SURGERY
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A Pernicious Triad : Arthritis , Obesity and
Chronic Pain
Each of these health problems causes harm in its own way , and it ' s not unusual for veterinary patients to present with all three . Early detection and intervention and a multimodal management strategy are keys to taming this tangled trio .
By Jennifer Gaumnitz , Senior Content Specialist
Arthritis affects at least 20 percent of the pet population , which can lead to chronic pain , and veterinarians are all too aware of the pet obesity epidemic in the United States . So how do you help these patients , either by slowing the progression of this triad or by tackling these intertwined , yet individual problems ?
In a recent Fetch dvm360 session , Tara Edwards , DVM , DACVSMR , CCRT , CVPP , CVMA , said she often sees arthritis patients that are battling not only arthritis but also dealing with the consequences of obesity and , likewise , obese patients on the cusp of developing arthritis .
“ There ’ s often this negative cycle of obesity leading to inactivity , leading to weight gain , leading to arthritis . Or flip that around , where we have arthritis leading to inactivity , leading to weight gain , leading to obesity ,” she says .
Dr . Edwards explains that both arthritis and obesity limit movement , impact cartilage health , contribute to muscle atrophy , result in weakness and alter biomechanics . As such , both are significant contributors to chronic pain in pets . “ Patients are painful before they have altered mobility or lameness ,” she says . “ So , if we ’ re waiting for lameness , we ’ ve missed the boat on early pain management and early arthritis detection .”
Arthritis is a progressive disease , and any change in function is often due to an increase in pain . Among the goals of arthritis patient care are prevention of pain and minimization of disability , she says . This requires earlier identification of arthritis and the implementation of a multimodal arthritis treatment strategy . “ Because veterinary patients are nonverbal ,” she says , “ We need to excel at history taking and physical examinations .”
Since veterinarians rely on clients to be their eyes and ears , it ’ s also essential to educate clients about the clinical signs of arthritis , the progressive nature of the disease and the impact that contributing factors , such as obesity , have on the disease . Education also encourages compliance with your recommended treatments and helps clients understand the need for regular recheck appointments .
Pain Begets More Pain When a patient suffers from osteoarthritis , obesity and chronic pain , it has long-term exposure to pain signals . “ This can alter the physiology in the spinal cord , decrease pain thresholds , lead to the activation of pain pathways and result in spontaneous electrical activity , exaggerated response to stimuli and altered descending inhibition ,” she notes .
The central nervous system ( CNS ) has its own system of checks and balances , and the descending inhibition pathway is a way the body turns down the intensity of incoming pain signals , Dr . Edwards says . That can change when there is chronic pain . The more pain pathways are utilised , the more efficient the body becomes at transmitting and processing the pain signals . This is called central sensitisation or the amplification of pain . Pain begets more pain . These changes in the spinal cord result in hyperalgesia ( an exaggerated pain response to a potentially painful stimulus ) or perhaps even allodynia ( an exaggerated pain response to a nonpainful stimulus ). Chronic vet360
Issue 01 | MARCH 2018 | 12