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Treating Chronic Pain in Dogs

Photo of a bottle of DLPA

More information on arthritis:

Also see these articles:


Disclaimer: I am not a veterinarian, nor do I have any formal training in any medical field. The information presented here is not meant to replace your vet's advice or prescribed medications, but only to suggest additional options to explore, based on your dog's condition.


DLPA

DLPA (DL-Phenylalanine) is a nutritional supplement that helps with chronic pain. I know of one elderly and feeble Newfoundland who was helped greatly with this supplement, and there are reports on the web of other dogs being helped as well. My Piglet initially responded very well to DLPA, then got worse again, though I continue to give it to her (150 mg twice a day). It appears to be very safe. It is best given away from food, but can be given with meals if needed.

I have seen a variety of dosage recommendations, including the following:
3 to 10 mg/kg which converts to 1.5 to 5 mg per pound of bodyweight (I believe this is twice a day)
To convert your dog's weight in pounds to kilograms, divide by 2.2 (my 33 pound dog weighs 15 kg)
125 to 500 mg twice a day
250 to 500 mg twice a day
5-10 mg per pound of body weight two to three times a day -- this recommendation is in the book Homeopathic Remedies for Cats and Dogs by Don Hamilton, DVM. In humans, very high doses (over 1500 mg/day) of DLPA may cause numbness, tingling or other signs of nerve damage, so this is something to be aware of if you do use high doses.

DLPA is mostly available in 500 mg capsules, occasionally I have seen it in 375 mg capsules. JoMar Labs offers 300 mg capsules, plus a powder form with 1.6 grams (1,600 mg) per teaspoon (1/4 teaspoon would have 400 mg). When smaller doses are needed, you might use Arthroplex (available at HolisticPetInfo and Wellvet), which is a glucosamine supplement that also contains DLPA (DL-Phenylalanine, 75 mg per capsule). Also see Oliver's Supplements, where the "mood enhancer" version contains 75 mg DLPA in the small size, 150 mg in the medium size, and 200 mg in the large size, along with a similar amount of boswellia plus cherry extract.

I also found a product called Curcumin Plus (formerly Phenocane) that could be used for smaller dogs. It is manufactured by Golden Tones (formerly Health Advances Dr. Donsbach) and also sold under the OxyLife brand name, and is available at  Seacoast Vitamins, H&M Herbs, and Pure Prescriptions. Curcumin plus is a mixture of curcumin (250-350 mg), boswellia (175 mg) and DLPA (75 mg). Curcumin (also called turmeric) and boswellia have natural anti-inflammatory properties.

See the following for more information:
DLPA in the nutritional control of arthritis and chronic pain
Phenylalanine
DLPA

Note that DLPA should not be given with MAOIs (such as Anipryl/l-deprenyl/selegiline, or Amitraz, found in the Preventic collar and used to treat demodectic mange), as it can cause a severe increase in blood pressure in humans. It is fine to combine DLPA with other pain meds, including Tramadol and everything else listed on this web page.

Here are some places that carry DLPA, also called DL-Phenylalanine:

http://www.vitacost.com/Twinlab-DLPA
http://www.vitacost.com/NSI-DL-Phenylalanine
http://www.puritan.com/ (search for DL-Phenylalanine)
http://www.swansonvitamins.com (Item #SW873)

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MEDICATIONS

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Tramadol

Tramadol (Ultram) is a synthetic opioid that appears to be safer than most narcotics, and is easier to get as it is not a controlled substance. It is apparently much less likely to cause dependence and can be used long term for chronic pain, although withdrawal effects can occur and you should avoid abruptly stopping the drug if it is used for very long. Like the other drugs mentioned, it may work best when combined with NSAIDs.

Recommended dosage from the Veterinary Anesthesia & Analgesia Support Group's Chronic Pain Management web page has increased:

In dogs, a starting dose of 3-5 mg/kg TID (up to 5 mg/kg QID) works well, though higher dose (10 mg/kg TID-QID) can be used if needed.

TID means three times a day, and QID means four times a day. A kg is 2.2 lbs, so 3 to 5 mg/kg is equivalent to 1.4 to 2.3 mg per pound of body weight.

See the following articles for more info (note that some are human oriented):

Note that Tramadol should not be given with MAOIs (such as Anipryl/l-deprenyl/selegiline, and the Preventic Tick Collar, which contains Amitraz, another MAOI). It should be used with caution when combining with SSRIs (such as Prozac, Zoloft and Paxil) or TCAs (such as Elavil and Clomicalm) due to the risk of serotonin syndrome. It may also be dangerous if combined with St. John's Wort. Tramadol is metabolized 70% thru the liver and 30% thru the kidneys, so dosage must be reduced when using with a dog that has liver or kidney disease. Tramadol in high doses has been known to lead to seizures. It should be used with extreme caution in animals that are prone to seizures. Tramadol can cause constipation. Give a stool softener if needed.

Although drugs used to treat pain are generally reserved for use after NSAIDS no longer work or cannot be tolerated, there is a school of thought that says perhaps they should be used sooner, since they are safer. They can also be used together, to reduce the dosage of NSAIDs.

I did some price checking on Tramadol, and found a huge variance in prices. Costco had by far the best price, and you can order prescription drugs from them without being a member, though they do not ship to Arkansas, Illinois, Louisiana, Michigan, Nebraska, and Tennessee. Masters Marketing in the UK also has great prices.

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NSAIDs

If you find you must use NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) to control pain in your dog, be very cautious. All of them can cause gastric upset and ulceration. Giving with food can help to prevent stomach upset, but not ulceration. It is safest to do blood work before starting any NSAID, and about two weeks after starting, to be sure that it is not affecting the liver or kidneys. If you use these drugs long term, you should continue to monitor blood work at least every six months to a year (more often if problems are suspected or more likely due to the health status of the dog).

See below for more information on various NSAIDs. Note that COX-2 selective drugs are newer, and were expected to be safer, as they reduce the risk of gastric ulceration, but they can still cause other side effects, including liver and kidney failure. It is most important to know if a drug is COX-2 selective when switching from one NSAID to another. See the paragraph below on switching NSAIDs for more information.

Never combine NSAIDs (including aspirin) with each other, or with prednisone, as the risk of gastric ulceration is greatly increased.

See NSAID Labels for links to actual product labels.

If your dog shows any signs of problems whatsoever with these drugs, discontinue and notify your vet immediately. Problems may include any of the following: vomiting, diarrhea, dark or bloody stools, changes in appetite, changes in the frequency or amount of urination and drinking, drooling, difficulty swallowing, yellowing of the whites of the eyes, or any behavioral change such as aggression or lethargy, disorientation, staring off into space, circling, lack of coordination when walking, or hyperactivity.

Never give your dog human medications other than aspirin, as listed above. Drugs such as Advil (ibuprofen) and Aleve (naproxen) cause serious gastric ulceration and can be very dangerous for dogs. Tylenol (acetaminophen) is sometimes used for dogs, but can cause irreversible liver damage in a few, and is deadly to cats. See Tylenol with Codeine below for more information.

Switching from one NSAID (including aspirin) to another, or from an NSAID to prednisone (or vice versa), can be dangerous. It is best to wait AT LEAST a week in between, preferably longer, before starting the new drug. This is particularly important when you are switching FROM one of the older generation NSAIDS that are COX-1 inhibitors (not COX-2 selective), including Aspirin and White Willow Bark. Etogesic also inhibits COX-1. Metacam and Rimadyl are somewhere in the middle, being mildly COX-2 selective and relatively COX-1 sparing. I heard from one vet that fatal reactions to Deramaxx were much more likely in dogs that had been given Aspirin in the preceding 7-14 days. If you are switching from one COX-2 selective drug to another, such as from Rimadyl to Deramaxx, or from a COX-2 selective drug to Aspirin, then the danger is less, and you may be able to switch after just 24 hours. If you need pain relief in between switching from one NSAID to another, consider using Tramadol.

NSAIDs often can cause gastric ulceration and stomach upset. Giving with food can help to prevent stomach upset, but not ulceration. There is a drug you can give concurrently with any NSAID to help prevent these side effects. It is called Misoprostol (Cytotec). VetInfo says "Misoprostol decreases gastric acid secretion and has other protective properties that help prevent ulcers. There are several published dose ranges, which do not totally agree, but the overlap point seems to be at about 3mcg/kg two or three times a day. Your vet may need to tailor this dosage for your particular dog's needs. It is important to remember to follow other directions intended to reduce gastric irritation, such as giving the NSAID with or shortly after meals and at the dosage schedule recommended by your veterinarian." See the following for more info:
Misoprostol and More: Making NSAIDs easier on your dog's gut
More on NSAIDs and your dog's gut

Other drugs used to help reduce the potential for stomach ulceration and GI upset include sucralfate (Carafate) and slippery elm (herbal supplement that coats and soothes the digestive tract). The antacids cimetidine (Tagamet), omeprazole (Prilosec), and ranitidine (Zantac) may help symptoms but do not really treat the underlying problem.

One vet who specializes in pain management advocates the following precautions when using NSAIDs (see Aspirin: OK for people, but people aren't dogs for more information):

See the following for more information on the use of NSAIDs for treating arthritis:

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Steroids

Corticosteroids, such as prednisone, methylprednisolone (Medrol) and dexamethasone, are the strongest anti-inflammatories available. Because long-term use of steroids can cause a number of undesirable side effects, these are best used short-term to get inflammation under control, and near the end of life, when nothing else works to preserve quality of life. My dog Piglet was on prednisone for the last six months of her life, which allowed her to continue to be mobile after NSAIDs were no longer effective. My other dog, Nattie, was on prednisone off and on for the last two years of her life to control the symptoms of chronic bronchitis, and she did very well despite having early stage renal disease.

To reduce the side effects of continuous use of steroids, it's best to give them every other day rather than daily, even if the dosage has to be higher. Steroids are usually started at high doses for a few days, with the dosage gradually reduced to the lowest dose needed to control symptoms. Steroids should never be stopped abruptly, as the body becomes dependent on them and stopping them suddenly can be dangerous, especially when they are given long term on a daily basis (giving them every other day helps to prevent this danger). Always work with your vet to determine the proper dosage and schedule for giving steroids.

Steroids cause increased appetite, thirst and urination, especially at high doses. Chronic use can also lead to muscle loss and weakness. Steroids suppress the immune system, which can make your dog more susceptible to infection, such as bladder infections. Steroids can also cause gastric ulceration. Always give them with food to help reduce stomach upset and irritation.

Steroids should never be combined with NSAIDs, which should be discontinued for at least 72 hours before switching from either one to the other. They can be combined with all other types of pain medication. When used for more than 4 months, monitoring of blood work and urinalysis should be done.

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Tylenol and Tylenol with Codeine

Tylenol (acetaminophen) is sometimes used for dogs, but can cause irreversible liver damage in a few, and is deadly to cats. Tylenol is not an anti-inflammatory. It is considered a COX-3 inhibitor, and can be combined with NSAIDs for greater pain relief if needed. Tylenol with codeine can also be used for additional pain relief. This combination may be especially useful for dogs who cannot tolerate NSAIDs. Tylenol has a narrow margin of safety; the dosage for dogs is lower than for people. This drug should only be used under veterinary supervision. More info:

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Antidepressants and other Drugs Used to Control Chronic Pain

Amitriptyline (Elavil Rx) and other tricyclic antidepressants (TCA) such as clomipramine (Clomicalm), seem to help in chronic pain when used alone or in conjunction with narcotics, NSAIDs or steroids. Use caution when combining with Tramadol (don't use high doses of each together). Amitriptyline is available inexpensively thru Costco and Walmart but clomipramine is not used for humans and is therefore usually more expensive.

Neurontin (gabapentin) is an anticonvulsant medicine which is also used for chronic pain. This is not a licensed medication in dogs but is licensed as a neurogenic pain killer in humans and has been used for dogs as well. Suggested dosage for chronic pain is 10 mg/kg twice a day, but dosages as low as 1.25 mg/kg once a day are sometimes effective, and dosages as high as 10 mg/kg four times a day can be given. Neurontin can also be given with NSAIDs, steroids or narcotics. See Chronic Pain and this summary for more info on its use in dogs for treating chronic pain. Also see The Other AEDs for more information on the use of this drug in dogs for epilepsy. Note this drug can be expensive, but the generic version is available inexpensively from Costco.

Amantadine is now being used to help control chronic pain in dogs. It is a drug normally used to treat Parkinson's disease. It works as an NMDA receptor antagonist, similar to some opioids, but is not a narcotic itself. It offers little in the way of pain control itself, but potentiates (makes the effect stronger) other drugs used for pain control, so it has to be used concurrently with other pain control drugs. It can be used concurrently with Tramadol, NSAIDs, corticosteroids, gabapentin and opioids. It is inexpensive. You will need to use the liquid version for all but large dogs. I was able to get the liquid version from Costco (it's not listed on their web site, but they were able to order it for me). See the following for more info:

Evolving Roles of NSAIDs in Clinical Practice "When other drugs are required, our first choice is generally amantadine (3 mg/kg once daily). Owners commonly report a significant improvement when amantadine is given."
Chronic Pain "Amantadine is the most commonly used oral NMDA receptor antagonist. It was originally developed as an antiviral compound, and has also been used to treat extrapyramidal drug reactions and Parkinson’s disease in humans. The standard dose used to block receptors in dogs and cats is 3-5 mg/kg SID. It may be given on a continual basis if needed, though in most cases it can be given daily for 7-14 days and then discontinued until pain worsens again. Amantadine is available as 100 mg capsules and a 10 mg/ml oral liquid. Elimination is almost exclusively via the kidneys, so dose reductions should be considered in cases of severe renal failure. Side effects are rare, but can include agitation or diarrhea."
VIN "I have used tramadol, amantadine, and tylenol with or without codeine chronically in dogs on pred (for other reasons) as well as omega 3EFA and SamE."
Osteoarthritis & Your Pet "Drugs such as amantadine (NMDA inhibitor), narcotics such as tramadol and morphine, acetaminophen (Tylenol {to be used in dogs only—never in cats}, combinations of these drugs provide a quality of life to a pet that would otherwise be miserable."
Amantadine "It is used in conjunction with your primary analgesic to prevent dorsal horn windup. It has no significant analgesic effects of its own, so must be considered a supplement for those animals that opioids and/or NSAIDs are not quite doing the job. The dose most use is 3mg/kg once daily. It is available in 100mg tablets or a syrup. . . . It has been used as an adjunct to NSAIDs to treat pain due to osteoarthritis dogs weighing 25-40 kg at a dosage of a single 100 mg capsule daily."
Amantadine and Amitriptyline (Elavil) -- Additional information on usage in dogs.
Dextromethorphan may work similarly to amantadine (above) to potentiate other drugs. This drug is available as an over-the-counter cough medicine, but make sure you find one that has no other active ingredients, as many cold remedies can be dangerous to dogs. Possible choices include Robitussin CoughGels, Dexalone and Vicks Formula 44 Cough Relief liquid. Recommended dosage of dextromethorphan for pain is 0.5 - 2 mg/kg (0.25 - 1 mg/lb) of body weight, given three to four times a day, according to VASG (scroll down near the bottom of the page to see the sections on NMDA receptor antagonists and dextromethorphan). Note this drug is metabolized though the liver, while amantadine is processed through the kidneys, so the choice of which to try might depend on whether your dog has kidney or liver problems.

Be very cautious about combining drugs used to control chronic pain. Be sure your vet knows all the drugs your dog is on, including aspirin, before adding any of the above. Many of these can be used together for greater pain relief, but there are also dangerous interactions between some of them. Note that the Preventic Tick Collar uses Amitraz, an MAOI that may be dangerous when combined with anti-depressants or certain pain relieving drugs.

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Narcotics

When you reach a point that even NSAIDs do not help enough, narcotic therapy may be an option.

See Tramadol above for information on a narcotic-like drug that many people are using to treat chronic pain with good success.

Hydrocodone can be used in combination with NSAIDs to provide additional pain relief. Vicodin, which is a combination of Hydrocodone and Acetaminophen is sometimes used, but should not be combined with NSAIDs due to the danger of toxicity from the Acetaminophen. Codeine can also be used, though it is not as effective. Oxycodone or a  Fentanyl (Duragesic) patch are other narcotics that can be used for pain, but tend to have more of a narcotic effect and so are best used only for short periods, but even that may make a big difference. Click here for more info (scroll down).

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Doxycycline

I have heard that an antibiotic, Doxycycline, may be helpful for arthritis. One person contacted me to report success treating her 16-year-old shepherd/border collie mix with doxcycline (10 mg/kg daily) for osteoarthritis. The dog has been on this treatment for six or seven years, and has responded better to doxycycline than to trials of NSAIDs such as Rimadyl. The dog's owner, a veterinary student, said doxycycline was mentioned as an option in a pain management lecture.

Anther person reported her own osteoarthritis in her knee, hip and fingers improved markedly when she was on long term doxy for other reasons.

Doxycycline should always be given with food, not only to help prevent digestive upset, but also to make sure that it does not get caught in the esophagus, where it can cause major problems, including irritation and esophageal strictures.

Apparently, doxycycline has an anti-inflammatory effect that can be as great or greater than commonly used NSAIDs such as Rimadyl that can be more dangerous. There is a possibility that it may also be effective because of treating infections in the joint that contribute to arthritis. It is available inexpensively thru Costco and Walmart.See the following articles for more information:

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THERAPIES


Shock Wave Therapy

My article, Shock Wave Therapy for Dogs With Arthritis, was published in the Whole Dog Journal in the May, 2008 issue.

Extracorporeal shock wave therapy (ESWT), also called acoustic compression therapy (ACT) has been used in horses since the late 1990s to stimulate healing of musculoskeletal injuries, including bone fractures and tendonitis (bowed tendons). It has also been used with people since 1992 to treat heel spurs, plantar fasciitis, tennis elbow,  femoral head necrosis, and other disorders. Beginning in 1999, it has been used in dogs to treat arthritis pain, hip dysplasia, and other musculoskeletal conditions. Note that the treatment will not slow the progression of arthritis, it only affects the pain.

Shock wave therapy requires sedation or general anesthesia, along with pain medication, as the treatment itself can be mildly to severely painful depending on the intensity that is used. It can also be quite noisy, which may be frightening to the patient. Treatment lasts just a few  minutes per treatment site. Recent x-rays are needed in order to determine exactly where treatment should be centered.

Early studies show that up to 80% of dogs with arthritis will show marked improvement with this therapy. One to four treatments are done at intervals of 10 to 30 days apart. Benefits may last anywhere from several months to over a year before the treatment needs to be repeated. This is considered a conventional (not holistic) therapy, but it is still experimental. It is not yet widely available, at least not for dogs, but you could contact your closest veterinary school to see if they offer this treatment, or contact the manufacturers of the machines to see if there are vets in your area who are offering this therapy for dogs. See below for a list of the places I know about who are offering shock wave therapy for dogs, and contact information for the manufacturers.

Shock waves are focused sound (acoustic) waves that produce maximum energy at a specific site within the body. There are three types of shock wave therapy: electrohydraulic, piezoelectric and electromagnetic. No significant difference in effectiveness between these has been demonstrated. Electrohydraulic devices have been the most studied in the US and are the only ones approved by the FDA for use with people.

There is a fourth type of device that produces radial pressure waves, which are different from shock waves. Radial pressure waves are lower intensity than shock waves, and are unfocused. Maximum energy is produced at the skin surface and dissipates from there. For that reason, radial pressure wave therapy (RPWT) is more suited to soft-tissue applications near the surface. More treatments with less time in between are needed when using RPWT. It may be done under light sedation, as it is less painful due to the lower intensity of the waves. Little research on RPWT has been done in the US, but it has been studied more in Europe.

Here are some web sites with more information:

Shock Wave Therapy Can Help Promote Bone Healing and Reduce Pain
From the University of Illinois Veterinary Teaching Hospital: "In addition to providing healing and anti-inflammatory properties, shock wave therapy works two ways to reduce pain. Its anti-inflammatory action reduces the amount of inflammatory biochemicals that cause pain. 'In addition, this therapy seems to temporarily disrupt nerve impulse transmission,' thus reducing the perception of pain, Dr. Byron explains. These pain reducing properties can be very useful for treating dogs and horses with arthritis."

Shock wave therapy - more shock than wave?
"ESWT has been advocated for treatment of osteoarthritis in the dog and horse. Canine patients with osteoarthritis of the stifle had higher peak vertical forces and increased range of motion as compared to control dogs. ESWT decreased lameness in 80% of horses treated for osteoarthritis of the tarsometatarsal and distal intertarsal joints. Shockwaves do not appear to slow the progression of OA, but it does appear to decrease the pain. This may be accomplished by decreasing synovitis or by reduction of sensory nerve conduction."

A dog wheelchair for Ivan
Notes from someone who tried this therapy for her dog with severe spondylosis: "I have been telling Ivan he is just about the poster boy for handicapped pets.com...elbow dysplasia on both front legs (his right front since only 9 months old), ACL surgery on right hind when less than 3 years old, ACL partial tear on his left stifle (that has healed better than the one that had surgery) hypothyroid since 2 1/2 years old, spondylosis requiring a wheelchair (which shockwave therapy, acupuncture and summer warmth allowed him to walk without for about 4 1/2 months in 2005!  :^)  ) and yet he just keeps on wagging his tail and being happy."

Advances in Extracorporeal Shock Wave Therapy for Dogs
Extracorporeal Shock Wave Therapy: What? Why? Safety?

What I've heard from people who have tried it
A 13-year-old Lab with arthritis in both hips, her spinal column, and right hock, and who had just torn a ligament in her right knee. Vet recommended two treatments, three to four weeks apart, and expected to see 80% improvement that would last six to seven months. The vet treated the hips, hocks and knees with shock wave therapy. Within a few days of the first treatment, the dog was going for walks without limping or her legs buckling under her, wagging her tail and playing with toys again. There was some regression after two weeks, but improvement resumed following the second treatment three weeks after the first. Eight months later, she continues to enjoy long walks, but is slower than she used to be.
A 3-year-old dog at the same clinic with severe elbow problems had a single treatment and the improvement lasted a year and a half before another session was needed.

An 11-year-old, 45 lb mixed breed dog was so lame in one front leg that she could no longer put weight on it. The problem had been very long-term, gradually increasing in intensity over the years. Two shock wave treatments were done, one month apart. No improvement was seen until 2-3 weeks following the second treatment, when the dog suddenly began "running around like a puppy again." The improvement continued for about a year and a half, with just occasional mild limping. She then began getting worse and the owner is planning another treatment.

I tried shock wave therapy with my dog, Piglet, when she was 15 1/2 years old. One treatment was done in August, 2007, followed by a second treatment a month later (1,000 pulses per elbow each time). It appears to have helped a little, but not a lot. Starting 2-3 weeks after the second treatment, Piglet began taking longer walks again -- some lasting 1 to 2 hours, while most walks in the prior six months had been 30-45 minutes. She is still slow, walking rather than trotting, but she is exploring more and resting less. The vet commented that Piglet has more bony growth around her joints than most animals he sees (her arthritis is very severe), which may possibly have limited the amount of improvement that could be achieved. The vet who treated Piglet says he sees marked improvement in about 90% of the animals he treats (which include horses and one goat).

If anyone else tries this therapy, I'd appreciate it if you would let me know the results (see bottom of page for my contact info).

Practices I've found offering this therapy (in alphabetical order by state):

Here are the devices I know about. To find a vet in your area, you can try contacting the equipment manufacturers or distributors: The University of Tennessee is enrolling dogs with arthritis in the hips, elbows or knees to evaluate the benefits of shock wave therapy (ESWT), low level laser therapy (LLLT, also known as cold laser therapy), transcutaneous electrical nerve stimulation (TENS), and acupuncture. The study is ongoing as of September, 2009.

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Regenerative Stem Cell Therapy

Regenerative cell therapy is a new and experimental form of treatment for arthritis and soft tissue (tendon and ligament) injuries in both large and small animals.

This therapy was first offered commercially to veterinarians by a company called Vet-Stem. Another company, MediVet America, began offering stem cell therapy more recently. It's possible that MediVet's technology may work even better, plus it may be less expensive, according to feedback I have received.

Stem cell therapy involves injecting stem cells directly into the affected joints (intra-articular), or occasionally injecting them intravenously, if many sites need to be treated or the sites are not reachable. This is done in a two-step process:

  1. First, a small incision is made in your dog's abdomen (or elsewhere) under general anesthesia to withdraw some fat. Vet-Stem has a laboratory in San Diego where the stem cells are extracted and sent back. MediVet has a laboratory in Kentucky that performs the same service, and also offers in-house processors to veterinarians.
  2. The extracted stems cells are then injected into the joint while the dog is heavily sedated or under short-acting anesthesia.

Excerpts from Vet-Stem's web site:

In the same way that Vet-Stem Regenerative Cell (VSRC) therapy has demonstrated successful therapeutic outcomes in horses with tendon and ligament injuries, fractures, and joint disease, it is now being used to treat osteoarthritis in dogs.

Since 2005, selected clinics have treated dogs with osteoarthritis and orthopedic soft tissue injuries. Initial studies demonstrate that intra-articular administration of VSRCs significantly decreases pain and improves comfort in the majority of cases. Duration of the benefit from a single injection varies from several months to more than one year.

Clinical trials for osteoarthritis of the canine elbow, hip, and stifle [knee]  are ongoing with successful results soon to be published.

A press release from September, 2007 states, "Vet-Stem’s clients in the United States have already treated over 2500 horses and over 100 dogs with arthritis, tendon, and ligament injuries with a success rate of over 70% return to normal performance."

From what I can tell, any improvement is not permanent and the treatment will need to be repeated periodically. Extra stem cells can be harvested so that the second treatment can skip the first step.

The Vet-Stem web site lists veterinarians offering this therapy, including several orthopedic and surgical specialists in my area who have excellent reputations. I spoke with one of them, who told me that he has not yet tried this therapy, but saw films of an older Akita who improved dramatically with it. He estimated the cost would be in the neighborhood of $2,500, which includes around $1,200 for the lab to process the stem cells, in addition to the general anesthesia costs and pre-surgery blood tests and x-rays that would be needed. This vet felt that the treatment was too experimental to justify doing it on my 16-year-old dog, and she's doing well enough now (following shock wave therapy) that I don't feel it's necessary. There is also a good chance that it might not be possible to get the needle into her joints to inject the stem cells due to the excessive amount of bony build-up around her elbows from the arthritis.

If there is no one in your area offering this therapy, you may want to try talking to your own vet, or to orthopedic specialists or holistic vets (who are often more open to new methodologies) in your area, to see if any  would be willing to try it with your dog, since it requires no special skill and is quite safe to do.

If anyone tries this therapy with their dog, I would be very interested in hearing about your experience (my contact info is below at the bottom of the page). Here's the feedback I've gotten so far:

April, 2009: I've heard from three people who have tried it. All think it helped their dogs, though not as much as they'd hoped. I read a second-hand report from another person who had this done for suspected partially torn cruciate ligaments in both knees who felt the treatment was completely successful and the dog was still sound a year and a half after it was done (now 10-year-old Standard Poodle who does agility). Note that I wouldn't expect it to work for cruciate ligaments that were completely ruptured.

September, 2010: Dani Weinberg tried Vet-Stem stem cell therapy in July for her 8-year-old GSD, Caro, who had very severe problems with one elbow, not even wanting to put weight on the leg. Following the procedure, Dani was advised to limit Caro's activity for four weeks and to do physical therapy, which Caro received. Dani is very happy with the results so far. Caro is now off Rimadyl except occasionally as needed, and has been able to resume normal activity. He still gets Tramadol at half the previous dosage. She plans to give another injection this month on the advice of the orthopedic surgeon, using stem cells that were harvested in July. The surgeon, Dr. Schwarz of Veterinary Emergency & Specialty Center in Albuquerque, NM, told her that he is seeing an 85% success rate, with just a few dogs needing additional treatment later on. Initial cost was $3,200, including follow-up visits and physical therapy, plus she will pay another $1,000 for the second injection. Contact Dani for more infomation: daniw@earthlink.net .

An article published in June, 2009, says that four veterinary schools are now researching stem cell therapy, though mostly aimed at horses. The schools are Colorado State University, University of Pennsylvania, UC Davis, and Cornell. The article does talk about its use in dogs as well: UC Davis opens stem-cell program for horses

Links to additional articles about stem cell therapy:

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Pulsed Signal Therapy (PST)

Photo of Piglet getting PSTPulsed Signal Therapy (PST) Non-invasive, painless therapy consists of nine treatments administered anywhere from 8 to 24 hours apart, each lasting half an hour. Claims significant improvement in over 70% of patients. Cost is "comparable to that of long-term NSAIDS like Rimadyl."

I did quite a bit of research on PST in June, 2008, before deciding to try it on Piglet. In my opinion, there is little science behind this treatment, though a few studies have shown that pulsed electromagnetic field (PEMF) therapy can help with delayed healing of bone fractures. PST is a form of PEMF that was patented by Richard Markoll. Unfortunately, Mr. Markoll has been involved in all of the "studies" on PST, which I do not find reliable. Most are more about marketing than about science. PEMF has been studied and is widely used in Europe for pain management and treatment of osteoarthritis. See the following for examples:
Pulsed electromagnetic field therapy in the management of knee OA
Pulsed magnetic field therapy for osteoarthritis of the knee--a double-blind sham-controlled trial
Exposure to a specific pulsed low-frequency magnetic field: a double-blind placebo-controlled study of effects on pain ratings in rheumatoid arthritis and fibromyalgia patients
Also see Magnetic Field Therapy an Attractive Option for a brief overview of PEMF applications.

A review of human studies found that pulsed electrical stimulation to encourage cartilage growth might be able to improve osteoarthritis of the knee, but more research is needed to be certain.

The vets who use PST have been very impressed with the results, seeing improvement in 80% or  more of the dogs treated, and the improvement is often profound, even "miraculous." PST works better for hips than it does for elbows, according to the vets who use it, but they feel it can definitely decrease pain and increase range of motion for dogs with elbow dysplasia. Treatment for elbow problems may need to be repeated in one to two years, which is not usually necessary for other joints.

Piglet (see picture above) had PST done by Dr. Erin Troy at the Canine Rehabilitation Center in Walnut Creek, CA. The cost was $800, plus $50 for the required veterinary consultation. Dr. Troy feels that PST likely works best when there is enough cartilage remaining in the joint for the PST to stimulate, but unfortunately it's not possible to measure how much cartilage is there. PST also works best if the legs are extended, opening up the joints, which is easier to do on some dogs than on others. Because Piglet's arthritis is so advanced, it is questionable how much cartilage she has left. In addition, she is not the type of dog who will relax in a treatment situation (although her elbows don't bend very well any longer, meaning that her legs are more extended when she lies down than would be true for a healthy dog). For these reasons, I felt that PST was a longshot to help her, but it would not hurt, and I believed it worth a try. We started therapy 7/7/08. Maximum improvement  takes up to 16 weeks, though positive changes can be seen  much sooner with some dogs. Unfortunately, PST did not help Piglet at all.

While researching PEMF, I came across a number of sites that sell devices you can use at home. Again, none have any science behind them, and I feel most probably have little value. However, if PST is not available in your area, they might be worth a try. The best option I found for dogs is the Bio-Puls Magnetic Therapy Bed and Electromagnetic Therapy Jacket, made by Respond Systems. These items are expensive, but they offer a rental option for three months or more that allows you to try them out (if you decide to keep them, the rental price is applied to your purchase). The New England Canine Rehabilitation & Fitness Center appears to be using this jacket, based on their pictures, but I was unable to get additional information from them. I also found HealFast Therapy PetPatches that claim to provide PEMF therapy in a convenient patch (I'm not impressed with their web site, which has limited information, such as how long these patches are good for, and recommends products I cannot find listed there).

Note that PST and PEMF are not the same as static magnet therapy, which does not appear to have any scientific support. Pulsed electromagnetic fields would have a different effect on the body than magnets.

If anyone has tried PST, or the Bio-Pulse bed or jacket, or any other form of PEMF, I would be interested in hearing from you (my contact information is at the bottom of the page).

Assisi Loop: Assisi Animal Health tPEMF (pulsed electromagnetic field) Loop device claims to help with post-surgical pain and healing, osteoarthritis, inflammation, and wound healing. A portable version that can be used at home is now available, but it can only be ordered by your vet.

Frequency of treatment will vary depending on the ailment being treated and the dog's response. From How to use the Assisi Loop and how soon you’ll see results:

Suggested retail price is $249 (as of June 2014) plus $20 shipping for either portable product. Available only with a veterinary prescription. See the company's Consumers web page for brochures on how to talk to your vet about Assisi and information you can give to your vet, or to request that Assisi send information to your vet. If your vet will not give you a prescription, the company may be able to refer you to another vet in your area who will.

If anyone tries these devices, I would appreciate feedback as to how you feel it worked for your dog. More info:

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Laser Therapy

Laser Therapy (also called low-level laser therapy or cold laser therapy) is becoming more and more popular as a treatment for chronic pain and for speeding healing following injury or surgery. Painless. The suggested protocol will vary depending on a number of factors -- for example, The Spaw suggests applying 6 times over a 3 week period, followed by monthly maintenance treatments . See the following for more information:

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Other Therapies

Acupuncture is commonly used to alleviate pain of various kinds, including arthritis pain. If acupuncture helps your dog, you may want to consider using Gold Bead Implants, which work like permanent acupuncture. See the Gold Beads Implant Directory for articles with more information and a list of some of the vets who perform this treatment.

Many people have had success using chiropractic treatments and/or Massage Therapy, which you can learn to do yourself at home (the book that was recommended to me by the physical therapists who worked on Piglet after her knee surgery is Canine Massage by Hourdebaigt, now also available as an e-book).

Hydrotherapy using swimming or underwater treadmills is becoming more available and can be very helpful, especially following surgery. Here are a few facilities offering hydrotherapy that I know about (listed alphabetically by state), followed by other sites with listings:

I came across several other therapies while researching the ones above, but I have little information on them. If anyone has tried them with their dog, please let me know (contact information below).

Neuromuscular Electrical Stimulation (NMES) Electrical stimulation used to prevent atrophy post-injury or surgery or to increase strength in atrophied muscles.

Transcutaneous Electrical Nerve Stimulation (TENS) Uses electrical impulse to reduce pain. I had trouble finding much information on this. I think it may be the type of electrical stimulation that is often employed in conjunction with acupuncture. A review of human studies found that TENS and AL-TENS over at least four weeks are effective for pain control and relief of knee stiffness in osteoarthritis.

Dodger getting ultrasound therapy for a pulled groin muscle.Therapeutic Ultrasound Non-invasive treatment offers short-term pain relief. Direct contact with skin is required, meaning the area must be shaved and ultrasound gel used. An updated review of the use of therapeutic ultrasound found that it may be beneficial in some cases of osteoarthritis and possibly other situations as well..

A friend used therapeutic ultrasound for her Rottweiler's pulled groin muscle (pictured at right receiving treatment). Improvement was immediate, with complete return to normal function after the second treatment over two days. She also had therapeutic ultrasound done on her own shoulder (partially torn rotator cuff that causes chronic pain) and was amazed at how much better her shoulder felt the next morning, giving her a range of motion she had not had in some time. For her, the improvement only lasted one week, though repeated treatments might prolong effect.

Platelet-Enhanced Plasma Therapy (C-PET), also called platelet-rich plasma (PRP) therapy. Filters your dog's own blood in a manner of minutes into plasma that is injected into arthritic joints. The claim is that the platelets provide cushioning that provides relief quickly (often within days), while growth factors help to repair damage to the joint and slow progression of the disease. Improvement may last up to one year following a single injection. Somewhat similar to stem cell therapy, but less expensive, though there will still be costs associated with anesthesia or sedation when the joint is injected. The entire process can be done in half an hour with the proper equipment. This treatment has been used in horses for some time, primarily for ligament and tendon injuries, but has only started being used for dogs around 2008. See the following for more information:

These sites have more information on some of the above therapies:

One Pro’s Take on Orthopedic Advances Quick overview of platelet-rich plasma (PRP) therapy, stem cell therapy, various types of cruciate ligament repair, joint replacement, disc surgery, and rehab treatments, including therapeutic ultrasound, low-intensity laser therapy, physical therapy in general, electrical stimulation and underwater treadmills.

Physical and Alternative Therapies in the Management of Arthritic Patients Talks about the use of heat and cold therapy, therapeutic ultrasound, neuromuscular electro-stimulation, shock-wave therapy, osteopathy and acupuncture.

The orthopaedic patient: conservative treatment, physiotherapy and rehabilitation Discusses thermotherapy (heat and cold), massage, transcutaneous electrical nerve stimulation (TENS), extracorporeal shock wave therapy (ESWT) and more.

TOPS Veterinary Rehab Information on cryo (ice) and heat therapy, neuromuscular electrical stimulation, pulsed signal therapy, therapeutic ultrasound, and more.

The Spaw Canine Sports Medicine and Rehabilitation Information on  cryo (ice) and heat therapy, neuromuscular electrical stimulation, laser therapy, pulsed signal therapy, therapeutic ultrasound, and more.

Getting the Dog Moving After Surgery Article from the Journal of the American Animal Hospital Association that discusses cryotherapy, range of motion exercises, heat, neuromuscular electrical stimulation, therapeutic exercises, pain control and more.

Rehabilitation and Conditioning for Animals See links on right side of page for more information on ice and heat, ultrasound therapy, and more.

Canine Rehabilitation Institute associated with Colorado State University lets you search for graduates by state.

Canine Physical Therapy Assistance lists physical therapists and other related fields by state (scroll down).

There is an experimental treatment for dogs with Ossifying Spondylitis, or with IVD/IDD (Intervertebral Disk Disease) called RVI (Rubeola Virus Immunomodulator). It is actually a type of vaccine that has been used with horses and has only recently started being tested for use with dogs. I have heard one first hand report of a dog with spondylitis who improved greatly on this treatment regime.

The University of Tennessee is enrolling dogs with arthritis in the hips, elbows or knees to evaluate the benefits of shock wave therapy (ESWT), low level laser therapy (LLLT, also known as cold laser therapy), transcutaneous electrical nerve stimulation (TENS), and acupuncture. The study is ongoing as of September, 2009.

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Comfort Aids

SnoozAIR Bed One person wrote to me, "My Smudge, a Great Dane/Lab mix who has hip dysplasia and arthritis throughout her body, has great difficulty sitting down, you can tell it hurts. I have used some of the best Orthopedic beds on the market, but the foam (even though it's high quality) does not last long and even adding more doesn't help much. By accident, I found a bed that holds up, is easy to clean and best of all, helps Smudge be so much more comfortable. She sits down much quicker and it does not give way, it supports her weight. Smudge is a big dog, she weighs 104 pounds."
Also see the SnooZZy OrthoAir Inflatable Dog Bed at SitStay, which appears similar but is less expensive and comes in a variety of sizes.

DogLeggs Piglet got these for Christmas one year. They kept her elbows warm and padded at all times. They appear to be comfortable, she wore them all of the time for a couple of years except when we went on our walks and during the day when it was hot, and she seemed to enjoy them.

There are a number of products that can help dogs who have trouble getting up, or who loose their footing on slippery floors.

See Post Surgical Aids for information on a variety of devices that may be helpful, including slings, braces, support harnesses, boots, and more.

Bed warmers can provide warmth and comfort to aching joints. Here are some that I've heard about:

If  you've found something that works well for your dog, let me know. My contact information is at the bottom of the page.


Links to More Information

The following sites have additional information about control of chronic pain in dogs:

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If you have any questions or comments, you can contact me, but I have less time to answer questions than I used to, and it may be several days to a week before I can respond. My name is Mary Straus and you can email me at either or

   


Rocky is a Yorkie-Poodle mix who had suffered from digestive problems his whole life. Click on his image to read about the diet his owner finally found to help him.
Pashoshe Fisher, a Chihuahua, was a wonderful, joyful companion to his owner for 19 & a half years. He was on a high quality raw diet for over half his life.
This is Ella, my Norwich Terrier.