I recently acupunctured a 13-year-old Sheltie whose owner had heard that acupuncture was an effective way to relieve arthritis pain in dogs. I sat with the Sheltie lying at my feet as the owner described the dog’s “clicking” in the hind legs and difficulty getting up off the floor. One of the questions I asked was, “Is your dog on a joint supplement?”
When the owner responded with a no, I have to confess, my heart leaped with joy. The only place we had to go with this dog was UP!
1+1+1 can equal 5: Why combining therapies improves results for your arthritic dog
Though I did acupuncture the dog that day, we also talked about a host of other options for treating her grey-muzzled Sheltie. Why? Because the ideal way to relieve arthritis pain in dogs is with a multi-modal (or combination) approach.
Treatment is designed to harness the power of synergism. I like to explain this as taking a “1 + 1 + 1 equals 5” approach. In other words, by using a combination of therapies, you can supercharge the outcome through a collective effect.
In our culture, the knee-jerk reaction for treating a painful condition, such as arthritis, is taking medication to alleviate discomfort. And while medication is absolutely an important part of relieving arthritis pain in dogs, there are so many more options that can help dogs feel and move better.
Since arthritis is not a curable condition, a flexible approach that incorporates pain relief, exercise, diet management, and alternative medicine is optimal for management. Ultimately, the goal is excellent quality of life and good mobility with minimal pain.
How to relieve arthritis pain in dogs: the ultimate guide
As promised in Part I of our series on canine arthritis (Canine Arthritis or Aging? Learn the 7 Signs of Arthritis in Dogs), this week, we follow up with the heart of the message—how to relieve arthritis pain in dogs. And I’d recommend you grab a cup of coffee and prop up your feet because this is intended to be a thorough discussion. I’ll cover the full gamut of options—from the best medications for arthritis in dogs to alternative treatment options.
PART 1: PAIN MEDICATIONS
The facts about using pain meds to relieve arthritis pain in dogs
Non-steroidal anti inflammatories (NSAIDs)
These are the oldest and most frequently used medications for the treatment of arthritis. Aspirin was once the regularly prescribed over-the-counter medication for dogs in pain. And you can still find it available through online pet pharmacies, which frankly causes me distress. This is because more potent and safer canine-specific medications have largely replaced the use of aspirin in veterinary medicine.
Aspirin inhibits platelets, which are cell fragments critical to blood clotting. The anti-clotting effect of aspirin lasts a week or longer. Aspirin can also interact with the medications veterinarians use leading to GI ulceration. So if a client gives aspirin at home—even one dose—I’m hindered from prescribing safer, more effective veterinary NSAIDs for seven to 10 days AFTER the last aspirin dose.
If you take away nothing else from this article, remember this:
NSAIDs work by downregulating inflammatory mediators in the body called prostaglandins. PGs, as they are known, are responsible for many normal body functions. Pertinent to our story, PGs regulate acid secretion in the stomach and blood flow to the kidneys, as well as mediate inflammation.
Common NSAIDs for relieving arthritis pain in dogs
NSAIDs are very effective at controlling pain. The most common ones in veterinary medicine include carprofen, meloxicam, deracoxib, and firocoxib. These work by decreasing inflammatory prostaglandins. The problem with these helpful drugs is that they can also downregulate the good PGs that are needed in the body—the ones that impact the stomach and kidneys. This explains why tummy upset/ulceration and impaired kidney function are the two main side effects of NSAIDs that vets worry about.
If your dog is placed on one of these medications long term, your veterinarian will likely want to monitor kidney and liver values, as well as blood cell counts, at least every six months. While these drugs are considered very safe overall, it is important to monitor for changes and be proactive about addressing concerns.
A focus of NSAID research is finding drugs that specifically target the inflammatory mediators and do not interfere with the other “good” PGs. A newer medication on the market, Galliprant® (grapiprant), is very specifically targeted at a particular inflammatory mediator called EP4 PG. This drug is thus considered to be more gentle on the kidneys.
Since it is new to the marketplace, Galliprant® remains under patent, so only the brand name is available. While expensive, it can serve as an excellent choice for dogs with preexisting organ dysfunction or in cases where ongoing monitoring is not feasible.
It’s important to note that while NSAIDs are frequently the first line of treatment for arthritic and painful dogs, this is not necessarily the best first step. Motivated by compassion and concern, we often seek a “quick fix” for what ails our beloved canine companions. Unfortunately, there is no quick fix for arthritis.
While NSAIDs may play an important role in treatment, dietary changes, exercise, modifications of your dog’s environment, and additional medical therapies can all be helpful BEFORE NSAIDs are prescribed. Some studies have even shown that NSAIDs destroy chondrocytes—the cells responsible for producing joint cartilage. This can actually cause arthritis to worsen.
In recent years, the effectiveness of tramadol for pain control in canines has come into question. Tramadol mimics the activity of opioid medications like morphine, as it binds to the same receptors in the central nervous system. Because of this, it is now classified as a controlled substance like opioids. It is questionable whether dogs can metabolize tramadol into its active form, which is what imparts the pain control effects.
Many veterinarians have abandoned the use of tramadol for pain in dogs because several studies have shown that it is a poor choice for pain management on its own. However, having prescribed tramadol to hundreds upon hundreds of patients over 15 years of veterinary practice, I am a fan of this drug as one part of multi-modal pain and mobility management for dogs.
Thankfully, I’m not on an island alone in my opinion. In a recent interview with Dr. Ralph Harvey, a specialist board certified by the American College of Veterinary Anesthesia and Analgesia, he explains how tramadol may have a different mechanism of action to help dogs. For more information, please listen to my podcast, Managing Pain in Dogs With Dr. Harvey.
Incidentally, Tramadol is bitter and many dogs despise its taste and smell. If you’re at your wit’s end trying to give your dog tramadol or other medications, help is here. Please refer to my article on how to pill a dog: Your Dog Won’t Take Pills? 5 Easy Solutions for Uncooperative Pooches.
Frequently used in human medicine to control seizures and treat nerve-related pain, gabapentin has been making waves in the veterinary medicine scene over the past decade. It has proven excellent in a variety of ways, including as a sedative for stressful procedures and possibly as adjunctive pain control.
The mechanism of action by which it treats pain is not well understood, but it seems to help dogs most with pain from the nervous system (neuropathic pain). Also, it has a large safety margin, so the dose can be adjusted according to a patient’s needs.
You might be surprised to read that amantadine is actually an antiviral agent against Influenza A in humans. As it turns out, it also has nMDA antagonist properties, which seem to make it helpful in combating discomfort. nMDA receptors are found throughout the central nervous system. When neurotransmitters bind these receptors, chronic pain can be worsened.
Amantadine antagonizes those receptors and theoretically downregulates the sensation of pain. It is thought to be most helpful in chronic pain states, which is what arthritis and joint pain represent. Studies are lacking in veterinary medicine. But in cases where the pain is poorly controlled with conventional treatments (NSAIDs and opioids), amantadine might be a useful addition to other medications.
PART 2: SUPPLEMENTS
Choosing supplements to help relieve arthritis pain in dogs
Much has been made of this supplement in both the human and veterinary worlds. There is scientific debate whether oral glucosamine and chondroitin, the two most common ingredients in joint supplements, are absorbed and improve joint mechanics. Personally, I believe the case is strong that these compounds increase the production of joint fluid and promote health of the cartilage that line the joint surfaces.
While Glucosamine and chondroitin aren’t necessarily “the magic bullet”, they are an important component in the multi-modal management of arthritis in senior dogs. Further, because the two supplements are virtually harmless, there is no reason not to try them, either as a preventative or treatment.
Dogs may respond differently to different products, expressing a type of individual variation, much like humans. Some people respond better to certain supplements or medication than others. Once starting a product, I recommend a 30-day trial for my patients. There are several options when you purchase a “joint supplement” and quality varies significantly.
Quality matters, so consult your veterinarian before choosing a joint health product. In addition to the active ingredient list, there are also other bioactive compounds which can be present and helpful along with glucosamine and chondroitin, such as MSM (methylsulfonylmethane), avocado/soybean unsaponifiables (ASU), and herbs.
Omega-3 Fatty Acids
Omega-3s reduce inflammation throughout the body, benefiting skin, eyes, bladder, brain, and joints. Their anti-inflammatory properties make them appropriate for many conditions. (I recommend this supplement for all my arthritic patients.) Two separate scientific studies in 2010 suggested that dogs with chronic osteoarthritis who were fed omega-3 fatty acids demonstrated improvement in their pain levels and arthritic conditions. I recommend Nordic Naturals Omega-3 Pet—which comes in a liquid or gel cap and can be purchased online.
New Zealand Deer Velvet
I first learned of New Zealand Deer Velvet, a joint supplement for dogs, at the 2017 American Academy of Veterinary Acupuncture annual meeting. After speaking at length with two veterinary colleagues who raved about it, I cautiously bought four bottles to try.
I gave them to my senior patients suffering from joint pain to see if the claims were true. I was somewhat surprised when every single one of them improved, and their owners requested more. Though its mechanism is not fully understood, I’ve seen deer velvet enhance energy and vitality in my patients without negative side effects.
While you might think of turmeric in terms of the kitchen, there is plenty of research in human medicine to support its anti-inflammatory effects. Currently, there is not much literature on the use of turmeric in dogs. However, it is anecdotally reported to be a useful adjunctive therapy. In other words, it “assists” the primary treatment.
As with all supplements, sourcing turmeric should be done through a company with good internal quality control. Choosing a veterinary product is important. Thorne’s CurcuVet, sold through veterinarians, is the one I prescribe.
PART 3: DIET AND WEIGHT LOSS
Keeping your arthritic dog slim is key for pain management
Keeping your dog slim is imperative in managing pain. Excessive weight on joints can exacerbate arthritis. But how do you know if your dog needs to lose weight? Purina offers the Body Condition Score chart or you can learn more by watching my YouTube video demonstration here: Canine Body Condition Score: Find Your Dog’s Number.
In general, when lightly running your fingers along your dog’s ribs, you should be able to feel them. The same is true for the spine—you should be able to palpate the spines of the vertebral bodies with gentle downward pressure. Lastly, when looking at your dog from above and behind, he or she should have a tapered waist.
This varies by breed, of course. A Bulldog at a healthy weight will not have as clearly defined a waist as a Labrador Retriever. So please keep in mind that these are generalities. Your veterinarian can help guide you in proper body condition for your dog.
Gentle, regular exercise
If weight loss is in your dog’s future, there are two important approaches. The first is gentle and regular exercise. Exercise actually helps arthritis by preventing the joints from becoming stiff. Avoid becoming a weekend warrior, however, as this can be painful for dogs. Exercise should be daily and at a pace that your dog will tolerate.
Diet restriction is the second important step in keeping your dog slim as a way to help manage arthritis pain. An easy way to reduce calories is to avoid unhealthy dog treats. Many widely available dog treats are the “McDonald’s” of dog food—delicious but full of empty calories. If your dog loves his treats, substitute healthy choices like blueberries, carrots, and sweet potatoes.
Caloric restriction can also help. The Pet Nutrition Alliance is an excellent resource for a weight loss plan, although any plan should only be undertaken with veterinary supervision. Thankfully, there are many excellent weight loss diets on the market for our dogs.
Part 4: HOME MODIFICATIONS
Making changes to everyday surroundings can help ease your dog’s arthritis pain
Slick surfaces like hardwood and tile floors, stairs, and furniture can prove difficult for painful pets. You can make your dog much more comfortable by considering some simple home modification approaches. Here are five helpful tips:
- If you have steps in your home, consider “taping” the edges of all of them. The tape will serve as a visual guide for your dog.
- At night, leave a nightlight on if your dog is prone to wander.
- If your dog likes to sleep on the bed or couch, purchase a set of dog stairs to make access easier.
- Outside the house, you can use short ramps to lessen climbing onto or off of porches, as well as to help your dog into the car.
- If your senior dog slips on the slick floors of your home, ToeGrips may be the ideal solution. Slipping and sliding not only takes a toll on a dog’s body, but walking on hardwood and tile floors can become intimidating, which clearly impacts quality of life. Applied to the dog’s toenails, ToeGrips help a dog walk on slick surfaces and can dramatically improve mobility. For more information, please read ToeGrips for Older Dogs: Bigsby’s Success Story.
PART 5: ALTERNATIVE THERAPIES
Taking a holistic approach to treating arthritis pain in dogs
Acupuncture is a large part of traditional Chinese medicine, and it is used the world over.
The theory behind acupuncture relies on energy flowing through the body (qi). It is aligned along meridians. Using needles, these meridians can be stimulated to impact the flow of qi. While this belief system is controversial, there is scientific explanation behind it, such as stimulation of nerve receptors in the region to relieve discomfort.
As a veterinarian who practices acupuncture, I believe that—like all pain management—it should be used in adjunct with other treatments. For more information on canine acupuncture, please visit the International Veterinary Acupuncture Society’s website. (As an aside, IVAS is also the organization where I received my training.)
Physical therapy and rehab
This might be one of the most helpful and underutilized tools available in treating arthritis in dogs. Thankfully, it’s one of the fastest growing aspects of veterinary medicine. Veterinarians are quickly recognizing the benefits of physical therapy for animals—which includes weight loss and mobility management for arthritic dogs.
Underwater treadmill therapy is a gentle form of exercise that helps with mobility and pain. The therapy allows the dog to exercise without overdoing it because the water supports the dog’s body mass as he or she is walking.
More and more rehabilitation centers are becoming available for pets. You can search for one near you on the American Association of Rehabilitation Veterinarian’s website.
Canine arthritis home assessment tool
The website, Canine Arthritis Management, is a top-notch, extensive resource developed by a veterinary surgeon. Its mission is to help practitioners and pet owners treat dogs with arthritic pain. It approaches the multi-modal management strategy using an excellent pyramid-based outline. Additionally, you will find tools to help you assess your dog at home. (The site also provides guidance for veterinarians.)
As your dog’s biggest advocate, please speak with your veterinarian
Finally, please find comfort in the fact that arthritis pain in dogs, while not curable, can be managed effectively. Your dog does not have to suffer! Talk to your veterinarian about the different treatment options available. Improving the quality of life for your beloved canine companion is possible.
What questions do you have about how to relieve arthritis pain in dogs?
Please comment below. We can all learn from each other.