Page 155 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir author advises a 6 week trial of the client s that there may be an overall bene t of controlled
preferred combination before assessment of
exercise. A risk factor of ball and stick chasing in
the development of elbow and hip dysplasia has
clinical response.
been shown. Short periods of intense exercise
Grapipant: This is a new non-COX inhibiting (such as chasing balls, jumping and bursts of
NSAI . It targets the EP4 prostaglandin receptor intense running) may be more likely to induce
which is the primary mediator of canine lameness in dogs with osteoarthritis than
osteoarthritis pain and in ammation. It potentially controlled lead exercise over longer periods. In
has fewer side e fects than traditional NSAI s. the absence of research on this matter clients
may be asked to identify exercise patterns
Cats: Osteoarthritis is extremely common in associated with increased lameness and modify
cats with one study showing 9 of cats having their pet’s routine accordingly.
osteoarthritis. NSAI use in cats is limited with
only meloxicam licensed for long term use 14 Physiotherapy
days). However, continuous use may be A review of the evidence for physiotherapy in
tolerated and tapering the dose is companion animals is beyond the scope of this
recommended in cats. In longer term use, chapter. In humans, water- and land-based
haematology, biochemistry, urinalysis and exercises are useful in the management of
blood pressure monitoring are recommended osteoarthritic joints and the author believes a
at least every 6 months . abapentin is an combination of water- and land-based
e ective analgesic in cats with orthopaedic pain exercises is an important part of multimodal
and amantadine has been used experimentally. therapy for chronic orthopaedic pain (see
Oral transmucosal delivery of buprenorphine Chapter 6b .
can provide good analgesia.
Weight loss management
Surgery besity is often identi ed in patients with
Joint replacement may provide a rapid and osteoarthritis. While increased joint loading is
marked improvement in pain control and is undoubtedly a contributing factor to joint pain,
readily available for the hip and sti e. utcomes the relationship between obesity and
for elbow replacement are more variable. Hip osteoarthritis is complex. Increased body fat has
replacement is also available and reliable for been associated with osteoarthritis in dogs and
small dogs and cats. Early intervention may be weight loss is likely to be bene cial in the
preferable and such procedures should be treatment of canine osteoarthritis.
discussed with the client early in the course of
the disease. Arthrodesis o ers an e ective Cell-based therapies
treatment for intractably painful joints and Intra-articular injections of mesenchymal stem
arthroplasty techni ues o er improved limb use cells and of platelet-rich plasma have shown
although the outcome is less predictable than e cacy in clinical trials in patients with
joint replacement or arthrodesis. Extra-articular osteoarthritis. While there are no studies in dogs
osteotomy techniques have been used to comparing e cacy with more conventional
manage pain in the elbow and arthroscopy may treatment, cell therapies may o er ad unctive
o er clinical bene t in osteoarthritic oints. treatment options in refractory cases.
Exercise Other therapies
Exercise intolerance is a common nding in Extracorporeal shockwave therapy igure 7.17
animals with osteoarthritis but little research is has been used successfully in a number of
available. One study showed that trotting dogs orthopaedic conditions and bene cial e ects in
for 1. km increased lameness in the short term. hip osteoarthritis have been described.
hat the bene ts of exercise are in the long Transcutaneous electric nerve stimulation
term are unknown and it has been suggested ENS has been shown to have a short term

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