The most common source of chronic pain in dogs is arthritis, also known as degenerative joint disease. Arthritis develops with age in many dogs, but can also begin earlier in life in dogs with hip or elbow dysplasia or as the consequence of an injury. In a select few cases, surgery may be of benefit, but in most dogs, treatment involves attempts at preventing further joint damage, increasing mobility and decreasing pain. The best way to treat arthritis is via a multi-modal approach, combining several different therapies / medications to achieve a better result than one treatment alone. Your dog does not have to be in pain – we will discuss some of the options available below. As always prior to starting any therapies and treatments, have a good discussion with your veterinarian about the condition at hand.
Joint Supplements / Nutraceuticals
Omega three fatty acids, as found in cold water fish oils, are known to have anti-inflammatory properties and may reduce some joint inflammation. Regular fish oils may work well, but there are veterinary specific brands, which may have an even better effect. Many people use flax seed oil, but it is not as effective in dogs as the oil in flax seeds needs to be converted in the body to an omega 3 fatty acid – and humans are much more efficient at this process than dogs. Stick with fish oil.
Glucosamine and chondroitin sulfate
Cartilage is composed of a number of elements, including chondroitin sulfate and glucosamine metabolites. These compounds are the building blocks of cartilage and by supplementing the diet with them, you are assuring that your dog has these components available to repair damaged cartilage. Glucosamine and chondroitin sulfate are available in a number of oral chewable supplements, making administration very easy. Dogs have been found to absorb glucosamine better than humans, making it potentially more effective than in people. There may even be a subtle anti-inflammatory effect from them. We have seen some remarkable results with glucosamine supplementation, but there a few caveats: it takes several weeks to months to show an effect and quality of the product is essential. Most glucosamines on the market (especially human brands / generics) are of poor quality and are not absorbed well. The branded veterinary products are tested and found to be far superior. We are happy to chat with you about these brands and have Dasuquin Advanced in stock at all times.
Anti-oxidants and free radical scavengers
Free radicals are compounds that can damage cells and are thought to contribute to aging. They are formed in the body via natural processes and from external sources, such as pollution, sunlight, food contaminants, etc. In human medicine free radical scavenging molecules are being used to help slow aging and possibly aid in slowing arthritis. This is still a new field and we expect more research developments in free radical scavengers in the near future. Anti-oxidants include Vitamins C and E, S-adenyl Methionine (sAMe), and Superoxide Dismutase.
MSM, or methyl sulfonyl methane, is frequently combined with glucosamine chondroitin sulfate. It, too has anti-inflammatory properties. The compound contains a large amount of sulfur, an essential element in glycosaminoglycans, a main component of cartilage that enables cartilage to absorb water and stay soft. MSM provides another building block to help repair cartilage.
Adequan(R) – polysulfated glycosaminoglycans
All of the above supplements / nutritional additives are taken by mouth, but there is one that has proven very effective and is approved by the FDA for use in dogs, which is given via injection. Adequan(R), composed of glycosaminoglycans, has been shown to stimulate cartilage repair, inhibit destructive enzymes, and increase joint fluid. Giving Adequan(R) is not as scary as it sounds: many dogs tolerate injections very well and we can even show you how to give them at home. The biggest fear is conquering your own fear of injections – the dogs don’t care! Adequan(R) is highly recommended for most dogs with arthritis as its benefits can be tremendous and the side effects minimal.
With any medication it is important to follow your veterinarian’s directions carefully. Many medications are safe to administer, but have specific dosing amounts and are not safe to be combined with other medications. You should also never increase the dose or frequency of administration of medications without consultation with your veterinarian. In addition many of the arthritis medications are flavored and should be kept in a cabinet, far out of the reach of dogs and children. This is especially true of NSAIDs (discussed below).
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
The most common medications used to treat chronic arthritis are non-steroidal anti-inflammatory drug (NSAIDs). These medications work by inhibiting the production of cyclooxygenase, an enzyme which stimulates cells to produce prostaglandins, a group of chemicals that cause inflammation. Prostaglandins contribute to pain, inflammation, further joint damage, and fever. The inflammation produced further damages the dog’s joints, leading to more discomfort. Prostaglandins are important for other bodily functions, including supporting platelets and blood clotting, stomach lining protection, blood flow to the kidneys, etc., therefore NSAIDs must be used carefully.
When used under the direction of a veterinarian, with routine monitoring, NSAIDs provide the most reliable and effective pain management for arthritis. Many dogs with severe pain will have remarkable responses to NSAIDs. The most common veterinary approved NSAIDs include Rimadyl (carprofen), Deramaxx (deracoxib), Previcox (firocoxib), and Metacam (meloxicam).
NSAIDs should be used with caution in any dog with kidney, liver, heart, endocrine, and intestinal disorders. Never give your dog another NSAID or corticosteroid unless specifically directed by your veterinarian. District Vet doctors most commonly use Rimadyl and have it in stock at all times.
While NSAIDs control inflammation and to a lesser degree pain, there are several medications commonly used to control pain itself. Remember, arthritis is painful and this is why dogs are lame when walking. Tramadol works directly upon pain pathways, making dogs more comfortable quickly. It may be used alone or in combination with NSAIDs as they have very different mechanisms of action. Tramadol works similar to morphine: it blocks opiod receptors in the brain, leading to less sensation of pain. The effects of the medication can last from 6-12 hours, depending upon the dog, but the medication is generally given twice daily. Use with caution in dogs with seizures and those on anti-depressants or other medications. The main side-effect we have seen with tramadol is mild sedation, but it can also cause constipation or insomnia.
Gabapentin has recently gained favor in the treatment of chronic arthritis in dogs. It works via mimicking the activity of GABA, a chemical in the brain which helps calm nerve activity. Traditionally gabapentin has been used to treat seizures, but at a different dose, it helps address chronic pain, too. The medication is considered quite safe to use, with the most common problems including sedation and wobbling when walking. Usually adjusting the dose takes care of these issues. Gabapentin may be used in combination with several other arthritis medications.
Other therapies aside from nutritional support and medications may also be employed to control arthritis pain and discomfort. Cold laser therapy (CLT) has been gaining in popularity and use over the past few years. CLT works via shining a beam of light at a certain frequency, which gently warms tissues, many times resulting in pain relief, decreased inflammation, increased blood flow, enhancement of immune cells to combat pathogens, and tissue regeneration. The therapy is given over a number of sessions, generally twice per week for a month, and does not require sedation or have any side effects. It is particularly useful post injury and may be combined with any other form of arthritis treatment. We have several strengths of gabapentin here in the office.
Although last in the article, rehabilitation therapy is integrative to many arthritis and post-injury protocols. As in humans rehab helps increase mobility, decrease pain, and helps strengthen muscles and bones. There are many modalities in rehab, from using an underwater treadmill (allows dogs to more freely use their legs with less pressure), to manual flexion / extension / massage of joints, to chiropractics and acupuncture. Rehabilitation therapies will require their own article in the near future.
Please remember that the above content is only for informational purposes. Never treat your pet without being under the direct supervision of your veterinarian. And as always you may feel free to contact one of us at District Vet if you have questions or concerns about your dog.