Melissa Mazzeo Melissa is an author, editor, and best friend to Phoebe (pictured) and Finian, both rescued Chihuahua mixes.

Penn Vet’s Dr. Kara Brown Talks to Big Barker About Advances in Treating Canine Joint Pain and Disease!

3 min read

Big Barker’s consulting veterinarian, Dr. Sarah Wooten, continues her interview series with this discussion with Dr. Kara Brown, Resident Fellow, Large Animal Cardiology & Ultrasonography, University of Pennsylvania School of Veterinary Medicine, New Bolton Center. We were honored to have the chance to chat with Dr. Brown about the exciting developments happening at Penn Vet. There’s something here for both dog owners and clinicians—we hope you enjoy!

Dr. Sarah Wooten: How many dogs are currently suffering from osteoarthritis in the United States?

Dr. Kara Brown: Currently there are an estimated 72 million dogs in the United States who have been diagnosed with arthritis; however, I believe this is an underestimation of the actual number of dogs who have arthritis pain because of under-reporting (i.e. dogs who are not being seen by a veterinarian or owners who are unaware that their dogs have arthritis).

SW: When I ask clients how their older pet is doing, they often say, “Oh, he is doing OK. He is slowing down, but you know, he’s getting older.” People still don’t get that “slowing down” means that something is wrong. Do you have any tips on how to explain to the general pet-owner population that “slowing down” isn’t a normal old-age change but a sign of pain or other disease?

KB: I think the first step is raising awareness that “slowing down” means there is something going on. The trick is communicating it in a way that delivers the information in a non-judgmental or -condescending way.

SW: What is your advice to veterinarians on how to do this?

KB: In focus groups with owners, it was noted that when pet owners talk about pain in their pets, they mean acute pain, such as the pain associated with trauma or acute illness. When veterinarians use the word “pain” in association with chronic pain and pet owners realize that their pet has been suffering for a long time, they feel bad or ashamed that they have been missing that fact. That awareness can actually present a barrier to care. The thought that their pet has been suffering in silence for a long time is not palatable to most loving pet owners.

Instead of talking about pain itself, describe the behaviors associated with chronic aches and pains, such as sleeping more, moving more slowly, or increased crankiness. Along that same line, instead of telling the client about the signs of chronic pain, show them. A picture is always worth a thousand words. The best way to show the client is to send them home with a one-week trial of NSAIDS (barring any pre-existing medical conditions that would preclude the use of NSAIDS) and ask the client to see if any of the behaviors improve – basically what their dog would be like once the discomfort was handled. Your clients will see the improvement in their dogs themselves.

SW: If surgery is not an option, what are your top recommendations on how to improve quality of life and reduce chronic pain in a dog with chronic joint disease?

KB:

  1. Weight control is far and away the most important, most effective, most cost-conscious at-home treatment. If your dog is overweight, work with your veterinarian to achieve a healthy weight for him or her.
  2. Engaging your dog in non-concussive force activities, like swimming, keeps muscle activity and mass up, and is an effective way to manage pain.
  3. Give a high-quality bioavailable joint supplement. Dogs have variable responses, but most of the supplements are safe, and some dogs really benefit.
  4. I recommend judicious use of NSAIDs with appropriate monitoring. In my experience, tramadol and gabapentin are not as effective for pain control unless there is neuropathic pain, which gabapentin is useful in controlling.

SW: What are the most exciting advances in pain management for canines that we should be looking for in the next 5 years?

KB: I believe the future of pain management is in joint specific treatments. Currently, pain management with NSAIDS affects the whole dog and can have negative side effects. Our research is revealing some unusual and unexpected pain-management properties of a compound called “resiniferatoxin” (RTX), a red-hot sap produced by a Moroccan cousin of the chili pepper plant. When the chemical—about 1,000 times more potent than the capsaicin that gives chili peppers their kick—makes contact with the pain-transmitted nerve cells, it spurs a rush of calcium into the cells, destroying them and providing relief from cancer’s life-depleting pain. When we give RTX in the spinal fluid in the spinal cord, those pain cells are permanently deleted, and they can’t send the signal.

We studied this compound on its ability to reduce pain in dogs with cancer.  After taking injections of RTX, dogs who were virtually immobile due to pain were able to run and jump almost as if they felt no pain at all. The cancer persisted—and eventually proved fatal—but owners reported weeks or months of happy times after RTX treatment.

RTX can only be delivered by spinal injection and patients must be anesthetized during application. I believe it could eventually provide another tool in doctors’ and veterinarians’ ongoing fight to relieve pain.

Other exciting advancements include research into joint-specific stem cells and long-lasting intra-articular treatments. Stay tuned!

SW: Can you walk me through how to utilize the Canine Brief Pain Inventory (CBPI) in private practice, and how to help pet owners utilize this tool?

KB: The Canine Brief Pain Inventory (Canine BPI) allows owners to rate the severity of their dog’s pain and the degree to which that pain interferes with function. Initially developed to assess pain related to osteoarthritis, the Canine BPI has been shown to be an appropriate measure for pain caused by bone cancer as well.

The inventory can be useful in raising client awareness of their dog’s pain, and it can also be used to evaluate whether your pain-management strategies are actually helping your patients. It uses quantitative statistical results based on the owner’s perception of their dog’s behavior at home.

While this tool was originally developed for research purposes, it has been downloaded all over the world for use in private practice, especially in canine rehabilitation. In order for the results to be valid, the same owner has to fill out the questionnaire each time, even if there is more than one owner. The survey can be downloaded at

http://www.vet.upenn.edu/research/clinical-trials/vcic/pennchart/cbpi-tool

 

Dr. Sarah Wooten is Big Barker’s consulting veterinarian. Dr. Wooten is a small animal veterinarian with more than 15 years of clinical experience. She is an expert contributor to sites such as vetstreet.com, DVM360.com, and The Bark Magazine.

Melissa Mazzeo
Melissa Mazzeo Melissa is an author, editor, and best friend to Phoebe (pictured) and Finian, both rescued Chihuahua mixes.

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