Oh’ Dem Achy Bones – Part 2
by Dr. Janice Mitchell
With cold winter temperatures and the accompanying stiff achey bodies, part two of this article, as promised, will focus on the supplements and medications used to combat chronic joint pain.
There are numerous treatments and products to manage joint pain.
Each one has proponents and detractors. One thing that is agreed on by experts is that arthritis management should be “multimodal” which means best results come when many different approaches are used concurrently.
Let’s start with the cartilage and muscle support supplements.
The body has natural mechanisms to rebuild damaged cartilage and improve muscle mass on its own but these mechanisms require raw materials. A common method of addressing arthritis, especially when it is in earlier stages, is to provide these materials orally as nutritional supplements. There are two important caveats:
• First, these products require weeks to build up in the body to a point where there is a detectable result. They are considered slow-acting, plus their effects are generally mild.
• You can identify products that have been authorized for sale in Canada by looking for the eight-digit Natural Product Number (NPN) or Homeopathic Medicine Number (DIN-HM) on the label. A NPN or DINHM means that the product can be legally sold in Canada and is safe and effective when used according to the instructions on the label.
1. Glucosamine and chondroitin sulfate.
These products are cartilage components harvested chiefly from sea mollusks. By taking these components orally, the patient is able to have plenty of the necessary building blocks needed to repair damaged cartilage.
2. Creatine: Creatine is a substance contained mostly in muscle and taking supplements in modest doses will improve endurance and muscle strength.
3. MSM (Methyl Sulfonyl Methane): MSM provides nutritional building blocks for cartilage repair. Beyond this, MSM seems to have anti-inflammatory properties and may act as an antioxidant.
4. Hyaluronic acid: Helpful especially in the production of lubricating joint (synovial) fluid.
There are also a number of natural extracts and herbal products with anti-inflammatory properties. Some are anti-oxidants while others interfere with the inflammatory cascade to limit pain as well as the inflammation.
Most are modest in their abilities. Some are fast acting while others must build up in the body for several weeks. For brevity purposes, I will list off the commonly used anti-inflammatory supplements.
1. Green-lipped mussel extract
2. Omega Three Fatty acids: derived from cold-water fish oils, this supplement has primarily been used to treat itchy skin but has also benefited many arthritic dogs and cats. These products require at least one month to build up to adequate amounts.
3. Devils’ Claw (a South African herb) and similar plant polyphenols like turmeric.
4. Cannabinoids – currently there are numerous legal and regulatory issues surrounding this one.
5. Antioxidants such as Vitamin C, Vitamin E, sAMe – they help inactivate free radical molecules and slow age-related changes.
And now for the prescription medications. Two major categories include the anti-inflammatories (known as the Non-Steroidal Anti-Inflammatories or NSAIDS) and the straight pain relief medications.
NSAIDS work by suppressing the effects of prostaglandins.
Prostaglandins are important mediators of inflammation and pain in joints and we definitely want less of them. That said, there are “good” prostaglandins that one needs to maintain kidney and stomach circulation.
So we want to hamper bad prostaglandins and leave the good ones alone.
Common NSAIDS that achieve this are prescribed by your veterinarian and may include meloxicam, deracoxib and robenacoxib to name a few. Cats are uniquely sensitive to these medications as the feline liver processes them extremely slowly. Meloxicam and robenacoxib are approved for cats and only for extremely brief use (single use or a few days only).
What about aspirin? Human beings are much more resistant to the problems caused by suppressing good prostaglandins. Most of us can just grab a bottle of ibuprofen or aspirin out of the medicine cabinet and take a couple of pills when we have inflammatory pain. The problem with the human over-the-counter NSAIDS is that they suppress all prostaglandins both good and bad and this is not really optimal/safe pain treatment for dogs and is out of the question for cats. When it comes to NSAIDs, it is crucial to consult your veterinarian.
Straight pain relief medications, such as gabapentin and tramadol, do nothing for the disease process but they do help with the pain. They can be combined with each other and/or with any of the other medications/supplements listed here. These medications have some potential for drowsiness that will make a weak animal even weaker, so it is important to find the dose that relieves pain and improves mobility without making the pet sleepy.
In conclusion, the arthritic pet has a large menu of medications to select from and while proper medication is an important part of therapy, weight control and proper exercise should not be forgotten. Proper exercise is excellent physical therapy for the arthritic pet, as it is crucial to maintain as much muscle mass as possible to support the abnormal joint. Remember, treatment for joint disease is likely to involve a combination of medications in addition to physical activities and to check with your veterinarian before attempting to assemble a regimen on your own.