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.

Have a look at our FREE DOWNLOADS and find documents like the BAD DAY/GOOD DAY DIARY - https://caninearthritis.co.uk/how-cam-can-help/downloads/

and also check out our ACUTE FLARE KITS that are for free in our Member Zone (available at only £35 per year - increased September 2024) and other helpful tools - https://caninearthritis.co.uk/how-cam-can-help/tools/

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

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

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.

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/

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Learn more about CARE:

https://caninearthritis.org

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.

Join the BIG WALK: https://caninearthritis.co.uk/get-involved/the-big-walk/

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

If you just love what you see and hear from CAM and would like to sign up to our newsletter then you can do so here: https://landing.mailerlite.com/webforms/landing/h7p1e

Please support CAM and pop over to our online shop where all profits go back into creating this service: https://www.camonlineshop.com/

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

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.

We are having our BIG WALK check it out via: https://caninearthritis.co.uk/get-involved/the-big-walk/

In this special episode, Dr. Hannah Capon, Ernie Ward, and Alex German delve into the critical issue of weight management and obesity in dogs, offering perspectives from both America and England. (May 2021 FULL VIDEO: You can find the full video in CAM MemberZone.

https://caninearthritis.co.uk/member-zone)

There is an obesity epidemic raging through our cat and dog population! The figures are terrifying – with 50-60% of owned cats and dogs being clinically overweight if not obese. CAM was lucky enough to have Dr. Ernie Ward and Prof. Alex German join Hannah Capon to share their immense knowledge and enthusiasm for managing weight in our pets. The health concerns from excess weight include OA, diabetes, cardiovascular disease, and cancer. A big takeaway is that 97% of the causes are human-led, meaning we have a huge opportunity to change. It isn’t just about excess feeding; many factors lead to unhealthy weight gain, but excess weight in youth often persists for life.

Prof. Alex German:

Alex German is the Royal Canin Professor of Small Animal Medicine at the University of Liverpool, a Diplomat of the European College of Veterinary Internal Medicine, and a Senior Fellow of the Higher Education Academy. He has led the Royal Canin Weight Management Clinic for 15 years, focusing on improving the quality of life for overweight pets through clinical excellence, research, and education.

Dr. Ernie Ward:

Dr. Ernie Ward, known as ‘America’s Pet Advocate,’ has dedicated his career to improving animal care. He focuses on obesity, nutrition, behavioral issues, and innovative care for aging pets, always emphasizing the pet’s best interest.

Key Insights:

1. Impact of Weight Loss: A mere 6-9% reduction in a dog's body weight can significantly enhance their quality of life and mood.

2. Osteoarthritis Treatment: Weight loss stands as the most effective treatment for osteoarthritis, supported by substantial scientific evidence.

3. Proactive Weight Management: Monitoring a dog's weight should begin from puppyhood, with regular weigh-ins and recording to promptly address any fluctuations.

4. Sensitive Communication: When discussing weight with dog owners, professionals may want to use phrases such as body shape when discussing weight with dog owners.

5. Health Risks: An obese dog faces severe future health risks, essentially becoming a ticking time bomb.

Relevant links:

Join Holly‘s Army and get support for your weight loss journey: https://www.facebook.com/share/g/8AcWZohTyJh9ykgD/?mibextid=K35XfP

Visit the Association for Pet Obesity Prevention for more resources and information on managing pet obesity. https://www.petobesityprevention.org

Check out the Labrador Lifetime Study for detailed research findings on the impact of weight management on osteoarthritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830602/

Weight Loss Tips: Subscribe to our 6-day email series here: https://landing.mailerlite.com/webforms/landing/f3m8k3

Enjoy this insightful episode and take a proactive step in managing your pet’s weight for a healthier and happier life.

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Learn more about CARE:

Website: 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.

In this episode of Canine Arthritis Matters, Hannah discusses with Dr. James Hunt, Dr. Katie Smithers and Evie Tummon the importance and application of teleguidance in managing canine arthritis. Teleguidance involves remote consultations to help dog owners manage their pets' arthritis symptoms from home, providing expert advice and support without the need for in-person visits. This service aims to enhance the quality of life for arthritic dogs by offering tailored pain management strategies and lifestyle recommendations.

Additionally, it addresses the biopsychosocial aspects of caregiving, recognizing the emotional and psychological impacts on pet owners and providing them with necessary support.

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.

Dr. Katie Smithers is an RCVS Advanced Practitioner in Veterinary Anaesthesia with a deep interest in pain management. She has extensive experience in both first opinion and referral practice settings and currently runs a peripatetic pain management clinic in South Wales.

Evie Tummon is a dedicated registered veterinary nurse specializing in geriatric care and pain management. She runs successful pain clinics in Cornwall and collaborates with Canine Arthritis Management (CAM), organizing educational outreach and support for pet owners.

Take Home Messages

1. Comprehensive Remote Care: Teleguidance offers detailed remote consultations to manage canine arthritis, reducing the need for in-person visits

2. Time-Intensive Process: Each case involves significant time for video/photo analysis, history taking, and collaboration, ensuring thorough care .

3. Holistic Observations: By observing dogs at home, the service minimizes stress and improves the accuracy of assessments and education .

4. Support for Caregivers: The service also addresses the emotional/psychological needs of pet owners, supporting them in managing their pet’s chronic pain .

TELEGUIDANCE

- No Prescriptions or Diagnoses: Teleguidance supports existing veterinary care by offering insights and management strategies based on previously established diagnoses, without prescribing or diagnosing .

- Stress Reduction: Observing dogs in their home environment reduces stress and anxiety, allowing for more accurate assessments of their condition and behavior .

- Educational Value: The service emphasizes caregiver education, providing detailed guidance and advice tailored to each pet’s needs, improving overall care and management .

Relevant Links

Canine Arthritis Teleguidance: Find out more about our Teleguidance Service - https://caninearthritisteleguidance.co.uk

Pet Pain Relief: https://petpainrelief.co.uk

Canine Arthritis Essentials Course: Reduce your dog's arthritis pain and make sure they have a good quality of life with this easy-to-follow, affordable course. https://www.cameducation.co.uk/course/camessentials

And find our other courses here: https://www.cameducation.co.uk/courses

Have a look at our member zone: https://caninearthritis.co.uk/member-zone/

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Learn more about CARE:

Website: 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.

Dr. Lascelles is Professor in Small Animal Surgery and Pain Management at North Carolina State University. His research program (Translational Research in Pain [TRiP]) develops methods to measure pain associated with spontaneous disease in animals, and seeks to understand the underlying neurobiology. His work improves pain control in companion animals, and facilitates analgesic development in human medicine.
He is director of the Comparative Pain Research and Education Centre (CPREC). He has authored over 200 peer reviewed research papers and reviews and 250 research abstracts, as well as over 30 book chapters. He is co-founder of AniV8, a company dedicated to developing innovative methods of measuring pain.

Duncan Lascelles discusses how diagnosing osteoarthritis (OA) later in life (from 8 years) makes it difficult to manage, suggesting that OA is a developmental disease starting in younger dogs. His research with Elanco on dogs aged 8 months to 4 years found that 41% had OA, and 24% of those exhibited mild or greater pain. This evidence suggests OA in young dogs is associated with pain and early management can alleviate long-term suffering. The COAST staging system for OA can help vets recognize and manage early signs.

1. Early Onset of OA:

OA is prevalent in young dogs, with 41% of dogs aged 8 months to 4 years showing radiographic signs. Early detection and management can reduce pain later in life.

2. Proactive Veterinary Care:

Vets should look for early signs of OA and educate owners on the importance of early intervention to prevent severe symptoms as dogs age.

3. Positive Communication:

Frame the diagnosis positively to engage owners. Emphasize treatment options that can enhance the dog’s quality of life instead of focusing on the chronic nature of OA.

4. Comprehensive Management:

Use a multimodal approach with medication, lifestyle changes, and environmental modifications. Duncan’s “3+3 formula” suggests initial intensive care followed by a personalized, sustainable plan.

Links to Dr. Duncan Lascelles:

https://cvm.ncsu.edu/people/dxlascel/

https://youtube.com/live/N3NpulLOy9E

CAM Courses:

Is my dog in pain? Are you worried your dog may be in pain? Learn how to identify signs of pain and prepare for your dog’s vet consult: https://www.cameducation.co.uk/course/is-my-dog-in-pain

Young dog joint care: Learn how to protect your young dog’s joint health so they can have a long and active life! https://www.cameducation.co.uk/course/young-dog-joint-care

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Learn more about CARE:

Website: 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.

In Episode 2 of Canine Arthritis Matters, hosts Hannah Capon and Kristin Kirkby Shaw share their personal journeys managing osteoarthritis in their own dogs. They discuss the challenges, early signs, and importance of a multimodal approach to care, including lifestyle changes and weight management. Their stories underscore the need for early detection and proactive management to improve the quality of life for dogs with arthritis and chronic pain and how hard it can be for the caregiver.

1. Personal Experiences:

Kristin shares stories about her dogs Bella, Bailey, and Beans, highlighting the difficulties of managing OA and the impact of early recognition and intervention.

Hannah reflects on her experiences with her dog Holly, emphasizing the importance of identifying pain early and the potential intervention points throughout a dog’s life.

2. Behavioral Indicators of Pain:

Both hosts discuss the subtle signs of pain in dogs, such as lip licking, breath holding, and changes in behavior like noise sensitivity or aggression.

3. Rehabilitation and Multimodal Approaches:

The importance of integrating rehabilitation techniques, such as massage, acupuncture, and therapeutic exercises, into the management of OA.

The future of veterinary practice, including the incorporation of multi-specialty teams and a holistic approach to managing chronic conditions.

4. Educational Resources:

Highlighting the need for continuous education for both veterinarians and pet owners to improve the early detection and management of OA.

Tune in to gain insights and practical tips from their experiences.

Dr. Hannah Capon:

Hannah Capon is a renowned veterinarian and founder of Canine Arthritis Management (CAM https://caninearthritis.co.uk), a platform dedicated to educating dog owners and veterinary professionals about arthritis. With a passion for improving the quality of life for arthritic dogs, Hannah is a leading voice in the field of canine pain management. Inspired by her own dogs’ battles with arthritis, she combines professional expertise with personal experience to make a difference.

Dr. Kristin Kirkby Shaw: Dr. Kristin Kirkby Shaw (CARE https://caninearthritis.org) is a veterinarian specialized in surgery and rehabilitation/sports medicine with over 14 years of clinical experience managing arthritis and chronic pain. She has firsthand experience dealing with arthritis and pain in her own dogs. Kristin founded CARE, a website dedicated to providing practical, evidence-based tools and resources for those caring for dogs with arthritis. She is passionate about educating veterinary professionals and caregivers on the early signs of arthritis and methods to manage it, ensuring a high quality of life for affected dogs.

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Learn more about CARE:

Website: 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.

In the first episode of Canine Arthritis Matters, hosts Dr. Hannah Capon (founder CAM https://caninearthritis.co.uk) and Dr. Kristin Kirkby Shaw (founder of CARE https://caninearthritis.org) introduce themselves and share their journeys in veterinary medicine that led them to focus on osteoarthritis (OA) in dogs. They discuss their personal and professional experiences with canine OA, their goals for the podcast, and the importance of multidisciplinary approaches in managing OA. Future episodes will feature interviews with experts in the field, and each episode will provide practical tips for managing OA in dogs. Dr. Hannah Capon:

Hannah Capon is a renowned veterinarian and founder of Canine Arthritis Management (CAM https://caninearthritis.co.uk), a platform dedicated to educating dog owners and veterinary professionals about arthritis. With a passion for improving the quality of life for arthritic dogs, Hannah is a leading voice in the field of canine pain management. Inspired by her own dogs’ battles with arthritis, she combines professional expertise with personal experience to make a difference.

Dr. Kristin Kirkby Shaw: Dr. Kristin Kirkby Shaw is a veterinarian specialized in surgery and rehabilitation/sports medicine with over 14 years of clinical experience managing arthritis and chronic pain. She has firsthand experience dealing with arthritis and pain in her own dogs. Kristin founded CARE, a website dedicated to providing practical, evidence-based tools and resources for those caring for dogs with arthritis. She is passionate about educating veterinary professionals and caregivers on the early signs of arthritis and methods to manage it, ensuring a high quality of life for affected dogs.

Further informations:

VOA podcast Russell Chandler: https://vet-oa.com/podcast/

The Veterinary Rehabilitation Podcast: https://podcasts.apple.com/ch/podcast/the-veterinary-rehabilitation-podcast/id1277186348

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Learn more about CARE:

Website: 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.