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Pain management - Do any supplements work?

Horse Care
#1

Long story short, my 20 year old retired gelding has significant arthritic changes in his hocks. He acts like a horse with shivers when you pick up his hooves just to pick them out. The vets say there’s nowhere to inject anymore and they don’t think systemic injections (e.q. adequan) will help based on the extent of the damage radiographs. He’s on 57mg previcox/equioxx a day.

I’ve tried a few supplements… high doses of MSM… He’s on SmartComfort now. Have you found anything that might provide some relief? We are past the point of glucosamine, hyaluronic acid, and chondroitin sulfate being of much benefit. Any other suggestions?

I’m absolutely open to quality of life discussions, which I’ve raised with the vet. They’ve both said they don’t think we’re there yet.

#2

My mare is 24 and also on Equioxx. I’m not sure it helps her at all. I’ve tried a few different oral supplements as well as Adequan and joint injections. Never a very noticeable improvement. About a month ago I started her on Cosequin with MSM. I do think it is helping her. She doesn’t take as long to warm up, isn’t as stiff walking out of her stall, is more enthusiastic in general. Some days she feels like she’s gliding around the arena. Definitely try it if you haven’t already. I think it’s the only oral supplement with proven results.

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#3

No. Devil’s Claw and Yucca both have anti-inflammatory properties, but both are less reliable and less consistent than the FDA approved options: bute, banamine, and previcox. Some horses respond better to one than the others, so if you haven’t already, consider switching for two weeks to see if you notice a difference. You can also double-up (dose two different NSAIDS simultaneously) for a short period of time to get through a farrier appointment for instance. It does sound like you may be past the Adequan, Legend, Pentosan discussion.

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#4

Thanks. We use dormosedan for farrier appointments. I haven’t used bute on him in years because the equioxx worked better, but maybe it’s time to try that again.

#5

Have you tried to shockwave his hocks? It should cost about the same as joint injections and may provide some relief.

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#6

I think at this point with the arthritis where it is, you are more looking for something a bit stronger then an oral supplement. Oral supplements are more a preventative instead of a fix.

Although I always plug Triacta HA wherever I can, because it’s amazing. I don’t think you’re at a point where a supplement can provide much.

Have you looked into Previcox? It should help with inflammation and is easier on their stomachs. Highly recommend giving it a shot considering your horses age and your vet thinking no more injections will help. It’s more about keeping him comfortable at this point.

If you can do BOT to help with blood flow or red light therapy, it’s always a great idea.

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#7

So…I guess I see this horse as a very realistic candidate for euthanasia.

Not even being able to stand on three legs for a few moments to have his feet picked out without a strong physical response that indicates he’s experiencing much more pain, to me, is a red flag. The next step is you’ll find him down and unable to rise, and at that point he’s made the decision for you.

If he’s not a candidate for injections anymore, I would assume it is because there is literally no more cartilage left to lubricate…he’s bone on bone in probably multiple hock joints, which can be excruciatingly painful (ask anyone who has ever had hip replacement/knee replacement due to advanced OA). So your options really come down to how well you can manage his pain symptoms, which in this case means I don’t see much of an anything beyond pain medication being useful, and he’s already on Previcox.

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#8

It was after my old gelding got to that point that I scheduled his euthanasia. I’m so sorry that you’re having the same experience.

We did buy my horse about six more months of relative comfort with gabapentin, in addition to the Equioxx he was already on. It’s worth trying if your vet thinks it might help, and it’s not a terribly expensive drug.

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#9

:point_down: :point_down: :slight_smile:

Other than needing help for the farrier, how does he move otherwise? Does he lie down to sleep? Does he struggle to get up?

I’m not sure if your OP means that the HA/glucosamine/etc didn’t work on their own so then you went to firocoxib. I know he’s on the SmartComfort now, but I’d be careful of adding Devil’s Claw to firocoxib.

Acti-flex has a good amount of several proven ingredients, including HA (not in the SC), that is fairly economical even if you double-dosed it, so might be worth a try. Even if it doesn’t actively help the hocks, no doubt the hocks are taking a toll on the rest of his body, so maaayyyybe the combination of these ingredients will help enough elsewhere.

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#10

I don’t have a ton of experience in this area but I did rescue an older TB mare who had arthritis pain in her right front due to a previous injury. I did oral supplements but really the thing that helped her most was on her worst days I gave her Bute and the transformation was dramatic.

Given your boys age and progression I would give him what works to make him comfortable.

#11

At this point I think you have two options. Euthanasia or pain killers. While many pain drugs have long term side effects that is not really a concern in your horse’s case. Knowing that the arthritis will not get better means focusing on pain management. When the pain can no longer be managed or side effects from the drugs become an issue it is then time for euthanasia.

It is a horrible feeling to accept that all we can do is pain management because it acknowledges that the time remaining is short and we’re going to have to say goodbye sooner than later. I remember making that decision for my QH. It sucked, but it was all I could do for him.

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#12

Agreed!

#13

Completely agree with this.

But if you really want to try some more thing, I have had excellent results with Tumeric. I have a retired gelding here with a few joint issues, and farrier appointments were getting really difficult/uncomfortable for him. I’d been giving him two grams of bute for appointments, but he’d still been getting pretty difficult due to the discomfort he experiences having to stand on three legs. We put him on daily Tumeric just to see what would happen, because I had some left over that my mare wouldn’t eat, and I was astonished. I mean, I thought it’d help a little bit, but legit the last farrier appointment he didn’t need any bute and he stood like a rock. Best he’d ever been for the farrier since he’s been at my barn.

Of course, I’m sure it won’t be quite so magical for all horses but, it’s really cheap and worth a try, IMO.

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#14

Is your gelding lying down ever? If not, your vets are wrong and it IS indeed time to consider euthanasia. If he is still lying down at night, to roll, etc., then maybe something stronger or that works in a different way (gabapentin?) to help with foot picking and farrier. That said, if my horse had that much difficulty with such basic requirements, I would insist that he be put down. Stronger/different drugs will only give YOU a bit more time.

If the horse is suffering with no reasonable possibility of resolution to that suffering then it is time. If there is joint fusion that will likely bring relief given time, then there is reasonable possibility, but it sounds like that is not what’s going on here. Sorry you and he are going through this.

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#15

Sascha mentioned above about gabapentin. So here’s what I’ve got going on. 19 year old mare, former show hunter. Long time broodmare. Excellent built, moving, and minded, so absolutely worth the time, effort and money; not to mention I’m helplessly attached to her. I was told when I acquired her about this time last year that she was an ET mare only because she was unable to stand when carrying a foal due to a stifle injury. No big deal, I had a recipient mare for her. I tried 3 unsuccessful flushes this year while she was till in another state, at the farm where my stallion stands.

Fast forward to this fall when I brought her home, I saw no real lameness except that she just didn’t like to push off the injured stifle when trotting. Otherwise happy, healthy, and did not seem to be in pain. Well twice in the last month she has ended up down with her bad stifle down, and unable to get up. She has to be rolled over in order to stand. I took her in for X-rays and found a spectacular bone spur, bone on bone, and some substantial bone remodeling. The mare must be incredibly stoic; my vet said he was surprised she could walk. Not only can this mare walk, she can trot and buck around with her recipient mares quite well.

We have discussed injections (will need ultrasound due to the lack of space from degraded cartilage), possibly Adaquan or Legend when we get closer to breeding season. But he prescribed both Equiox and Gabapentin. Gabapentin is (from what he told me) is used for patients with bone cancer for bone pain, as it is not just an anti-inflammatory but rather works on the neurological level. Obviously with as stoic as she seems to be, it’s hard to ask her the question “do you feel any better?”. But a few days ago, she was down with her bad stifle down and had no issue standing up on her own. Your millage may vary, and we are only a short few weeks in to this. But might be worth looking in to. I’m not at all about making a horse suffer, but I am absolutely for letting a horse tell me if they want to keep going or not. Mine seems to see no issue and she’s pretty sure she has no limitations (my anxiety says otherwise).

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#16

Thanks for your reply. When my vet and I looked at his hock rads together, my first question was “Do we need to have a quality of life discussion?” He’s known my horse since we imported him 13 years ago. And my second vet has worked on him for 8 years. They counseled me through making a quality of life decision on my pony. I trust them when they tell me they don’t think we’re at that point. But it’s always on my mind. I’ve been there a few times. My ability to keep him comfortable is obviously the primary factor. Hence why I’m here seeing if there’s anything we haven’t tried yet.

The problem isn’t the three legs he’s standing on. It’s the pain in the leg that’s raised. He struggles to put it back down.

#17

He moves shorter and flatter. He’ll trot out in the pasture, but he typically doesn’t canter more than a few steps. He lies down to sleep. He typically take 3-7 naps outside a day and he lays down in his stall at night. He does not currently struggle to get up, which I find surprising.

What’s the concern with Devil’s Claw and firocoxib?

#18

We have not tried that. I’m familiar with shock wave for muscle and soft tissue issues, but it wasn’t on my radar for arthritic issues. I’ll ask. Thanks.

#19

Thanks for the gabapentin suggests. I’ll ask about that, too. We used it on our dog for several month before we put him down, and it helped him tremendously. I appreciate all the suggestions. I’m absolutely willing to consider euthanasia, and I’ve always erred on the side of making that decision earlier rather than later. I honestly don’t think we’re there yet with him, but I’ll think on that more based on your promptings. Thank you all for the feedback!

#20

I just want to say thanks for doing all you can for an old guy, and being realistic about when enough is enough. I wish more people were like you.

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