Monday, October 17, 2011

Arthritis and Bone Cancer Pain in Dogs and Cats

What Can I Do About My Pet’s Arthritis
Or Bone Cancer Pain?

What is arthritis?

Osteoarthritis is a chronic degenerative disease that may affect any joint but is commonly found in a pet’s hip, elbow, shoulder, stifle (knee) , carpus (wrist), hock (ankle) or intervertebral joints (in the spine).  It occurs when cartilage in the joint is damaged, either following a traumatic event or with wear and tear that increases in athletic animals, obese animals, or when the joint is congenitally (born that way) abnormal.

 Cartilage decreases joint stress by reducing impact on the ends of the bones in joints, like a shock absorber.  When cartilage is damaged inflammatory changes occur, leading to destruction of the cartilage and then damage to the underlying bone.  
Signs of arthritis include:  Reluctance to take walks of usual length, stiffness that may disappear once the pet has ‘warmed up’, difficulty climbing stairs, climbing in the car, on the bed or a sofa, rising from rest, limping, licking of a single joint, acting withdrawn, spending less time playing with family, soreness when touched, and sometimes aggression when touched or approached.

Key points about Arthritis:
  • Signs of arthritis may be subtle and easy to miss
  • Cats may be reluctant to jump up on surfaces they used to get on.  They may have litter box accidents if they are having difficulty getting in and out of the box.  They may also just subtly slow down.
  • Early treatment of arthritis is critical to slow progression of the disease
  • Maintaining lean body weight  is absolutely critical for arthritic patients
  • Newer concepts of arthritis management involve proper exercise to maintain muscle mass and decrease pain
  • Non-skid surfaces in the home, padded bedding, raised bowls, and ramps are ways to minimize they pet’s efforts to maintain comfort, stability, balance, or mobility.
  • Structure-modifying agents are most effective when started early and maintained long term
  • Nonsteroidal anti-inflammatory and analgesic drugs, acupuncture, and physical therapy may be recommended for later stages of the disease

What can I do for my pet?
  • Weight Reduction: Ask your doctor about your pet’s body condition score (BCS), which should be normal or slightly underweight.  If your pet is overweight, have your pet’s bloodwork evaluated for diseases that can contribute to obesity, and discuss a weight loss diet with your veterinarian.
  • Controlled Exercise:  Low-impact exercise is best; swimming or walking through shallow water is ideal.  Leash walking and controlled jogging are also acceptable.  Exercise for cats is important, too!
  • Nutraceuticals:  Synergistic combinations of nutraceuticals such as glucosamine/chondroitin sulfate contain compounds that support cartilage structure, prevent further deterioration, suppress inflammation, and reduce free radical damage.
  • Injectable Chondroprotective Agent: Talk to your veterinarian about an injectable agent that helps preserve cartilage in the joints.
  • Acupuncture and Massage: Both of these therapies may provide additional non-drug pain control. Ask your veterinarian.
  • Therapeutic Laser: We can use laser therapy on a number of different tissues including bone tumors, to decrease pain and boost the natural healing process in patients.  The effects of using laser light can speed up the healing process dramatically while decreasing the amount of scar tissue build up and increasing the pliable strength of wounds.  Lasers provide pain relief by stimulating the release of endorphins, activating natural anti-inflammatory cascades and increasing blood flow to damaged tissues.  Talk to your veterinarian about this pain reducing modality.
  • Prescription Drugs: Drugs are available that can reduce inflammation and suppress pain in pets with more advanced disease.  Side effects can be minimized by monitoring your pet’s blood work regularly. See below under bone cancer for the different pain control drugs.
Bone Cancer Drugs
No single medication is a match for the pain involved in what amounts to a slowly exploding bone. A combination of medications is needed to be palliative and should be considered only as a last resort if amputation or radiation therapy will not be pursued. There are several types of drugs that can be combined.
This class of drug has become the standard of care in humans with bone tumors yet bisphosphonates have not become as common a part of veterinary practice for this condition. Bisphosphonates act by inhibiting bone destruction, which in turn helps control the pain and bone damage caused by the bone tumor. The most common bisphosphonate in use for dogs is pamidronate, which is given as an IV drip over two hours in the hospital every 3 to 4 weeks.  Because bisphosphonate seem to be well tolerated, relatively inexpensive, and useful in numerous bone-destroying cancers, we expect to see this class of drug used more and more in small animal practice.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
There are many anti-inflammatory pain relievers developed for dogs and a couple that are used less frequently in cats.  These are typically given once or twice daily in tablet form at home. The patient should have good liver and kidney function in order to take medications of this class.  While there are NSAIDs commonly used by people, do not use these human medications on your pet without consulting a veterinarian.

Narcotic Pain Relievers
While these drugs do not have anti-inflammatory properties, they are well-known analgesics and have been used in an assortment of forms for thousands of years. They are particularly useful in chronic pain because they do not interact negatively with other pain relievers. Drowsiness is a potential side effect. Tramadol has been particularly popular as part of a drug combination for bone cancer pain but there are others that might also be considered, such as a fentanyl patch, buprenorphine, and other narcotics.
Miscellaneous Supplemental Pain Relievers
There are two drugs that are used as additional pain relievers for animals with chronic pain: gabapentin and amantadine. They work on neurologic pain, and in the treatment of arthritis, surgical pain, and other chronic pain states. 

For more information on this and other common diseases our pets get - please click on this link to learn more. 

Blog by:
Dr. Dana Lewis
Lap of Love Veterinarian
Pet Hospice and In Home Euthanasia
(919) 439-5922
Dr. Dana services the Raleigh North Carolina area including - Raleigh, Durham, Chapel Hill and the greater Triangle, as well as Wake, Durham, Orange, and Chatham counties.

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