Help for an older, terribly arthritic dog

[eventer_mi]

My female Sheltie, HRH Emma, is 11 years old and lately her arthritis has been hurting her horribly. A little history - when she was a pup, she got rolled by a horse when she was chasing the farm Border Collie around the arena (I know - bad mom). At the age of 9 she had her right hip operated on (FHO? I think it’s what it’s called). She used to do agility but then started refusing jumps and having trouble with the A-frame, so she’s mostly retired now (with the exception of a tunnel or two, which she adores).

These days she’s limping around the house, obviously uncomfortable. We have those Cool beds around the house, and she has a Back on Track bed which she ignores because she has trouble getting on and off it. I’ve got her on a joint RX (Canine 5000 - the top level stuff), and she gets acupuncture once a month. Is there any way I can make her more comfortable? With the hot weather, she’s taken to sleeping on the hard tile floors, which causes her to gimp terribly when she gets up. She was on a regimen of Adequan but it didn’t seem to do anything.

Help! What do YOU do for your arthritic dog? She still likes to play - mostly barking and doing some chasing with a soccer ball, longe whip, etc but it’s obvious she’s hurting. We take her for walks but bring along her “chariot” when she gets tired, so we can still walk her little brother and let her see the sights (she loves her chariot). I adore this little girl and want to do everything I can to extend her time with us and make her comfortable. We even considered another surgery, but the vet nixed that as it would be too invasive at her age. TIA!

[wendy]

she’s limping on the FHO leg? or some other leg? if it’s the FHO leg, it’s not arthritis- there’s no joint there anymore. Sometimes they can convert FHOs to total hip replacements which should help her a lot.

if she has any excess body weight, take it off. Give her lots of fish oil- 110 mg per kg. Give her painkillers- metacam, rimadyl, tramadol.

[chestnutmarebeware]

Deramaxx worked better for my huge lab-x pound puppy, Tilly, who had both arthritis and hip dysplasia. You may have to try several options, but when you find a pain med that works, you’ll be amazed at how much better she feels!

I also had one of the slings that goes under the belly to help Tilly negotiate the stairs down to the backyard because her hind end was so weak. I “helped” more when she went upstairs, but the light support made her more confident in both directions. Well worth the money…

[jkc313]

I would not give up on adequan injections twice a week but you need to add some better anti=inflammatories, something for neuropathic pain and a good narcotic pain medication (NOT tramadol). I would start her on 1000mg Fish Oil once a day. Were she my patient i would start her on previcox or meloxicam or deramaxx once a day, gabapentin twice a day but not hesitate to increase dose and frequency, and tablets of 10mg hydrocodone/325mg acetaminophen 2x a day. You dose that by the acetaminophen with maximum safe dose 15mg/kg 3x a day. Acupuncture is terrific. So are cold laser and massage but get the pain and inflammation under control first. There is a DMSO mixture applied topically to joints that your vet can find on VIN in the clinical pharmacology folder and the analgesia folder

[Guin]

Don’t bother with supplements; they do nothing past a certain point. Go to your vet and get Rimadyl or Deramaxx, and an RX for Tramadol. You’ll need to get the Tramadol filled at a CVS or Walgreen’s but it is cheap. Bring in the big guns here. Also, increase the acupuncture to once a week - once a month doesn’t do a lot. I found the effects from the acupuncture last about six days.

Edit: Not sure why previous poster is saying “NOT tramadol.” It is a proven painkiller and dogs suffer no side effects from it (it doesn’t “zone them out” or anything.) Furthermore it is very compatible with anti-inflammatories like Rimadyl and Deramaxx. Please go back to your vet for a pain management consultation. Drugs are really your dog’s friend now.

Edit 2: I am speaking from my own personal experience with my former old, horribly arthritic golden retriever. I will swear on a stack of bibles that the tramadol/rimadyl/acupuncture protocol gave him another six months of happy, comfortable life.

[SquishTheBunny]

NSAIDs. They should significantly help. Metacam, Dermaxx, Previcox, Rimadyl are all quite good - your vet will have a preference but generally they will all do the same thing.

You can also add tramadol and gabapentin for particularly ouchy days. Adequan cant hurt, but isnt likely to make your dog go from very painful to comfortable without additional NSAID support.

Finding a canine rehab/sports medicine vet would also be helpful. There are many stretches and accupunctures that can be done to help the muscles that are compensating for sore joints.

[Laurierace]

I personally would put my dog on pentosan. I have seen it work miracles on so many horses that I would love to try it on a dog as well.

[paulaedwina]

Tramadol gave me my Yoshi back. My vet prescribed Tramadol and Dasuquin (with MSM).

Paula

[jkc313]

The previous poster, me, has been treating chronic pain in dogs for years. If your Golden got some relief from tramadol, that’s great and I’m glad for you but you are wrong when you refer to tramadol as a “proven pain killer” or a “big Gun”. It’s not. It’s mu receptor affinity is almost non existent. It IS a fairly potent SSRI so if you did see relief it was probably due to the neuropathic component of his pain. Gabapentin works much better on neuropathic pain and that is proven. You can also increase the amount and frequency without worry. Tramadol can and will cause seratonin syndrome especially if given with certain antidepressants that have been used by us to treat pain. You speak from experience of one dog. I’ve treated hundreds and I hate this drug. It’s much more dangerous than opiods, it’s less predictable, and it’s analgesia property is minimal at best. It can be given with NSAIdS, sure, but so can opiods,APAP and a host of other drugs. In fact only aspirin, steroids, and other NSAIDS are contraindicated.
Vets have prescribed tramadol for years for 2 reasons:
1.It’s cheap
2. It wasn’t controlled.
I’ve seen so many dogs needlessly suffer and put down because a Vet would stop at Tramadol because he didn’t want to deal with the hassles of using controlled drugs, which is considerable.
Every Vet that deals with pain should subscribe to Veterinary Information Network (VIN). What they will quickly learn is that the more we learn about pain the more we realize how little we know about pain. The same is true about drugs and how they work in dogs.
I don’t want to bog down this thread but a few things need to be understood. There are different types of pain but most conditions have multiple pain types. Human orthopedic surgeons for years would not prescribe gabapentin due to the mistaken belief that pain from orthopedic causes did not have a neuropathic component. In addition to different types of pain, there are different causes. Inflammation for example which is why NSAIDS help.Pain perception occurs at multiple levels;local,pathways through the spinal cord, and the brain. Different types of pain cause the body to release chemicals some of which help, some of which cause further pain and some that will bind receptors preventing medications from working. An example is neuropathic pain which causes the opiod receptors to be bound. I hope you never herniate a disc in your neck. I have and my surgeon insisted all i needed was dilaudid and oxycontin which do nothing because they act on the mu receptor which is already bound by chemicals released by neuropathic pain.
So, it only makes sense that we attack pain in as many ways as we can without harming the pet. We should try to block pain pathways, treat inflammation, treat at the local, spinal and brain levels. We should treat pain by using medications that inhibit the effects of chemicals released by the body that make pain worse. To do this, we need to know how and where medications work, their interactions with each other if any and we need to understand where and how pain of all types exerts their effects. Frankly, we don’t know near enough but know drastically more than we did even 5 years ago. When I was taught in Vet School in the early 80s, I was told 2 ludicrous things:

1. Dogs don’t feel pain
2. Giving dogs pain medication would make things worse as they would hurt themselves.
   Those are 2 amazingly stupid statements but that was the level of pain management at the time.
   Finally, we must remember biological variation exists in dogs,people,cats, horses etc. Some people cannot take narcotics. Others have such a high tolerance they have to take “dangerous” doses for effects. Not all dogs will react the same to a drug and/or the dose of that drug. We need to know there are some universal truths, tylenol kills cats is one.
   Everyone on this thread should understand that as a profession, we Veterinarians have done a terrible job managing pain the past 50 years and are just beginning to correct that. You should also understand most of us know very little and still just robotically do what we were taught, most of which was wrong even a few years ago.

[java]

“we Veterinarians have done a terrible job managing pain the past 50 years and are just beginning to correct that. You should also understand most of us know very little and still just robotically do what we were taught, most of which was wrong even a few years ago”.

So true! The other problem with pain management in animals is the lack of controlled studies showing some of these drugs actually work so often we are left trying things that are used in human medicine but there can be huge species differences in response. NSAID’s have been well studied in animals in the recent past and have been shown to be effective and are one of the first line drugs to try for chronic arthritis. Some animals cannot tolerated NSAID’s and sometimes NSAIDS alone do not control the pain. The more pain pathways you can attack with different drugs the better, often the drugs work best together. I also like gabapentine for chronic neuropathic pain. Another very useful drug to use for neuropathic pain is amantadine. the pain-modifying effect of gabapentin is from down-regulation of calcium channels while amantadine acts as an NMDA-antagonist. In other words they work on different pathways of neuropathic pain. Amantadine by itself does not do anything but it potentiates the effect of other painkillers. Amantadine is one of the few drugs we use that has been researched (and shown to work) in dogs in combination with NSAIDs but it is often used with gabapentin and narcotics, it is quite safe to use. You can use NSAIDs, gabapentin, amantadine, narcotics all together for the best result.

I also have not been happy with response I have had when prescribing tramadol. It seems to be the drug de jour for referral practices for some reason(and they are quick to remove NSAID’s) even though studies on it’s effectiveness are lacking. I rarely use this drug anymore, just my personal observation.

[eventer_mi]

Hi everyone - thanks for the responses! One quick question - what are the long-term effects of putting a dog on Rimadyl daily? Emma has Rimadyl that we would give her when she was having a particularly bad day, but we were hesitant to give her it on a daily basis because we weren’t sure of the long-term effects. I want to do what’s best for this dog, but I don’t want to cause any other problems with medication.

[Laurierace]

[QUOTE=eventer_mi;7030784]
Hi everyone - thanks for the responses! One quick question - what are the long-term effects of putting a dog on Rimadyl daily? Emma has Rimadyl that we would give her when she was having a particularly bad day, but we were hesitant to give her it on a daily basis because we weren’t sure of the long-term effects. I want to do what’s best for this dog, but I don’t want to cause any other problems with medication.[/QUOTE]

I don’t like Rimadyl because I have seen it cause too many gastric upsets but you are at the point where you need to weigh the quality of life over the quantity of life. You do what you have to do to keep the quality of life good and worry about the ramifications when the time comes in my opinion. Been there, done that.

[SquishTheBunny]

Any NSAID you use could potentially have effects on the liver/kidneys. Also, anywhere along the GI system. Its always recommended to give with food, and to have bloodwork checked every 6 months to ensure your liver and renal functions arent compromised.

Any signs of inappetance, vomiting or diarrhea you should immediately stop.

Saying that, they are generally well tolerated in most patients - which is why they are so often recommended. Our referral practice always sends post-op orthopedic patients home on metacam (or their NSAID of choice) and also tramadol to be given IF the owners feel the patient has a particularly sore day. We do not dispense narcotics in most cases, as the dogs have epidurals or brachial plexus blocks so we rarely have much “catch up” to do with covering pain. Most clients report the extra tramadol has done the trick. I personally have seen many patients benefit from it, but no, its not the “big gun” that some people think it is. I think patients generally get better pain control from NSAIDs.

For procedures such as laminectomies, hemi’s, v-slots etc. patients will often transition from fentanyl CRI’s to a fentanyl patch + gabapentin + tramadol +NSAID.

For our arthritic patients we rarely send them home with a narcotic, most clients choose further workup for denervation or surgery, or euthanasia before they want their dog on continuous narcotics. We do frequently see septic arthritis or polyarthritis patients in hospital which are treated in hospital for a few days and do go home on a narcotic, for shorter term use.

General arthritis protocol for patients includes NSAIDs, Tramadol and Gabapentin. We often tell the owners to use the tramadol “as needed” and use the NSAID and Gabapentin on a routine basis. Polyglycan or Adequan is also recommended, as is sport rehab such as accupuncture, cold laser and stretches.

If your dog is currently only receiving an NSAID on an infrequent basis, you will likely notice a huge difference with giving it daily. I would not jump to narcotics as I have had my own dog on them for pain control and he was miserable with gastric cramping. When switched from hydromorphone to buprenorphine he was better, but was in a zombie state. But if your dog is in a lot of pain, narcotics are really the only thing that will get pain back under control. Also, legal scripting of narcotics varies between states/countries so keep that in mind as well.

[Calhoun]

I have had good luck with 50mg of Rimadyl daily on a 56lb dog and 50mg of Tramadol when she chases a rabbit and needs extra help. Have been doing this for a two years w/o side effects. Good luck with your dog.

[wendy]

but we were hesitant to give her it on a daily basis because we weren’t sure of the long-term effects.

a lot of dogs take rimadyl or metacam daily for years- many humans take metacam daily for years and years. It can cause GI upset, and generally they suggest drawing blood twice a year to see if the liver or kidney are reacting badly to the drugs.

tramadol HAS been studied for treating arthritis pain in both people and dogs, I wouldn’t hesitate to try it:

BMC Vet Res. 2012 Oct 4;8:185. doi: 10.1186/1746-6148-8-185.

Effect of analgesic therapy on clinical outcome measures in a randomized controlled trial using client-owned dogs with hip osteoarthritis.

Malek S, Sample SJ, Schwartz Z, Nemke B, Jacobson PB, Cozzi EM, Schaefer SL, Bleedorn JA, Holzman G, Muir P.

Source

Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.

Abstract

BACKGROUND:

Pain and impaired mobility because of osteoarthritis (OA) is common in dogs and humans. Efficacy studies of analgesic drug treatment of dogs with naturally occurring OA may be challenging, as a caregiver placebo effect is typically evident. However, little is known about effect sizes of common outcome-measures in canine clinical trials evaluating treatment of OA pain. Forty-nine client-owned dogs with hip OA were enrolled in a randomized, double-blinded placebo-controlled prospective trial. After a 1 week baseline period, dogs were randomly assigned to a treatment (ABT-116 - transient receptor potential vanilloid 1 (TRPV1) antagonist, Carprofen - non-steroidal anti-inflammatory drug (NSAID), Tramadol - synthetic opiate, or Placebo) for 2 weeks. Outcome-measures included physical examination parameters, owner questionnaire, activity monitoring, gait analysis, and use of rescue medication.

RESULTS:

Acute hyperthermia developed after ABT-116 treatment (P < 0.001). Treatment with carprofen (P ≤ 0.01) and tramadol (P ≤ 0.001) led to improved mobility assessed by owner questionnaire. Nighttime activity was increased after ABT-116 treatment (P = 0.01). Kinetic gait analysis did not reveal significant treatment effects. Use of rescue treatment decreased with treatment in the ABT-116 and Carprofen groups (P < 0.001). Questionnaire score and activity count at the end of treatment were correlated with age, clinical severity at trial entry, and outcome measure baseline status (SR ≥ ±0.40, P ≤ 0.005). Placebo treatment effects were evident with all variables studied.

CONCLUSION:

Treatment of hip OA in client-owned dogs is associated with a placebo effect for all variables that are commonly used for efficacy studies of analgesic drugs. This likely reflects caregiver bias or the phenomenon of regression to the mean. In the present study, outcome measures with significant effects also varied between groups, highlighting the value of using multiple outcome measures, as well as an a priori analysis of effect size associated with each measure. Effect size data from the present study could be used to inform design of future trials studying analgesic treatment of canine OA. Our results suggest that analgesic treatment with ABT-116 is not as effective as carprofen or tramadol for treatment of hip arthritis pain in client-owned dogs.

Clin Ther. 2004 Nov;26(11):1774-82.

Efficacy and tolerability of sustained-release tramadol in the treatment of symptomatic osteoarthritis of the hip or knee: a multicenter, randomized, double-blind, placebo-controlled study.

Malonne H, Coffiner M, Sonet B, Sereno A, Vanderbist F.

Source

Laboratoire de Physiologie et de Phannacologie, CP206-3, Institut de Pharmacie, Université Libre de Bruxelles,1050 Bruxelles, Belgium. hugues.malonne@ulb.ac.be

Abstract

BACKGROUND:

Opioid analgesics may be a useful alternative in patients with osteoarthritis who have not responded to first-line treatment with acetaminophen and in whom nonsteroidal anti-inflammatory drugs are contraindicated, ineffective, or poorly tolerated.

OBJECTIVE:

This study compared the efficacy and tolerability of tramadol LP 200 mg, a new once-daily,sustained-release formulation, with those of placebo in patients with osteoarthritis of the hip or knee.

METHODS:

In this multicenter, double-blind, placebo-controlled, parallel-group study, patients with osteoarthritis of the hip or knee (European League Against Rheumatism criteria) were randomized to receive either tramadol LP 200 mg once daily or placebo for 14 days. The primary efficacy end point was the change from baseline to the end of the study in scores on the Huskisson visual analog scale for pain. Secondary end points were change in the Lequesne functional discomfort index, global efficacy assessed by the patient and the investigator, time to improvement, and use of acetaminophen as rescue analgesic medication. Global tolerability was assessed by both patients and investigators at the end of the study The number and severity of adverse events occurring during the study and for 2 weeks thereafter were also recorded.

RESULTS:

Two hundred thirty patients (167 women, 63 men) were evaluable for efficacy and safety Demographic data for the tramadol and placebo groups were as follows: mean (SD) age, 67.1 (7.1) and 66.4 (92) years, respectively; female sex, 72.1% and 73.1%; and mean body weight, 74.7 (13.6) and 74.6 (14.8) kg. All patients were white. The completer analysis included 197 patients (85 tramadol, 112 placebo). Pain was significantly reduced in the tramadol LP group compared with the placebo group on day 7 (P = 0.002) and day 14 (P = 0.010). In the patient’s assessment of global efficacy, 77.6% (66) of the tramadol LP group reported improvement by day 14, compared with 59.8% (67) of the placebo group; in the investigator’s assessment, the efficacy of tramadol LP was rated very good or good for 612% (52) of patients, compared with 30.4% (34) for placebo. Improvement was reported before day 7 in 882% (75) of patients in the tramadol LP group, compared with 65.2% (73) in the placebo group (P = 0.021); the mean time from the initiation of treatment to reported improvement was 3 days for tramadol LP and 6 days for placebo (P < 0.001). Rates of response (defined as > or =30% pain reduction between days 0 and 14) were 64.7% (55) for tramadol LP and 50.0% (56) for placebo (P = 0.039); no rescue medication was used by 60.0% (51) of the tramadol LP group and 36.6% (41) of the placebo group (P - 0.001). One or more adverse event was reported by 45.0% (50) of the tramadol LP group, compared with 193% (23) of the placebo group (P < 0.001). As would be expected with an opiate agonist such as tramadol, the most common adverse events with this agent involved the gastrointestinal system (nausea, 22.5% [25] of patients; vomiting, 17.1% [19]) and the central nervous system (somnolence, 11.7% [13]).

CONCLUSIONS:

In this study, tramadol LP 200 mg was significantly more effective than placebo in alleviating pain in patients with osteoarthritis of the hip or knee. It appeared to be relatively well tolerated for an opioid compound.

PMID: 15639689 [PubMed - indexed for MEDLINE]

[BuddyRoo]

Your veterinarian is your best resource. If your pet has issues with the meds, get it looked into.

My 10YO lab is on carprofen (Rimadyl) and is doing okay. I’m on tramadol. It’s all about what works. It’s usually advised to check bloodwork for liver/kidney issues on these meds. But you have to balance it all–benefit/risk.

[Foxtrot_s]

I’m about to take our little bull terrier to the vet for the same reasons. I will make a note of some of the concerns here to ask him, so thanks for input.
She’s not getting any younger, and is a heavy, muscled dog, so even jumping off the ottoman hurts her.

[vacation1]

One thing to do with NSAIDs is to ask your vet to be conservative with the dose, and see how low you can keep it while having a positive effect. I’m wary of drug side effects, but the NSAIDs are pretty much essential for my 14-year-old collie mix. We started on Deramxx, which worked well. We switched to Metacam when the Deramaxx was unavailable (a problem with a human drug forced the maker to shut down the same factory, so a lot of people switched last year) and she suddenly started peeing enormous amounts without any control, so we went to Rimadyl. That’s been fine so far. She gets twice-a-year vet checks and bloodwork, which will hopefully keep me out in front of any side effects. Unfortunately, it seems like with older dogs you often end up with a choice between an illness that causes them discomfort/pain, and a treatment which can cause serious side effects. You know you’ll beat yourself up if the treatment hurts them, but the only option is not treating them, which will definitely hurt them. Argh.

We also tried a course of Adequan injections this spring, and while I didn’t notice a “she’s like a puppy!!!” miracle change, I do think it helped - she doesn’t limp ever now, and she had been limpy on morning walks, and her up/down action is faster.

[drawstraws]

Last fall my 12 year old heeler’s hips had gotten so bad that he could barely walk. I was having to carry all 60 pounds of him up the very steep stairs to my room a few times a day and I had to watch closely to make sure he didn’t fall down them.

Rimadyl and Tramadal did nothing for him. We also did Doxy for a couple of weeks just in case it was Lyme Disease but when the price of the meds went to $200+ for a weeks’ worth we cut those out.

We then went to Prednisone which worked great but it made him terrible to live with - he was obnoxiously hyper and because he felt like he was starving all the time he was constantly counter surfing, in the garbage, etc.

He’s now been on Previcoxx for a few months (best price I’ve found was through SmartPak - my vet just sent them the prescription) and is doing much better. He’s still a hair unsteady in the back end but seems comfortable and happy. Vets also recommended to keep him on an over-the-counter supplement (they recommended Cosequin but I bought a huge bottle of tabs online from Costco) and fish oil (also purchased from Costco). They do want me to bring him in occasionally to check his liver due to the meds, but at his age I figured it was worth the risk to let him be able to walk on his own without falling down all the time.

[stolen_virtue]

Wow, lots of replies. I have had my 13 year old Irish Wolfhound mix on HA for about a year now. She does well on it, without it she cannot get up very well and did not run to greet us. My other dog who has since passed, was also on HA for the last 3 years of his life. He died at 16 from kidney failure and was arthritic from breaking both of his front legs earlier in his life. I have had more success with HA in my dogs than horses.