A multimodal approach to pain management and mobility
According to some estimates, one in five dogs (20%) experience joint issues in their lifetimes, resulting in pain and possible mobility challenges.1 The foundations for the disease begin when pets are young—even just a few months old and into young adulthood. The earliest signs of disease, however, often go unnoticed or are dismissed in younger pets.
The veterinary professional team needs to work with the pet owner throughout all life stages of the pet, to ensure that osteoarthritis (OA) has a minimal impact on their quality of life. Rather than be staunchly prescriptive in saying there is only one way to manage OA pain in pets based on species or stage, look for ways to integrate foundational strategies with other multimodal options that make the most sense for each individual pet and that pet’s lifestyle.
In all cases where you have diagnosed OA-related pain in companion animals, a few strategies provide the foundation for slowing down the progression of the disease, minimizing compounding factors, and improving the quality of life.
Nutrition affects growth rates in young dogs and weight management in all pets. Diet plays an important role in how developmental diseases impact pre-disposed breeds. An excess intake of calories and protein, for example, along with too much dietary calcium through supplementation, may cause puppies to grow too much and too fast. In addition, obesity is a growing concern in adult dogs. The Association for Pet Obesity Prevention found that 22% of dog owners and 15% of cat owners considered their pets to be of normal weight, when the pet was actually overweight or obese.2 Therefore, that makes diet an important place to start with OA cases.
Controlled exercise is an essential component to successfully manage OA pain and mobility in both early and later stage OA. Veterinary teams need to instruct and coach clients about the importance of routine, appropriate exercise for maintaining mobility and overall health, but without causing undo joint stress or additional injury. In addition to injury prevention, dogs diagnosed with OA need routine stage-appropriate exercise:
- Early OA stages: moderate exercise daily, with perhaps specific fitness plans for more active pets
- Later OA stages: short sessions of moderate exercise a few times each day, perhaps additional low-impact conditioning (swimming, underwater treadmill, or specific rehabilitation exercises) under the direction of a qualified professional
NSAIDS. While there are a variety of pain medications, NSAIDs remain the most commonly used class of drugs for canine OA pain cases because they are the only prescription products with labeled claims for efficacy. With canine patients, veterinarians have the option to use NSAIDs both in short-term and long-term scenarios because of their rapid and predictable effectiveness for pain associated with OA.
Supplements. Increasingly, clients show interest in using nutraceuticals, and a majority of veterinarians are recommending supplements to support joint health in dogs and cats. If you are going to recommend supplements, consider the method of action as well as ingredient quality in your recommendation.
Many tend to think that multimodal means using more than one type of pain-relieving medication. However, medication is only one component of the OA management plan. Many management options can be combined based on OA stage and severity of clinical signs. In addition to setting expectations
Lastly, make sure clients understand that OA management is not a one-time visit, one-time fix. Set expectations for when and why clients should contact you in between planned recheck visits. For example, if they notice any changes in the pet, such as more signs of pain, increased limping or mobility issues, any physical or behavioral changes that may indicate a side effect, and any problems that come up with implementing the pain management plan at home, they should contact their veterinary team immediately.
1. Johnston, S.A. Osteoarthritis. Joint anatomy, physiology, and pathobiology. Veterinary Clinics of North America: Small Animal Practice. 1997. 27(4): 699-723.
2. Association for Pet Obesity Prevention. February 6, 2012. Big Pets Get Bigger: Latest Survey Shows Dog and Cat Obesity Epidemic Expanding.