Arthritis Pain Relief for Dogs: Alleviating Your Best Friend's Pain Safely
Meet the Expert: Dr. Jules Benson of Petplan
Managing Arthritis Pain Relief for Dogs
Nobody wants to see a pet suffer. If your canine buddy has a painful condition such as arthritis, you want to know what medications are safe to use for arthritis pain relief for dogs.
To get the best answers and advice for you about what to use to alleviate your pet's pain, we interviewed Dr. Jules Benson with Petplan.
Dr. Benson trained in the UK and graduated from the University of Liverpool. He expatriated to the US in 2006 and practices in Pennsylvania. Here is what he had to say about relieving your dog's pain
Donna Cosmato (DC): What types of prescription medicines are approved for use in dogs with arthritis?
Dr. Benson: Non-steroidal anti-inflammatory drugs (NSAIDs), opioids (tramadol, fentanyl), NMDA receptor antagonists (amantadine) and PSGAGs (Adequan).
DC: What is a NSAID?
Dr. Benson: The new generation of non-steroidal anti-inflammatory drugs is aimed at inhibiting a specific enzyme pathway that results in cyclooxygenase (COX) production. But specifically, they look to inhibit COX-2, which is involved in inflammation and pain, over COX-1, which is primarily responsible for what we commonly refer to as “housekeeping” enzymes.
DC: What are the FDA-approved NSAIDS for canine use? In what forms are these medications available?
Dr. Benson: Rimadyl (carprofen) – injectable, caplets and chewable tablets, used to relieve pain and reduce inflammation in dogs suffering from osteoarthritis or recovering from surgery. (Pfizer)
Deramaxx (deracoxib) – Available in a flavored, chewable tablet, it is used to treat pain and inflammation in cases of osteoarthritis or for those animals recovering from orthopedic surgery. (Novartis)
Metacam (meloxicam) – injectable, oral suspension, it is used to control pain and inflammation in patients with osteoarthritis and comes in oral syrup. (Boehringer Ingelheim)
Previcox (firocoxib) – used to reduce pain and inflammation for canines with osteoarthritis or post-operative pain and comes as chewable tablets. (Merial)
Your Vet Can Recommend the Best Pain Reliever
Note About Other Prescription Drugs for Canine Arthritis
DC: Two other prescriptions drugs sometimes prescribed for arthritis pain relief for dogs are Tepoxalin and Etodolac. The brand name for Tepoxalin is Zubrin; it is available as a rapidly disintegrating tablet. It is useful for controlling pain and inflammation and increasing mobility for arthritic patients. Dr. Benson did not include it on his list because he has never prescribed it.
The brand name for etodolac is Etogesic. It is available in tablet form and used to relieve pain and reduce swelling in arthritic canines. He omitted it because he feels there are other drugs that do a better job of relieving pain with fewer side effects.
Dr. Benson: To clarify, I use one of these three—Rimadyl, Deramaxx or Metacam—on a situational basis. Some dogs react better to one or the other but usually with those three I find one that works.
DC: So, primarily, you are working with and prescribing medications that you have used and trust?
Dr. Benson: That is correct. That is the safest way to practice.
DC: If the veterinarian prescribes an injectable form of a pain relief medication, can the owners do the injection themselves?
Dr.Benson: It depends. Veterinarians will not generally send home injectable forms of opioid medications like buprenorphine because of the risk of abuse. Additionally, NSAIDs are usually just as available by mouth as they are by injection, so oral use is recommended. However, it is common for owners to be trained on how to give injections of Adequan.
DC: What are the common side effects of each of these drugs?
Dr. Benson: Side effects are unusual when used at therapeutic doses, but it is normal to monitor the pet closely for at least the first 30 days when taking a medication consistently, and then at least every six months.
Side effects include:
- Gastrointestinal disease – Inhibition of some of the COX-1 enzymes can lead to disruption of the gastric mucosa.
- Kidney disease – COX enzymes play a small role in maintaining a proper blood supply to the kidneys, so NSAIDs are generally avoided in pets where there is existing kidney disease.
- Liver disease – Some pets may exhibit a direct hepatotoxic reaction to NSAIDs.
- Platelet function – Some NSAIDs can be associated with decreased clotting times (particularly aspirin)
DC: Are there breeds that are prone to developing arthritis?
Dr Benson: Yes, absolutely! You can very broadly say that large breed dogs are going to be more prone (especially to hip arthritis) than small size breeds. It is all mechanical; they have more weight on those joints proportionally.
With giant breed dogs like Newfoundlands and Swiss Mountain dogs, their life expectancy isn’t huge to start with. They have a life expectation of seven to eight years so by the time they reach seven or eight years, they may have mild arthritis.
These breeds are just not designed to live that long. In addition, they are not really designed by nature; we designed them and bred them, so there are inherent problems with that.
Bulldogs generally have terrible hips and a lot of the larger breed dogs such as German Shepherds also have poorly formed hips. Of course, this is just a generalization as there are obviously some German Shepherds that don’t have any problems at all.
By six to eight years of age, there are some hip problems in most Labs, most Golden Retrievers, most German Shepherds, and certainly most large breed dogs like Newfoundlands or Great Danes.
DC: Are there any over the counter (OTC) drugs that are effective as arthritis pain relievers for dogs?
Dr. Benson: Historically, aspirin has been used, and while this is cheap and can have significant analgesic effects, there are more effective and much safer drugs available. The most common problems we see with aspirin use are severe gastric ulceration and hemorrhage combined with clotting disorders.
Other OTC “painkillers” that we use in humans are highly toxic to dogs—for example, ibuprofen and acetaminophen—and accidental ingestion of these drugs is the top cause of serious poisoning in dogs.
DC: What are the risks of owners using OTC drugs for relieving pain in arthritic dogs?
Dr. Benson: Use of non-veterinary products can result in life-threatening poisoning and is a common occurrence.
DC: Are there any natural remedies such as vitamins or herbal supplements?
Dr. Benson: Use of oral nutraceuticals containing glucosamine/chondroitin has been anecdotally effective, but lacks what is considered scientific support. That is similarly the case with powdered green-lipped mussel extract.
Supplementing omega-3 fatty acids is considered wise, and I like the Nordic Naturals line of cod liver oil for pets, but there’s also a relatively new prescription food by Hill’s, j/d, that is specially formulated to help with mobility. It contains some chondroitin and helps maintain a healthy weight, but focuses on providing the correct balance of essential fatty acids.
There are several non-drug therapies that, again, may lack what is considered hard scientific backing, but that many clinicians feel are beneficial, including acupuncture and electroacupuncture, acupressure and transcutaneous electrical nerve stimulation. Similarly, there is laser therapy and shockwave therapy.
Stem cell therapy is a relatively new modality that some clinicians are finding useful in select cases but it is a somewhat costly surgical process with mixed results, so has been growing somewhat slowly.
As with humans, some degree of physical therapy can be useful in some cases (active, controlled exercise, including swimming), and other physical therapies like cold and heat therapy, massage therapy, passive physiotherapy and hydrotherapy are gaining popularity.
DC: What else should readers know about arthritis pain relief for dogs?
Dr. Benson: Of all the things you can do to help your dog, maintaining a healthy weight has to be number one on the list for a long and healthy life. It starts at the food bowl and snack jar. A recent study showed that dogs that were fed 25% less than their counterparts enjoyed an average of almost two more healthy years. (http://www.longliveyourdog.com/twoplus/)
Weight control is such an important aspect of joint disease that some orthopedic surgeons refuse to operate on an overweight dog until some weight loss has occurred.
DC: Dr. Benson, are there any last thoughts or recommendations that you want to make to our readers?
Dr. Benson: I think the weight issue is really important. I know I kind of bang on that in my last answer, but it is one of those things that is crucial. If you can keep a dog at a healthy weight, it goes so far in solving any problems that crop up later in life.
It sounds fairly simple but many people have problems keeping their dogs at a healthy weight. I’m not sure if the dogs are begging or if the owners are unsure of what to feed them.
It is really important to feed a high quality food and to feed properly so that you are not overfeeding. I think some breeds are more prone to gaining weight than others are. It is hard to keep breeds like Corgis, Pugs and to some degree, Labs within a good weight range. They are all prone to becoming overweight. With proper feeding habits and a proper amount of exercise, you can certainly do it.
The one thing I would touch on again is I think the idea has been that as pets get older they “slow down.” Many people come into me and they say “Well, he’s just slowing down; it’s just age.”
However, a lot of the time, the issue is chronic pain. If you feel their joints and see how far their hips move, we can put it down to chronic pain. If we can address some of that pain, the quality of life of some of these pets can be increased exponentially. It is amazing to see at times.
I know that owners get worried about giving medications over long periods, but I always look at it as a quality of life issue. If the pet is in chronic pain now, isn’t it better to give some degree of comfort relief from that?
Most of these medications are very safe. We test and try to make sure there are no adverse effects. Generally speaking, 99.9% of these medications are successful treatment options. I think it is one of those things where whenever we think of just growing old and just slowing down, there is often some underlying issue that we can fix.
It is important for owners to realize that and to understand the situation is not just that “Rover wants to sit in the corner.” Rover wants to sit in the corner because he doesn’t want to get up that much as his hips or elbows hurt.
Almost all these agents, with the exception of perhaps the opiods, slow down chronic inflammation and the destructive process. Chronic inflammation is a great way to further damage tissue. When we slow the inflammation process, we slow down the damage.
Over the Counter (OTC) or Prescription Drugs?
Given the overwhelming evidence presented here by Dr. Benson, it makes sense that using any OTC medication for pain relief for arthritis in dogs should done only on the advice of a veterinarian who can determine the correct weight-appropriate dose or prescribe a more appropriate prescription drug.
Research in animal medicines—like research in human medicines—is ongoing and new treatments are continually developed. Always take your dogs for regular veterinarian checkups. As a professional, your vet has the best qualification to monitor your pet’s health and make the proper recommendations when and if treatment for pain is necessary.
Dr. Benson's Response to Reader Carol Oding's Question
Recently, Carol Oding asked the following questions about her cat's arthritis in the comments section of this hub. Here is Dr. Benson's reply to her question: "Thanks for the article. I have an 11 year old cat with arthritis in her elbow. We tried acupuncture, but she's so afraid of going to the vet that I wonder if the stress doesn't outweigh the help. Do you have any suggestions?"
Response prepared by Dr. Jules Benson, VP of Veterinary Services at Petplan Pet Insurance
“It’s a great question. Cats can be tough customers – not only is their degree of pain or discomfort often difficult to judge, but taking some cats to the vet can be a stressful experience for all involved. I think this really boils down to whether the acupuncture is relieving the pain. As far as the stress is concerned, so long as the pet doesn’t have any cardiac or respiratory disease, if the visits are beneficial, then the “stress” is a fair trade-off.
With acupuncture, generally several sessions are warranted to see whether there’s clinical improvement. Assessing pain with cats can be difficult, but if mobility, attitude, appetite, or any combination of these three is improved after acupuncture visits, that’s generally a good sign.
Unfortunately, there are fewer options for dealing with orthopedic pain long-term in cats than in dogs – non-steroidal anti-inflammatory drugs can be used, but carry a higher risk of complication. Many vets have started using nutraceutical products like Cosequin and Adequan. Adequan especially is an interesting treatment modality – given as a regular injection, Adequan aims to decrease inflammation within the joint and decrease the rate of any arthritic changes. While Adequan is only licensed for dogs, more and more vets are using it safely in felines too. Ask your vet for more details.”
Email and follow-up telephone interview with Dr. Jules Benson, Petplan, 12/04/2011
Email response to my request for Dr. Benson to answer a reader's questions, 01/09/2012