Arthritis Treatment & Chronic Pain

January 11, 2020

 

 

Cats are masters at hiding illness & pain because they are guided by instinct to always pretend like they are perfectly fine in case there is a predator around who will choose the sick/weak looking prey. So, that means we often do not know when our kitty is painful. Arthritis is incredibly common in cats as they age, though they rarely limp or show overt signs of pain. They often simply "slow down" or sleep more or avoid jumping up/down or use intermediate objects (for example, jumping on a chair then table rather than straight from floor to table). 

 

Here are 2 great sites for helping you determine if your kitty may be exhibiting subtle signs of arthritis:
https://www.zoetispetcare.com/checklist/osteoarthritis-checklist-cat
https://catswitharthritis.com/

 

There are several arthritis/pain management options for cats. Arthritis is a condition that we often manage with multi-modal therapy using combinations of non-pharmaceuticals, supplements, and prescription medication.


Non pharmaceutical include:

  • K Laser therapy: Protocol for chronic arthritis typically 3 times first week, 2 times 2nd week, once 3rd week then monthly thereafter; takes 2-3 minutes each time; nurse appointments; $25 each session. The K Laser is a class IV therapeutic laser that can help manage pain and decrease inflammation. The energy produced by the laser increases circulation which helps to decrease inflammation, swelling, stiffness, and pain.

 

  • Electromagnetic therapy at home, using the Assisi Loop. See website: Assisi Animal Health :: For Pet Owners The Assisi Loop is around $275 and includes ~150 treatment sessions. It is suggested to start at 1 (15 minute) session 2-4 times a day the first week then 1-2 times a day thereafter. You place the loop on, under, or around the cat's problem area for each session.

 

  • Stem cell therapy involves obtaining stem cells from the patient and then returning them either to a specific location or IV throughout the entire body. Side effects from the stem cells are rare, since the stem cells came from the same patient. Stem cell therapy is compatible with most other treatments that may be used concurrently such as medications, supplements, and laser therapy.  Please see our website blog post for more information: https://www.catsmeowvets.com/single-post/2019/10/16/Stem-Cell-Therapy

 

  • Massage and passive range of motion - you can try massaging the sore areas at home or try exercises like gentle bicycle motion of the back legs.  

 

  • Exercise - try to promote increased exercise/activity through play sessions at home.

 

  • Weight control to maintain a healthy weight really helps the joints

 

  • Acupuncture (we do not offer this currently at our practice as it require special training/certification, but if interested we could refer you to a vet in the DFW area)

 

  • Environmental changes like incremental elevation (stairs/steps to help getting up on higher surfaces). Low-walled (or cut-out wall) litter box so it is easier to get in and out of the box. Raised food and water dishes so your cat does not have to bend down as much to access the bowls. Lots of padded bedding and considering heating pads or heated pet beds. It is also important to regularly trim nails to prevent any ingrown nails or the nails from getting caught on things. Cats with arthritis also often have a harder time grooming themselves so regular brushing is important.

 

Pharmaceutical options include:

  • Adequan (polysulfated glycosaminoglycan) injections - This is a medication given as an injection under the skin at home or in clinic. The medication helps to inhibit enzymes in the joints that break down/damage cartilage. It also helps to increase/thin out the joint fluid to keep the joint better lubricated. There is an initial loading period where this medication is given more frequently to increase the presence of the medication in the body. You start out giving 1-2 times per week, then a long term maintenance dose is used for chronic control. Most cats' maintenance dose is one injection under the skin every 3-4 weeks.

 

  • Glucosamine/chondroitin supplements - there are many supplement forms such as Cosequin or Flexadin Plus which contain formulas to support joint health and function. These products typically come in treat forms or as capsules that can be opened and powder mixed into food.

 

  • Flexadin Advanced - this is a chewy treat (triangle in shape) that contains UC-II cartilage. It is designed to decrease the body's reaction to cartilage fragments. It also contains omega-3 fatty acids (fish oil).  It works well given along with glucosamine & chondroitin.

 

  • Fish oil capsules - (~600 mg of fish oil/day). This is a great source of omega-3 fatty acids which can reduce inflammation. The capsules can be given orally or mixed into food at home. It also comes as a pump of liquid.

 

  • CBD (cannabidiol) is an ingredient derived from the hemp plant. It does not cause a high or dependency but can decrease pain and has the potential for being very useful for chronic pain such as in arthritis. CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. 

 

  • Gabapentin (a neuropathic pain medication) - This is medication that can be given orally as a capsule/tablet/liquid or the capsule can be opened and mixed into food. It is used to help manage signs of pain/discomfort at home. The main side effect is sedation/drowsiness. It is recommended to slowly build this medication up to an effective pain control dose that does not cause excessive sedation. Most cats tend to use the medication every 12 hours. If the medication is started and the cat is using it long term then it should not be stopped abruptly as rebound pain can occur.

 

  • NSAIDs (non-steroidal anti-inflammatory drugs)  - This class of medication decreases joint inflammation and helps manage pain. They are given every 24 hours as a liquid or pill or can be used as needed for flare-ups/bad days at home. These medications are off-label in the United States (though some are approved in cats for chronic use in other countries). If we use them chronically in cats, we use the doses used in other countries (which is a fraction of the dog dose).  NSAIDs cannot be given if your cat is on steroids such as prednisolone (or receiving depomedrol injections). Side effects of this type of medication can include tummy upset and potentially kidney damage (usually only if using high doses). If your cat is not eating/drinking well on this medication or starts having vomiting/abnormal bowel movements then stop right away and call the office. It is also recommended that we check the kidney values prior to starting the medication chronically and then monitor the kidney blood values on a regular basis (every 6-12 months) when a cat is on this medication long term/chronically to make sure the kidneys are tolerating the medication and not having side effects. Overdoses of this medication can be very damaging to the kidneys so always make sure you are giving the accurate amount at home.

     

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