You’re almost certainly familiar with the names of Non Steroidal Anti-Inflammatory Drugs (NSAIDs) like Rimadyl, Metacam, Deramaxx and Previcox. These drugs are frequently prescribed by veterinarians to manage inflammation and pain, not only for long term disease like arthritis, but also for injuries and other acute conditions.
At some point during your dog’s life, your vet may recommend NSAIDs. But the vet may not tell you about the risks associated with these drugs …
… information you need to make an educated decision about your dog’s care.
How NSAIDs Work
NSAIDs work by inhibiting the production of prostaglandins.1
Prostaglandins are made from fatty acids in every cell of the body. There are many different types of prostaglandins in the body and their main job is to mediate inflammation. When tissue damage occurs, an enzyme system converts arachidonic acid to prostaglandins. This conversion is called cyclooxygenase and there are two types: cox 1 and cox 2.2 NSAIDs are designed to inhibit cox 1, cox 2 or both.
Cox 1 functions of prostaglandins are to:
- promote blood vessel constriction and platelet clotting when needed
- inhibit stomach acid production and promote gastrointestinal mucus secretion to protect the gut lining
- increase blood flow to the kidneys
Cox 2 functions include:
- activating an inflammatory response with pain and fever
- inhibiting blood vessel constriction and platelet clotting when clotting is not needed
Manufacturers try to produce NSAIDs that inhibit cox 2 more than cox 1. Carprofen (the active ingredient in Rimadyl) has been shown to do this in vitro (i.e., not in a live animal).1 Aspirin inhibits both. This is why aspirin is said to thin the blood and can cause stomach ulcers.
This might be okay if you’re trying to prevent blood clots and stroke. This isn’t so good if your dog is taking aspirin for arthritis and then goes to the vet for a dental extraction, during which the bleeding can’t be stopped.
What The Experts Say
Dr Colin Burrows, an internal medicine specialist at the University of Florida College of Veterinary Medicine, states: “Aspirin and other NSAIDs frequently cause gastritis or peptic ulcers and should be avoided unless absolutely necessary. NSAIDs designated for human use, such as ibuprofen…, should never be used in dogs or cats. These drugs cause severe, frequently fatal gastric and intestinal ulceration.” 3
The manufacturers of Metacam explain, “As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal (gut), renal (kidney), hepatic (liver) toxicity…Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Serious adverse reactions associated with this drug class can occur without warning and in rare situations result in death.” 4
Kidney specialist Dr Gregory F Grauer warns that “dogs of advanced age, those with subclinical kidney disease, or on concurrent medications such as furosemide”(a diuretic) are at an increased risk for kidney damage when an NSAID is added to their treatment protocol.
Idiosyncratic reactions (meaning the cause is unknown) can occur with any NSAID use. Some dogs may be more prone to reaction due to genetic predisposition.
The reported incidence of liver disease from carprofen use is only 0.05 percent of dogs treated. Interestingly, carprofen is primarily metabolized in the liver. But not all reactions are reported, so that number might be understated.
Regardless of the percentages, a reaction doesn’t feel so rare when it affects your pet! I’ve seen a distraught pet owner who learns her dog has irreversible dry eye due to a course of the NSAID etodolac (Etogesic) and the anger of another whose pet suffers from kidney disease caused by deracoxib (Deramaxx).
And even worse, in most cases, dog owners are not forewarned of these dire side effects.
What To Watch For
If your dog is taking NSAIDs, you should monitor your dog for vomiting, blood in the vomit, black stool, blood in the stool, loss of appetite, grinding of the teeth, lethargy and, if blood work is performed, anemia or low protein in the blood due to blood loss through the gastrointestinal tract.
Benefits Vs Risks
Dr Wesley Roach and Dr Spencer Johnson from the College of Veterinary Medicine at the University of Georgia concur that NSAIDs should be used for the management of osteoarthritis. In addition they recommend chondroprotective agents such as injectable polysulfated glycosaminoglycans, oral glucosamine, chondroitin sulphate, hyaluron, opioids-such as butorphanol or Tramadol, and even acupuncture. They emphasize nutrition and low impact exercise (such as swimming) for weight control. Disease will progress despite these therapies, they say.5
The reason all these therapies are still recommended for maintenance, even with NSAID use, is because NSAIDs are not effective in improving joint health and, not surprisingly, they even damage joint health.
Two placebo-controlled masked studies on Metacam using 277 dogs demonstrated statistically significant improvement in all measured parameters in the first study and only in two parameters in the second study. All parameters were based on subjective evaluation of improvement only.
Making Arthritis Worse?
According to Dr Ross Hauser, “one of the most serious adverse reactions to NSAIDs, that is little appreciated, is that as a class of compounds they cause the breakdown of articular cartilage, thereby accelerating osteoarthritis, the very disease for which they are most commonly prescribed! The pathogenesis of osteoarthritis is accelerated by NSAIDs.” 6
Even the authors of the esteemed Small Animal Surgery textbook assert, “Most NSAIDs interfere with chondrocyte (cartilage cells) glycosaminoglycan synthesis and therefore should be used continuously only for a short time.” They suggest chondroprotective food additives, which may decrease joint inflammation. The same authors suggest gastroprotective medications alongside NSAIDs.7
It’s hard not to conclude that the risks outweigh the benefits of NSAIDs, especially when there are natural options that can be just as effective.
The Body’s Ability To Heal
“… the sensation of pain is a deeply ingrained trigger within the body to quickly protect it from harm.” – Jodie Gruenstern DVM
Sometimes we forget how good the body is at doing what it’s meant to do. The best approach to medicine is often not to interfere with the body’s natural processes. The concept of hormesis embraces this fact and teaches us that a little stress is something that helps the body to repair and strengthen.
Inflammation is a natural, protective, physiologic mechanism that’s necessary to stimulate the body’s healing processes. Inflammation is aptly derived from the Latin word meaning fire. Anyone who has experienced significant inflammation understands how the redness, swelling and pain of the inflammatory process feels like the burn of a flame on the skin.
It’s the acute (short lived) pain of inflammation that forces us to stop the insult to the tissue, which then allows the healing process to begin. If you touch a hot stove, the burn will only begin to heal once you remove your hand from the stove. If you touched the stove and didn’t feel any pain, your hand would suffer considerable burning and damage. But the sensation of pain is a deeply ingrained trigger within the body to quickly protect it from harm.
The longer term pain of chronic inflammation is more difficult to manage than just removing your hand from the hot stove. Inflammation becomes chronic because the cause of the body’s inflammatory response is persistently present. For example, a sliver or an intestinal foreign body will stimulate inflammatory cells to attempt to expel the invader until it’s removed.
So pain and inflammation would seem like a good thing for the body. Yet conventional medicine says we should suppress inflammation – I guess, because it hurts. Fortunately, there are other options.
Alternatives To NSAIDs
There are several natural treatment alternatives that have been shown to relieve discomfort in dogs without the deleterious side effects of NSAIDs.
A small double blinded study of dogs with moderate to severe osteoarthritis showed that dogs receiving the homeopathic blend Zeel® (made by Heel) for eight weeks had significantly less pain than their placebo peers, although carprofen was more effective. Homeopathy as a treatment is often seen as elusive and controversial, but considerably safer than an NSAID. This study warrants respect and further investigation.
In addition, two homeopathic remedies were found to inhibit leucocyte elastase activity in an in vitro study. Leucocyte elastase is an enzyme that’s released during an inflammatory response and damages articular cartilage. Arnica montana inhibited this enzyme activity by up to 70 percent. Similarly, Rhus toxicodendron inhibited the leucocyte elastase up to 77 percent. Less cartilage damage means less pain for your dog.8 Both of these remedies are contained in the Zeel complex.
These findings help scientists understand and accept the validity of homeopathic medicines. The more mainstream our natural treatments become, the more our animals will benefit.
From the same parent company Heel, comes Traumeel®. Made popular among humans who find it to be effective, many holistic veterinary practitioners and rehab specialists use this blend for dogs and cats. Zeel is most often recommended for osteoarthritic conditions while Traumeel is for soft tissue injuries. Each comes in tablet or injectable form.
*Note: Heel has exited the US and Canadian markets and Heel Inc. has been sold to MediNatura Inc. Effective January 1st, 2015, Zeel and Traumeel will be replaced by MediNatura products T-Relief Arthritis and T-Relief, respectively. These products will be available in the same dosage forms and sizes as Traumeel and Zeel.
This Chinese herb is a natural anti-inflammatory can replace or avoid many NSAID prescriptions. It’s especially interesting to note that corydalis is an analgesic that actually protects the GI tract. In a large sample of patients with stomach and intestinal ulcers or chronic inflammation of the stomach lining, corydalis improved healing and symptoms in 76percent of the patients.
A constituent of the herb called THP (tetrahydropalmatine) reduced nerve pain in 78percent of human patients tested in a 1990 study. Sedation and anticonvulsant effects are other indications for this herb. The species used is Corydalis yanhusuo, a native to the northern Chinese province of Zhejiang.
When mild sedation is desirable in addition to pain management, California poppy comes to the rescue! Clients who prefer to avoid NSAIDs for post-operative pain have been happy with their pet’s pain management when California poppy is prescribed. It contains small amounts of morphine and has analgesic effects that have been demonstrated in studies.
Boswellia is also an effective anti-inflammatory and is often used by migraine sufferers to manage their pain. Pet owners report their animals need less or no NSAIDs when they use Standard Process Boswellia Complex twice daily for their large breed dogs with osteoarthritis.
In a clinical trial with Boswellia serrata (BSB108, product of Bogar AG) 71percent of dogs with degenerative conditions showed improvement. A potential mechanism for this efficacy is due to the presence of boswellic acids in the herb, which have been shown to reduce inflammatory cell infiltrates.9
Quality and therefore efficacy can vary substantially among herbs and other natural supplements. This is why I recommend Standard Process Boswellia.
My experience with Arnica is with the herbal liniment from Buck Mountain Botanicals. This provided amazing relief for a Labrador Retriever with severe neurologic pain. When NSAIDs, Tramadol, and gabapentin did nothing, this old fashioned topical massaged on to the affected area brought immediate and long lasting relief.
While homeopathic preparations of Arnica are extremely safe, Arnica the herb when taken orally is extremely toxic, so licking must be prevented! Some active constituents in Arnica are the sesquiterpene lactones. Sesquiterpenes are a chemical class of constituents present in many herbals and essential oils.
Don’t underestimate the hot/cold relief you can give your dog with the essential oils, copaiba, wintergreen and peppermint. Massage these oils onto the affected area but save one drop of peppermint for last; peppermint is a potent oil that drives the others in deeper.
Copaiba is extremely high in beta-caryophyllene, a potent anti-inflammatory. Copaiba is a resin tapped directly from a Brazilian tree and not distilled. It is generally regarded as safe and may be taken orally or topically for arthritis. Wintergreen contains methyl salicylate, which is anti-inflammatory and analgesic when used for conditions such as arthritis, muscle and nerve pain.10
I use all three of these oils topically for almost all of my canine patients who have spondylosis, disc disease or osteoarthritis.
You may recognize salicylate or salicylic acid as the chemical constituent in aspirin. The chemical balance present in herbs and most essential oils is what helps prevent the side effects that commonly occur in the drug counterpart.
Natural products in the form that nature intended are usually the safest and most effective approach to controlling chronic inflammatory disorders, just as they have been historically. In fact, most medical discoveries began with a study of historical uses of plants as traditional remedies.
The plants begin to get more dangerous when their chemicals are isolated.
Noted herbalist Greg Tilford once told me, “Don’t ever forget, the whole herb is always greater than the sum of its parts.” Surely this is especially true when we’re discussing safety.
Natural remedies tend to facilitate the body’s innate ability to change or balance itself, while drugs tend to force the body into change.
Many natural approaches can be used simultaneously. They can also be used in conjunction with laser therapy, massage or acupuncture. Most work synergistically while some would be best alternated, especially the energy medicines.
All these natural options to pain and inflammation merit further investigation. Both double blind studies and massive amounts of anecdotal evidence are making a case for natural solutions. Pet owners have the right to be informed and to make educated decisions regarding how to best manage their best friend’s care.
- Plumb’s Veterinary Drug Handbook Plumb 2008
- Virtual Chembook Elmhurst College Ophardt 2003
- Clinical Medicine of the Dog and Cat Iowa State Press Schaer 2003
- Metacam insert, Boehringer Ingelheim Vetmedica, Inc.7/2010
- Clinical Veterinary Advisor Second Edition Cote 2011
- Journal of Prolotherapy Volume 2 Issue 1 February 2010
- Small Animal Surgery Mosby Fossum 1997 p.945
- Evidence-based Complementary and Alternative Medicine 2009 December (6) 4, 465-471
- Veterinary Herbal Medicine Wynn and Fougere 2007
- Essential Oils Desk Reference Fourth Edition 2009