Aches and chronic pain of arthritis PDF Print E-mail
News - Rubrieke
Tuesday, 28 March 2017 09:36
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Dr Liesel van der Merwe is a small animal medicine specialist. Send her your questions: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Dr Liesel van der Merwe

As our pets get older they develop conditions which can cause chronic discomfort and pain, just as we do. These include arthritis, back problems with pinched nerves and sometimes cancer.

Evaluation of pain in our pets is inherently difficult and even more so when you are at the vet because stress and anxiety can alter and blur the signs they show. Often we just think our older dogs and cats are showing normal signs of ageing when they become more inactive and slightly grumpy. However, this could be due to pain from chronic arthritis. A result of this inactivity is weight gain, which then worsens the problem.

Signs
Behavioural signs in our pets which may indicate pain are restlessness, resenting handling, depression, inactivity, reluctance to lie down and insomnia, taking a long time to urinate or defecate.

More obvious signs are abnormal posture (hunched), alterations in gait, licking or chewing at an area, trembling and increased muscle tension.

Cats are known to hide pain very effectively. In cats you can look for signs that include not grooming properly, inability to get into the litter box, aggressive behaviour when touched and being unable to jump on the bed or counter. Cats develop arthritis more frequently than previously thought.

Understanding the mechanisms of pain transmission assists your veterinarian in managing your pet’s discomfort. Inflammation occurs at the local area where the pain-causing condition occurs.

Typically inflamed areas have increased blood flow and are warm to the touch. The body produces proteins called cytokines, which are inflammatory mediators and attract white blood cells to the area where tissue irritation is occurring. This can also result in the up-regulation of nerve fibres that conduct pain.

Treatment
Treatment of pain at the local level, by treating the cause, is important. In cases of arthritis, anti-inflammatories are used to manage this aspect. Additional steps are weight loss and a good quality diet with added omega three fatty acids. There are special diets, but if these are out of your price range, then adding a good quality omega three supplement will help to reduce the inflammation of the joints in chronic arthritis.

Various joint supplements are also available with varying efficacy and individual responses reported.

Unfortunately anti-inflammatories have side effects, especially affecting the kidneys and stomach lining (ulcers). In general, these effects are very rare; my own dog has been on anti-inflammatories daily for four years now and is still healthy apart from his hip arthritis.

In dogs with pre-existing kidney disease, however, anti-inflammatories will negatively affect the kidneys and cannot be safely used.

Pain
If local management of the pain is insufficient or anti-inflammatories are contraindicated, then attention is paid to trying to limit the transmission of pain up the nerve fibres and into the spinal cord.

Pain is felt in the brain, thus the reduction of impulse to the brain will reduce the sensation of pain.

Here we are talking about the stronger morphine-type drugs which are scheduled substances and regulated by law.

These drugs act centrally in the nervous system to prevent input of painful ‘information’ and prevent the development of hypersensitivity to pain. Human medications are mainly used in veterinary medicine in this sphere.

Remember, though, not to use your own medications at home because the doses and reactions in dogs are different. Don’t even think of trying anything in cats, as they are especially sensitive to medications. Parasetamol is toxic to them and anti-inflammatories are only licensed for short-term use and only specific veterinary ones.

Because pain development, especially if chronic, involves multiple pathways, it is often unlikely that one form of treatment will completely control the signs. Treatment of pain has been likened to a pain pyramid. Anti-inflammatories and local management basic steps are the pyramid’s base. Stronger medications are added on in the cases which need it.

Multiple
When multiple medications are used together they will have a synergistic effect and the side effects can also often be reduced as the doses can be lower. So, eventually you may be using two to three different medications a day to manage your pet’s pain. This is not bad poly-pharmacy, but in fact a rational approach to the management of chronic pain in the more advanced cases.

A positive knock-on effect of pain control is that your pet will become more active again, which in turn strengthens the muscles and helps with joint health. Remember to keep exercise moderate initially otherwise you will cause further injury to the joints.

 

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