Acute versus Chronic Pain – Managing Harley’s Osteoarthritis

Pain and management of pain falls into two categories: acute and chronic.

ACUTE pain is often associated with procedures that involve anesthesia. This is something we as veterinarians anticipate, based on the age, specific health concerns of our patient and the procedure performed. We may address this anticipated pain by administering a combination of pre-anesthetic medications that have pain-relieving effects; local anesthetics that take effect just before, during, and after a procedure; and medications that are aimed at addressing post-operative pain.

Acute pain can be encountered in traumatic situations as well. Based on a specific animal and situation, we can tailor pain management to best suit that patient.

CHRONIC pain in veterinary patients is most commonly caused by osteoarthritis (OA).

Harley, a 12 year-old neutered male Chow mix owned by Mr. and Mrs. Jones, is a good example of a patient whose progressive osteoarthritis required a multi-modal approach for management of pain.

Recently, Mrs. Jones brought Harley to see Dr. Schaeffer to re-evaluate his pain management and currently treated hypothyroidism.

Harley  had been previously diagnosed with lumbar spinal pain, osteoarthritis at his hips and knees (stifles). He had a left cranial cruciate ligament rupture in his left stifle that was previously repaired, and he had begun having trouble getting up from laying down, especially over the last few months.

On exam, Harley had a decreased range of motion (ROM) on attempts to extend his hips fully. A similar decreased ROM was found at his left stifle, with scar tissue and crepitus (crackling) felt at that joint. He walks with a short and stiff gait in his hind legs.

Currently, Harley is given Metacam (a non-steroidal anti-inflammatory) daily, Tramadol (opioid-like pain medication) twice daily, and Gabapentin (decreases neuropathic pain) once daily. He is also given oral joint supplements, an omega fatty acid supplement and multiple herbal supplements.

In addition to medical pain management (drugs and supplements), we also discussed weight management for Harley. Although Mrs. Jones keeps a close eye on Harley’s weight, some additional weight loss could be helpful.

Water treadmill therapy for dogs

Consulting with a physical therapist or rehabilitation specialist was also discussed – short walks daily are helpful, but doing specific ROM exercises or underwater treadmill work could be of major benefit to Harley, like many dogs with progressive OA.

OA is best treated with a multi-modal strategy, taking into account a patient’s current medications (if any), diet and weight, exercise/activity routine, and supplements. Looking at the whole patient and all of the things that can affect their osteoarthritis will lead us to a better outcome for managing pain and quality of life.

If you observe your dog walking more stiffly than usual, feel free to speak with us at your next visit about osteoarthritis (OA) and pain management.