Pain, NSAIDs, and Supportive Care

My dog was diagnosed with significant back pain. Spinal X-rays revealed osteoarthritis (OA) and calcification of several intervertebral discs. Her veterinarian tells me that we must focus on managing her pain and providing her with appropriate supportive care. What might her treatment plan look like?

OA in the spine and degeneration of intervertebral discs can be a very significant source of pain and weakness in older dogs. Any time a dog exhibits weakness in the rear limbs, she should be evaluated for pain. Some cases of weakness arise from damage or degeneration of the spinal cord and the nerves. These patients may or may not be painful. However, some dogs with rear limb weakness are weak because they are painful. Relieving their pain, managing any joint disease, normalizing body condition, and managing their environment appropriately can all make important contributions to both comfort and mobility.

Once pain is diagnosed and localized, a personalized treatment plan can be developed. Your veterinarian will first determine if there are any metabolic issues you should be aware of. This means looking for any organ system compromise, as well as evaluating thyroid function, since the thyroid gland is so important to metabolic activity.

After the metabolic profile is completed, the next supportive step is to determine the most appropriate nutrient profile. If your dog is overweight, your veterinarian will help you create a clinically proven nutrient profile that will allow for weight normalization. Once normal body condition is achieved, your veterinarian will recommend a nutrient profile and portion both to maintain good body condition and to provide joint support as part of a multi-modal pain management strategy.

Next, it’s important to break the pain cycle caused by OA. Non-steroidal anti-inflammatory drugs (NSAIDs) provide the cornerstone of comprehensive pain management for inflammation. It’s necessary to schedule regular pain reassessments after starting medication. It’s also important to be vigilant for any side effects from NSAID. The most common adverse side effects are vomiting, diarrhea, and decreased appetite. Should your dog exhibit any of these three signs, stop the medication and contact your veterinarian immediately.

There will probably be additional medications and nutritional supplements (nutraceuticals) to complement the activity of the NSIAD. These additions may allow your veterinarian to decrease the dose of the NSAID needed for pain relief. Some dogs with painful OA who receive comprehensive, multi-modal therapy are able to discontinue their daily dose of NSAID, reserving the drug for pain flares or acute pain episodes. Even if they don’t need NSAID every day, owners of dogs with OA will need to keep NSAIDs handy.

The supportive care required for dogs with pain from OA will vary, depending upon their level of function and their living environment. The following supportive care options apply to most canine patients with the chronic pain of OA:

• Raised food and water dishes
  Dishes placed at a level between the elbow and shoulder allow the dog to eat and drink in a spine “neutral” position. This decreases strain on the lower back.

• Restricted access to stairs
  Many dogs with joint or back pain from OA experience secondary weakness or decreased balance. It’s a good idea to protect these dogs from unsupervised access to flights of stairs. Baby gates work very well for this.

• Non-skid floor surfaces
  Dogs with OA pain need and deserve to walk without worrying about their feet going out from under them. Aside from using non-skid area rugs in high traffic areas with slick floors, you may wish to consider using interlocking foam tiles like the ones used in day care centers and work-out gyms. They are easy to install, easy to remove, and easy to clean.

• Assistive devices
  Some dogs with OA do best with the occasional helping hand, such as a fabric sling or a walking wheelchair like a K-9 Cart®.

When a dog suffers from the pain of OA, it is important to get a complete and accurate diagnosis. A normal metabolic profile clears the way to initiate NSAID therapy - - the cornerstone of pain relief. Other medications and clinically proven nutraceuticals may also be added. Nutrition is an important facet of supportive care for canine patients in pain. Finally, there are environmental modifications that can make life easier and more fun for the dog involved.