Osteoarthritis Update 2019
A few months ago, Healthy Paws Pet Insurance issued its annual ranking of the top 10 ailments that triggered a visit to a veterinary clinic based on claims.
Pain was listed as reason #5 for dogs and #7 for cats. And as we know, osteoarthritis (OA) is a common cause of pain in pets.
We’re telling you this because you can help clinics stay in step with the best practices for managing pain related to osteoarthritis… providing relief for many of the patients they see.
How? By discussing pain management during your clinic visits, and showing veterinary teams the latest recommendations and solutions. This will help them continue playing a priceless role for pets suffering with OA pain.
Here’s the latest update on how practices can and should consider managing OA in 2019 and beyond.
OA management should involve multiple treatment modalities, including weight loss, appropriate exercise, environmental modification, NSAID (nonsteroidal anti-inflammatory drug) use, and joint support (nutraceuticals). NSAID use is the cornerstone of treatment, but it’s usually less successful without managing weight and exercise.
When initiating OA treatment, the practice team should discuss all aspects of management with the client. Remember that each patient should be approached individually, considering the age, normal activity levels, degree of impairment, and the owner's expectations.
If osteoarthritis is diagnosed early, the pain generally responds well to multimodal treatment. If diagnosed after the disease has become moderate to severe, even aggressive treatment may not eliminate all the pain. So, it’s important to discuss the signs of OA with clients and team members who may be involved in patient physical examinations.
Be especially proactive with dogs that are large-breed, overweight, middle-aged or older, or very active. Nutraceuticals ideally should be used early in the course of OA to help decrease disease progression. Because of the lack of significant side effects, supplementation may be recommended in pets predisposed to developing OA.
Often, finding an effective treatment requires some tinkering; chronic pain management, if required, must be individualized for each patient. The entire hospital staff should operate as a pain management team.
The pet owner is part of the team. Educate the owner on the underlying condition causing pain and the expected results and possible side effects of NSAID and other therapy. The owner needs to understand that treatment will be lifelong and they’ll need to evaluate the degree of their pet’s pain relief.
What about avoiding NSAIDS?
Veterinarians often avoid using NSAIDs in young or middle-aged dogs, because they want to use the drugs later in the disease process. This is not a logical approach because if pain is not alleviated, the musculoskeletal system is further compromised, causing decreased joint support and increased pain. And, NSAIDs generally do not have to be used for the rest of the dog’s life because early adoption allows increased exercise and weight control, which may provide enough pain relief to allow the NSAIDs to be discontinued.*
It’s also not true that the longer NSAIDs are used, the likelier the risk of an adverse event occurring. Most side effects occur within two to four weeks of initiating NSAID use. And for patients that require it, longer term (28 days or greater) use of NSAIDs, compared to short-term use, results in progressively reduced pain and increased function.*
Help practices work with clients to take a holistic pain-management approach.
When you’re talking with practices, ask about the current protocol, especially involving client conversations about the signs of OA.
Owners need to be aware that adequate pain control involves more than just treatment of the pain itself. Weight loss (if needed) and alteration of the pet's environment (e.g., placing rugs on slippery floors, using ramps instead of stairs) and exercise (e.g., controlled leash walking) are important parts of the treatment plan.
To help clinics in your territory embrace these recommendations and follow the latest pain-management protocols, steer them to the following guidelines and show them the latest related products in your catalog (NSAIDs, nutraceuticals, pet mobility support products, etc.).
American Animal Hospital Association (AAHA): Pain Management Guidelines for Dogs & Cats
The International Veterinary Academy of Pain Management (IVAPM) pain information and guidelines website, which includes a canine and feline dosage sheet and pain scale references for other species
This post is sponsored by DECHRA Veterinary Products.
*Reference: Innes, JF et al: Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Vet Rec 2010 Feb 20: 166(8); 226-230.