Pain Management
Pain management masks the symptoms of hip dysplasia but does not cure the underlying problem. Frustration and disappointment usually sets in when chronic, advanced, severe, or bilateral hip dysplasia is present and becomes poorly responsive to medication and expenses pile up. Pain management is NOT the treatment of choice for dogs with chronic, advanced, moderate, severe or bilateral hip dysplasia and/or osteoarthritis. Owner expectations for quality of life should be realistic, and animal owners should be advised that costs accumulate rapidly with long term use of pain management products and services. Over time, these costs often far exceed the cost of readily available permanent and successful total hip replacement.
A detailed discussion of medical management / indefinite pain control is lengthy. Pain control is not easy for animal owners to accurately assess due to the lack of verbal communications between the patient and the owner. The main categories include:
- weight loss
- exercise modification
- joint support supplementation
- pain relief medication
Excessive body weight results in excessive loads on the joint surfaces. The extra weight is detrimental to arthritis. For joints that are arthritic, extra weight aggravates the problem. The ideal body weight is sometimes difficult to predict. The Body Condition Score (BCS) on a 1 to 9 scale (with 1 being starvation and 9 being obesity) is a better indicator. Dogs with joint pain should have a BCS of 5 or less. An appropriate BCS should never be over-looked if pain management is opted. Implementation of a weight loss program should not be resisted, and compliance to achieve desired results is all-important – and too often inadequate for success. Weight loss is not easy because of the underlying pain, but a successful “program” can be as useful as medications.
Exercise with moderation is better than a sedentary life, but repeated vigorous and strenuous activity will usually result in more pain. This latter kind of activity may also accelerate the degenerative processes in the joints. Low-impact activity (short leash walks 2-3 times a day, swimming, walking on soft surfaces such as sand) can be effective. An organized rehabilitation program under the direction of a veterinary rehabilitation specialist with weight and nutrition expertise is best. Exercise will increase caloric burn for the weight loss program.
There are numerous “joint support” products on the market. Selection and recommendation of joint support products should be based on objective evidence of efficacy –which is sparse - in the veterinary literature. Popular products include injectable Adequan®, oral glucosamine such as Dasuquin/Cosequin®, oral supplementation with omega-3 fatty acid, and intra-articular injections of hyaluronic acid. Objectivity about results observed by animal owners is also important. Did the product being administered help, or not.
Pain control is commonly attempted with use of non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are sometimes combined with opiate-derivatives. Dog owners should be vigilant watching for side effects of pain control medications that most commonly affect the gastrointestinal tract (vomiting, diarrhea, gastric ulcers, &/or colitis) and/or kidneys (nephropathy).
