How To Treat Arthritis in Dogs and Cats: The Drug Truth
Arthritis in cats and dogs is a painful condition so what drugs are the best pain killers to give them? Are you worried about how safe they are? And how do we monitor our pets to make sure they are as pain free as possible without developing side effects?
If you haven't checked out the first two articles in this arthritis series then click through to find out all about arthritis and its diagnosis as well as the options for a holistic, drug free treatment of arthritis in dogs and cats.
Arthritis is however a progressive disease and at some point both our arthritic dogs and cats will need pain killing medication. If we deny them this treatment then we are failing to keep them as comfortable as possible and their quality of life will suffer as a result. There are a lot of myths and scare stories about the use of pain killers in dogs and cats which I will attempt to correct as our pets right to a pain free life is something I feel very strongly about.
First though, let me ask you this question:
If you were suffering from chronic pain would you rather take a drug that had a small risk of side effects or would you rather just live with the pain?
If you would rather completely avoid the risk of side effects and live in pain then would you even exclude something as common as aspirin (acetylsalicylic acid)? Did you know that this drug results in the annual death of approximately 3,000 people in the UK and up to 16,500 people in the US with a further 100,000 needing to be hospitalised.
There is no such thing as a drug that works as claimed without any risk of side-effects. If someone claims there is then you have to ask if the drug actually does anything at all.
Non steroidal anti inflammatory drugs (NSAIDS)
The most common medications given to alleviate the pain and inflammation associated with the crippling disease of osteoarthritis are known as non-steroidal anti-inflammatory drugs. Some common examples include carprofen, meloxicam, firocoxib and mavacoxib.
These drugs are available under many many different trade names worldwide with the most commonly known likely to be Rimadyl and Metacam. They are used in the treatment of both short term acute pain, such as following an injury or surgery, as well as being used to aid the management of long term chronic pain. Just like that found in arthritis.
These drugs work by reducing pain, inflammation and fever by stopping the formation of proteins needed for these events to occur. Side effects are uncommon and when they do occur are most often related to the intestines with diarrhoea and occasional vomiting being seen. If these develop then the drug should be stopped and your vet consulted.
If the drug is continued to be given, if they are given alongside other NSAIDs (such as aspirin or ibuprofen) or with steroids or if an overdose is administered then fatal ulceration and perforation of the stomach and intestines can occur (although this is not something I have ever witnessed or heard to have happened from any of my colleagues - it is very rare). If used appropriately the risk of this is absolutely tiny.
More serious side-effects are very rare but can include liver damage and kidney damage, or these conditions may be exacerbated if they are already present. It is exactly for this reason that monitoring blood samples are highly recommended in any patient, both before they start on long term NSAIDs and also periodically during treatment. Similarly if any concerns are noted such as a loss of appetite or increase in thirst, again the drug should be discontinued and advise sought from your vet.
All this being said the risk should not be overstated. Follow the dosing instructions, monitor your pet as advised and stop if any side effects are noted and the chance of a significant issue is very small indeed. These drugs are proven to be incredibly effective at relieving pain, improving mobility and greatly increasing an arthritic patients quality of life. They generally offer the best chance of making sure your pet is as pain free as possible.
For a complete in depth look at the safety of these drugs and how to minimize the risk of side effects then check out:
Alternatives to NSAIDs
Having said all that, our non steroidal anti inflammatories are not the be all and end all when it comes to relieving the pain caused by arthritis. There are several other options available for use in those animals which are still painful despite their use or for use in those patients for whom non-steroidal use should be avoided. This might be due to pre-existing kidney or liver disease as well as individuals who have previously experienced side effects.
These drugs all work at different levels of the pain pathway within the body and so can be given at the same time as each other in most cases. This may mean that an arthritic patient with advanced disease may need 2 or 3 different pain killers to ensure they are pain free with a good quality of life. This is the key point: a good quality of life. There is little point in my mind in restricting our painful patients to a single drug treatment if their quality of life remains poor.
Paracetamol (acetaminophen, tylenol) is one such drug that can be used in dogs only. It must never be given to cats as even a small dose will kill them. Used correctly in dogs though it is generally very safe and provides good additional pain relief with little risk of GI upset. Overdose can cause liver damage so care needs to be taken to dose appropriately. Dogs are not little humans.
Opiods related to morphine, such as tramadol and buprenorphine, can also be used in chronic pain situations. These act on the nervous system by preventing the transmission of pain signals to the brain. Buprenorphine is an effective pain killer for moderate pain and can be administered into the cheek or under the tongue as well as by injection. It is not typically used as a long term treatment but may be used where lameness becomes suddenly worse and it is more commonly used in cats compared to dogs.
Tramadol is also an opioid, although it works on different receptors to buprenorphine. It does not work for very long in dogs compared to people and its effect is less, as well as being much less predictable. It may provide enough additional pain relief when combined with other pain killing medications but I would be cautious about using it alone, especially for the treatment of advanced arthritis.
Gabapentin is another common drug used in the control of chronic pain. This is an anti fitting or anti seizure medication that has pain killing properties. It is commonly used when non-steroidal anti inflammatories fail to adequately control arthritic pain. While it can cause drowsiness and in-coordination these typically pass once an animal becomes used to taking it.
Amantidine is the final more common drug used in addition to NSAIDs. Although primarily a human antiviral and anti-Parkinson medication it has been recognised as having a place in the treatment of chronic pain. Again it is generally well tolerated although side-effects may include intestinal upset and agitation.
The bottom line with analgesic or pain killing medications is that there are several options which allows for a large number of different combinations to be trialed as felt appropriate for each individual. This may mean that several combinations of both drug type and dose given may need be worked through before the best plan for an individual is reached. This gives our arthritic patients the best chance of being pain free and as a result happy and mobile for as long as possible.
Perhaps the final treatment for arthritis is surgery. This is only an appropriate path for a small minority of patients. Joint replacement technology and surgical expertise are improving all the time and there are also several other salvage procedures to limit the effects of or to alleviate the pain due to hip dysplasia specifically. These options are definitely best discussed with your personal vet and the procedures are generally more specialist in nature.
How do we know treatment is working?
So we've started treatment. We had better be sure that it is working as well as we hope and that our pet is as pain free as possible so they can really get on with enjoying their life. We know that arthritis is a progressive condition and that despite our best efforts it will get worse in the future. This means we need to keep looking out for all of the signs of arthritis that let us know our cat or dog was suffering from the disease in the first place. This time though we should know exactly what to expect in our own individual animal.
Every dog or cat exhibits pain in a slightly different way and if you know how your pet shows discomfort you can act quickly. Don't be the owner who thinks that because you are giving fish oil and even anti-inflammatories your pet must be comfortable. If they are slow to get going in the morning, if they are withdrawn, if they struggle jumping then they may still be in pain and additional treatment may be needed.
Just as with the original diagnosis the longer the delay in starting treatment the harder it is to get pain levels back under control. Additional treatment may doesn't always mean drugs either. Further environmental management or the addition of different physical therapies may again make enough of a difference.
Monitoring our seniors (avoiding side-effects, maximising benefit)
As already discussed, cats and dogs on drug therapies should be having regular blood and urine testing to monitor body health and reduce the chance of side-effects becoming a serious problem. It is the non-steroidal anti-inflammatories that generally require the most monitoring with kidney and liver testing being most important. A pre-treatment blood test is always a good idea with scheduled follow ups as deemed appropriate for each individual pet. Blood testing won't always pick up every problem though so it's just as important to know what potential side effects a drug may cause and so what to look out for in your pet along with the action that should be taken if side effects do occur.
Unfortunately even with the best detection, treatment and monitoring, arthritis is a progressive condition. It will get worse with time. The good news however is that with all of the strategies I've discussed in this series there has never been a better time to be a cat or dog with arthritis. We are generally able to keep our arthritic dogs and cats comfortable and mobile with an excellent quality of life for far longer than ever before. If our pets stay otherwise healthy though, there will come a time when no further treatment options are left and their quality of life will start to suffer. At this point we will need to consider making that last difficult decision. We can do so much for our painful patients but unfortunately we can't turn back the clock completely. We should not let them suffer from long term untreatable pain merely existing rather than living. Quality of life is key.
I hope you're pet will really benefit from this series on arthritis and it will go some way towards living a happier pain free life. If you have any questions, comments or if you would like to share any stories about your own experiences of having a pet with arthritis then I would love to hear them and share them with the community in the comments below. Also consider signing up to the newsletter so you don't miss out on future content and let me continue to help you and your pet.
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