In the session on the management of chronic pain, Dr Samantha Lindley from the University of Glasgow outlined the misconceptions often held by owners of dogs with osteoarthritis. She explained how to recognise when these false notions may create a barrier to providing effective treatment for the animal – and how best to overcome them.
Samantha reminded colleagues how difficult it can be for pet owners to identify when their animal is experiencing chronic pain. She runs clinics at Glasgow dealing with both behavioural problems and chronic pain and said that in up to 70 percent of pets referred with issues like aggression, undiagnosed pain is the underlying cause.
One common mistake made by owners was to assume that any dog willing to exercise cannot be suffering from joint pain. But unlike cats – which do become more sedentary when they are living with arthritis – dogs may continue to enjoy walks and will run around to the extent that they will be stiff and uncomfortable the next day.
“It is important for clients to understand that when dogs are exercising, they are releasing adrenaline and endorphins and at that point they won’t be feeling the pain. Sometimes dogs may actually exercise more when they are in pain because they have learned that it can distract them from the discomfort that they are feeling,” she said.
Some owners believe that the pain felt by osteoarthritis patients must have some useful biological function, such as reducing the pet’s mobility and preventing further damage to the joint. But that is based on a misunderstanding of the difference between acute pain – which will often serve as a timely warning of real or potential tissue damage – and chronic pain. The latter is entirely maladaptive and may only exist as an unwelcome side-effect of the usefulness of the acute pain response, she said.
For any treatment plan to succeed, the veterinarian must ensure that their client understands that the goal of therapy for this condition is to manage the condition rather than necessarily achieving a cure. They must also be persuaded that it is important to deal with the emotional effects of chronic pain, as well as the sensory element.
Samantha said she has sometimes encountered owners who believe that drug treatment will “only mask the pain” and can therefore have a detrimental effect on the animal’s condition. Such opinions are a clear indication that the referring veterinarian has not satisfactorily explained the goal of treatment and the importance of minimising the emotional effects of the pet’s condition, she said.
Another common misconception is a result of the stoicism shown by most domestic species experiencing a chronic disease condition. The owner’s veterinary advisors will need to explain that this is another area in which there are significant differences in the response to different types of pain – the animal will not vocalise in the same way as they would when experiencing sudden acute pain, she said.
The successful management of canine osteoarthritis will usually require a multimodal approach involving a range of different interventions. Whatever drug therapies are proposed, it is quite possible that the client will have read on the internet that the preferred option has “killed someone’s beloved pet,” she warned colleagues. One group of medications that are often claimed to have serious adverse effects are glucocorticoids. She pointed out that these drugs are a valuable component of any osteoarthritis treatment plan and the clinician should take time to explain the likely effects of every available option.
Some owners are convinced that their pet can be treated using entirely non-pharmacological methods. Dr Lindley pointed out that this is rarely possible, especially for a new patient that is likely to have developed an exaggerated pain response and will need analgesia as a first stage treatment to minimise its discomfort.
When clients appear to have misgivings about conventional medical treatment, she said it is important to question them about their underlying reasons. By incorporating strategies such as acupuncture, physiotherapy and aquatherapy into the treatment, it is often possible to address the owner’s concerns about over-medication.
“I tell them that it may be possible to reduce the medication but cannot promise that it will be drug-free. Most clients are happy with this, what is frustrating for them is to be in a situation where the dog is on five different medications and it still isn’t getting any better.”
Clients must understand that these integrated medicine techniques are not entirely risk-free either. “Patients can – and have – died when have been given acupuncture,” she warned.
But she urged colleagues to remain open-minded when clients request a form of therapy that does not appear to have been studied as extensively as proven techniques, like acupuncture or physiotherapy. “Scientifically their ideas may be nonsense but owners will continue to seek these alternative forms of treatment. It may be helpful to find whether there is some good in them rather than to dismiss them out of hand.”