers.
Duralactin is a brand of microlactin, which is a milk- based protein from hyperimmunized cows. Microlactin affects inflammation at a different location than traditional NSAIDs. The pain relief can be significant but not always as good as an NSAID. There are virtually no side effects associated with Duralactin administration.
Dasuquin is good for mild to moderate pain associated with inflammation. It interferes with destructive enzymes in joints and is NOT designed for joint protection.
CanEVA is good for moderate to sever pain associated with inflammation: also beneficial for helping build muscle.
MUSCLE & STRENGTH BUILDING SUPPLEMENTS
L-carnitine supports all body functions that require a high amount of energy. The highest concentrations are found in the heart and skeletal muscles. In humans, L-carnitine helps to increase the growth of muscle cell fibers by increasing energy production within cells and by increasing the number of androgen receptor sites on the muscle cell surface, which in turn increases the level of circulating testosterone. This has the effect of increasing protein production and promoting muscle growth. L-carnitine has been shown to increase muscle mass in humans (Am J Clin Nutr 2007 Dec;86(6)1738-44).
CoQ10 is essential for all the elements of muscle growth, which include muscle contraction, exertion, fiber repair, and fiber enlargement. CoQ10 enhances ATP energy production in cells and also causes muscle fibers to become resistant to atrophy. It is believed that the combination of L-carnitine and CoQ10 is beneficial to muscle growth.
CanEVA is beneficial for helping build muscle mass; Also good for moderate to severe pain associated with inflammation.
Cosequin is the only product which has data to provide joint/cartilage protection and a preventative effect in dogs.
Welcatin Omega-3 fatty acids have been shown to decrease the inflammation within an arthritic joint. In dogs, the specific fatty acid, eicosapentanoic acid (EPA) has been shown to have the most effect. This is in contrast to humans and horses. Concentrated salmon oil (Welactin) and Hill’s Science Diet J/D all have EPA as the predominant omega-3 fatty acid. Hill’s Science Diet J/D has the appropriate amount and ratio of Omega 3 fatty acids.
Hyaflex is an EPA which is the important component for dogs. Dogs should receive ~ 58mg EPA per kg of body weight. EPA helps interfere with destructive enzymes in the joint.
Hyalun is hyaluronic acid which is the most abundant lubricant in the body, predominantly in joints and muscles; anything other than bio-identical HA (hyaluronic acid) may have detrimental effects. Used in dogs greater than 50lbs.
HOMEOPATHIC PAIN RELIEVER
Traumeel is a natural pain reliever for injuries such as sprains, dislocations and contusions in dogs.