Breakthrough pain – what is it and should we be worried about it? The simple answer is yes.

There is little in the literature regarding how prevalent it is in dogs, but in humans 16-95% of persistent pain conditions experience breakthrough pain which is severe or even excruciating, rapid in onset and can disable the patient. In this two-part live, Hannah and Gwen chat about breakthrough pain, starting with the three recognised subtypes in human literature: Incident, idiopathic and end of dose failure.

(September 2021 FULL VIDEO: You can find the full video in the Member Zone https://caninearthritis.co.uk/member-zone)

Guest info:

Gwen Covey-Crump qualified from the Royal Veterinary College in 2001 and worked in small animal practice before completing a residency in Veterinary Anaesthesia at the University of Bristol in 2004. She later joined the Queen's Veterinary Hospital at the University of Cambridge and returned to Bristol Vet School in 2009 as the lead Clinical Anaesthetist for Langford Veterinary Services. Gwen earned her European Diploma in Veterinary Anaesthesia and Analgesia in 2012 and now specializes in chronic pain management at Langford Vets, focusing on pharmacological therapies, environmental impacts on pain, and the connection between pain and behavior.

Key Takeaways:

1. Breakthrough Pain is Serious: It's a significant concern, often severe and rapid in onset, making it potentially disabling for patients, including dogs. Breakthrough pain, also known as acute flares, is a common but often overlooked aspect of osteoarthritis (OA) management in dogs, requiring better owner education.

2. Incident Pain: This subtype occurs due to trauma from activities like inappropriate exercise, highlighting the need for modified lifestyles and environments.

3. Idiopathic Pain: Diagnosed when no clear cause is found after excluding other conditions, stressing the importance of thorough reassessment when breakthrough pain is suspected.

4. End of Dose Failure: Occurs when pain relief isn't sustained due to incorrect dosing, underscoring the need for proper education on pain management and dosing. Proper dosing and timing of medications like gabapentin are crucial in managing chronic pain and preventing breakthrough pain in dogs.

5. Proactive Management: Understanding and identifying triggers for acute pain episodes, such as certain activities or dosing issues, can help prevent these painful flares. Adjusting the dog’s environment, like adding more rugs, can be as important as medication in managing pain and preventing flares.

6. Owner Vigilance: Pet owners need to be proactive and reflective, linking recent activities to pain episodes, as dogs won’t necessarily connect the two themselves.

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CAM is a self funded and self motivated initiative to improve the lives of dogs and their owners. If you feel that you would like to donate and support CAM to continue providing free education please do so here: https://www.justgiving.com/crowdfunding/camhelp

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Have questions send them to: info@caninearthritis.co.uk

Stay tuned to learn how early detection can make a significant difference in managing OA in younger dogs.

In this episode, Dr. Kristin Kirkby Shaw and Dr. Hannah Capon discuss cranial cruciate ligament (CCL) disease in dogs, a common and significant issue affecting many breeds. Kristin shares her recent experiences returning to clinical practice and emphasizes the importance of early detection and intervention in managing CCL injuries. They explore the terminology, diagnosis, and treatment options for CCL disease, with a particular focus on its connection to arthritis. The conversation also touches on the challenges of managing arthritis in dogs and the need for a deeper understanding among pet owners and veterinarians alike.

Key Takeaways:

1. CCL Disease and Its Prevalence:

• CCL disease is a common condition in dogs, particularly affecting breeds like Labradors, Rottweilers, and Golden Retrievers. Unlike humans, where ACL injuries are often traumatic, CCL issues in dogs typically develop gradually due to ligament degeneration.

2. Terminology Clarification:

• Understanding the various terms related to CCL disease is important for dog owners. The CCL in dogs is analogous to the ACL in humans, and the “stifle” refers to the dog’s knee joint. Familiarity with these terms helps in better communication with veterinarians.

3. Link Between CCL Disease and Arthritis:

• CCL Disease often begins with synovitis, or inflammation in the joint that starts to weaken the CCL and is essentially early arthritis. As the CCL weakens and instability develops in the stifle, arthritis progresses. Surgery to stabilize the stifle helps reduce arthritis, but long term even dogs that have surgery should be monitored for OA pain.

4. Diagnosis and Early Indicators:

• Early signs of CCL disease in dogs include subtle changes in gait, occasional lameness that is worse after exercise but improves with rest, sitting off to the side on their hip rather than symmetrically, and difficulty rising or jumping. CCL disease is often mistaken for hip arthritis or “general arthritis.” It is important that CCL disease is diagnosed because the treatment recommendations for CCL disease are different than arthritis in other joints.

5. Treatment Options and Challenges:

• Surgical interventions that stabilize the stifle joint, such as the TPLO (Tibial Plateau Leveling Osteotomy), are considered the first line treatment recommendation for CCL disease. TPLO is very effective at returning dogs to an active lifestyle, but it is very important to discuss the pros and cons of surgery with your surgeon. Managing post-operative care and long-term arthritis requires a comprehensive approach that considers the dog’s overall health, lifestyle, and the owner’s resources. If surgery is not pursued, arthritis will be need to be more aggressively managed.

6. Monitoring Sitting Posture:

• Teaching dogs to sit symmetrically from a young age can help in detecting changes in posture that may indicate underlying issues. If a dog starts sitting unevenly, it may be a sign of discomfort or joint problems that need veterinary attention.

7. Incorporating Rehab and Proprioception:

• Integrating rehabilitation or prehabilitation into surgical care plans is helpful. Proprioception exercises, which improve balance and body awareness, are simple yet effective for recovery and preventing further injuries. These exercises can be easily incorporated into daily routines despite their complex-sounding name.

Further links:

https://www.vetmed.wisc.edu/lab/corl/canine-genetic-testing/

https://caninearthritis.org/article/ccl-surgical-and-non-surgical-options-overview/

https://caninearthritis.org/article/ccl-non-surgical/

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Have questions send them to: info@caninearthritis.co.uk

Dr James Hunt returns to chat about non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs often get bad press so we asked James to come and clarify some of the facts from the misinformation. He and Hannah explain what NSAIDs are and how they work, adverse events and how to report them and ways to use these drugs as safely as possible. James has worked within research and speciality practice and offers a speciality mobile service in the south-west of the UK. (Published February, 2022 You can find the full video in YouTube https://www.youtube.com/live/GCutKdZl0nw)

More details can be found at http://petpainrelief.co.uk

Dr. James Hunt

is a renowned veterinary surgeon specializing in the management of painful conditions in dogs and cats. With over 25 years of experience, his primary focus has been on pain management. He holds multiple advanced qualifications, including a PhD in pain management, and has published extensively on the subject. Dr. Hunt also founded Pet Pain Relief, a clinical pain referral service in the UK.

Key takehomes

1. Efficacy and Safety of NSAIDs: NSAIDs are highly effective for managing osteoarthritis in dogs, with extensive evidence supporting their use. While they are associated with potential side effects, particularly gastrointestinal (GI) issues, these can be managed through proper dosing, careful monitoring, and selecting the right patient.

2. Importance of Proper Use: NSAIDs should be used at the correct dose and frequency. Owners should be aware of early signs of adverse effects, like decreased appetite, which could indicate GI issues. Consistent, long-term use often leads to better pain management, as intermittent or incorrect dosing reduces their effectiveness.

3. Individual Response Variability: Not all dogs respond to the same NSAID, and it may be necessary to try different NSAIDs to find the most effective one for a particular dog. If no improvement is seen after a few weeks of consistent use, the diagnosis should be re-evaluated.

4. Multimodal Pain Management: NSAIDs are most effective when used as part of a comprehensive pain management plan, which includes weight management, home modifications, and other therapies. This approach can reduce the reliance on NSAIDs over time.

5. Communication with Caregivers: Veterinarians should set clear expectations with pet owners about the outcomes of NSAID therapy. Improvement might not always be in mobility but could be seen in the dog’s mood or engagement. Regular follow-ups are crucial to assess the effectiveness and adjust the treatment plan accordingly.

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CAM is a self funded and self motivated initiative to improve the lives of dogs and their owners. If you feel that you would like to donate and support CAM to continue providing free education please do so here: https://www.justgiving.com/crowdfunding/camhelp

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Learn more about CAM:

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Learn more about CARE:

https://caninearthritis.org

Have questions send them to: info@caninearthritis.co.uk

Stay tuned to learn how early detection can make a significant difference in managing OA in younger dogs.