Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

2020 ◽  
Vol 22 (11) ◽  
pp. 1069-1083
Author(s):  
Nathalie Dowgray ◽  
Eithne Comerford
Keyword(s):  
Chronic Pain ◽  
Best Practice ◽  
Clinical Situation ◽  
Evidence Base ◽  
Degenerative Joint Disease ◽  
Visual Observation ◽  
Good Evidence ◽  
Joint Disease ◽  
High Prevalence ◽  
Central Stimulation

Practical relevance: An understanding of the process of musculoskeletal ageing – which all senior and geriatric cats will experience – is vital to maintaining the health and welfare of our ageing cat population. Clinical challenges: Assessment of the feline musculoskeletal system is not always straightforward. Diagnosis of impairment relies on input from owners and veterinarians in terms of visual observation, and clinical and orthopaedic examination, in addition to diagnostic imaging Audience: This review is written for the primary care veterinary team. Aims: The goals are to raise awareness and improve clinical diagnosis of musculoskeletal impairment as a result of ageing. The article also reviews therapeutic options and considers the evidence available for the prevention/deceleration of musculoskeletal ageing and impairment. Evidence base: There is good evidence of a high prevalence of osteoarthritis (OA) and degenerative joint disease (DJD) in older cats. There is also good evidence to indicate that functional impairment and chronic pain are sequelae of musculoskeletal disease. However, there is a paucity of information for what is best practice for the management and treatment of musculoskeletal impairment in a clinical situation. There is also a lack of evidence on how prevention of central stimulation of the nervous system caused by musculoskeletal impairment and, in turn the development of chronic pain, can be avoided.

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

scholarly journals Bioregulatory drugs in osteoarthritis management

2019 ◽  
pp. 76-83
Author(s):  
O. A. Shavlovskaya
Keyword(s):  
Chronic Pain ◽  
Pain Relief ◽  
Combined Treatment ◽  
Pain Syndrome ◽  
Cartilage Destruction ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Functional Improvement ◽  
Chronic Pain Syndrome ◽  
Matrix Loss

Osteoarthritis (OA) is a degenerative joint disease. Modern theories consider various structural (cartilage destruction) and biophysical disorders (matrix loss of glycosaminoglycans) as the basis of acute and chronic pain syndrome. The main aim of OA therapy is pain relief and functional improvement. To manage pain syndrome in OA it is reasonable to use complex bioregulatory drugs (CBD) (Traumeel S, Zeel T, Discus compositum) both in monotherapy and in combined treatment. The effectiveness of CBD is comparable to that of NSAIDs and CS.

Incorporating a rehabilitation ethos into the management of canine osteoarthritis

2021 ◽  
Vol 26 (7) ◽  
pp. 139-146
Author(s):  
Hannah Capon
Keyword(s):  
Complex Disease ◽  
Evidence Base ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Mobility Function ◽  
High Incidence ◽  
Related Quality ◽  
Health Related

Osteoarthritis is a painful and debilitating degenerative condition with an extremely high incidence. Consequently, it is frequently encountered in first opinion practice and was recently cited as a primary cause of welfare compromise through extensive population studies carried out by Vet Compass, a division of the Royal Veterinary College. In the preceding article of this series (https://doi.org/10.12968/coan.2021.0014), the author provided a brief overview of the complexity of chronic pain associated with osteoarthritis and advocated for a polypharmacy approach guided by the clinical presentation. However, pain is only one clinical manifestation of degenerative joint disease. Osteoarthritis affects the whole joint and local support structures, as well as impacting the entire musculoskeletal system. Interventions targeting the multitude of consequences of this disease are likely to have greater impact on long-term analgesia, independent mobility, function, longevity and overall health-related quality of life. This article introduces the clinical reasoning and evidence base associated with an integrated multimodal approach to a multifaceted and complex disease.

scholarly journals Early CPAP reduced mortality in covid-19 patients. Audit results from Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

2020 ◽  
Author(s):  
Abdul Ashish ◽  
Alison Unsworth ◽  
Jane Martindale ◽  
Luigi Sedda ◽  
Ramachandran Sundar ◽  
...  
Keyword(s):  
Best Practice ◽  
Small Sample Size ◽  
Clinical Care ◽  
Evidence Base ◽  
Good Evidence ◽  
Small Sample ◽  
Teaching Hospitals ◽  
Sufficient Evidence ◽  
Recent Experience ◽  
Common Clinical Practice

AbstractCOVID-19 infection typically causes pneumonia with bilateral changes on Chest radiograph. There is significant hypoxia and use of oxygen for patients admitted to hospital is standard. The use of Continuous Positive Airway Pressure (CPAP) in patients with COVID-19 has now become established as a common clinical practice based on recent experience. It is given as part of “best endeavours” treatment in the absence of sufficient evidence to guide best practice. The use of CPAP as a step up in clinical care is now common but has a poor evidence base.Using routinely collected data, the use of CPAP as a supportive non-invasive ventilatory treatment is described in 35 patients with COVID infection. Patients given early CPAP and in particular within 48 hours of admission, are shown to have a better outcome (a significant probability of lower mortality) than patients who received late CPAP (more than 48 hours after admission).Although the analysis is affected by a small sample size, the results have shown good evidence that supports the early use of CPAP in patients with COVID-19 infection.

scholarly journals Treatment and Prevention of Osteoarthritis through Exercise and Sports

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Victor Valderrabano ◽  
Christina Steiger
Keyword(s):  
Pain Relief ◽  
Muscle Function ◽  
Symptomatic Treatment ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Joint Function ◽  
Treatment And Prevention ◽  
High Prevalence ◽  
Strengthening Exercises ◽  
Prevention And Treatment

Osteoarthritis (OA) is a degenerative joint disease with a high prevalence among older people. To date, the pathogenesis of the disease and the link between muscle function and OA is not entirely understood. As there is no known cure for OA, current research focuses on prevention and symptomatic treatment of the disorder. Recent research has indicated that muscle weakness precedes the onset of OA symptoms. Furthermore, several studies show a beneficial effect of land-based aerobic and strengthening exercises on pain relief and joint function. Therefore, current research focuses on the possibility to employ exercise and sports in the prevention and treatment of OA.

scholarly journals Extracorporeal shockwave treatment in knee osteoarthritis: therapeutic effects and possible mechanism

2020 ◽  
Vol 40 (11) ◽  
Author(s):  
Senbo An ◽  
Jingyi Li ◽  
Wenqing Xie ◽  
Ni Yin ◽  
Yusheng Li ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Specific Treatment ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Therapeutic Effects ◽  
Management Options ◽  
Extracorporeal Shockwave ◽  
Joint Activities ◽  
Shockwave Therapy ◽  
Cardinal Symptoms

Abstract Osteoarthritis (OA), the most common degenerative joint disease, is characterized by the cardinal symptoms of chronic pain and restricted joint activity. The complicated pathological changes associated with OA and unclear mechanistic etiology have rendered existing non-surgical OA management options unsatisfactory. Increasing clinical and experimental evidence suggests that extracorporeal shockwave therapy (ESWT) is beneficial in OA treatment. ESWT is found to have modifying effects on cartilage and subchondral bone alterations in OA progression, as well as the clinical complaints of patients, including chronic pain and limited joint activities. However, the specific treatment strategy regarding the dosage and frequency of ESWT is still underdetermined. This review discusses the existing evidence regarding the therapeutic indications and possible mechanism of ESWT for OA treatment.

scholarly journals Efficacy and Safety of an Anti-nerve Growth Factor Antibody (Frunevetmab) for the Treatment of Degenerative Joint Disease-Associated Chronic Pain in Cats: A Multisite Pilot Field Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Margaret E. Gruen ◽  
Jamie A. E. Myers ◽  
B. Duncan X. Lascelles
Keyword(s):  
Chronic Pain ◽  
Nerve Growth Factor ◽  
Pain Management ◽  
Growth Factor ◽  
Unmet Need ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Efficacy And Safety ◽  
Nerve Growth ◽  
Objectively Measured

Background: Pain management for cats with degenerative joint disease (DJD) remains a critical unmet need. Recent work has shown promise for a feline-specific anti-nerve growth factor monoclonal antibody (frunevetmab) to deliver safe and effective pain management. Our objectives were to evaluate the efficacy and safety of frunevetmab administered twice using two administration routes (subcutaneous and intravenous) compared to placebo.Methods: This was a randomized placebo-controlled, double-masked study. After a week-long pain and activity baseline, 126 cats were randomized to receive injections of frunevetmab (IV then SC; n = 42 or SC then SC; n = 43) or placebo (IV then SC; n = 41) on Days 0 and 28. Owners completed questionnaires on Days 14, 28, 42, and 56. Accelerometry data were collected continuously throughout.Results: Owner questionnaire results showed significant improvement in frunevetmab-treated cats [compared to placebo; (p < 0.05)] at Days 42 and 56; no difference was found between routes of administration for frunevetmab. All groups had decreased objectively measured weekly activity from baseline; frunevetmab-treated cats had a mean decrease of 0.9%, while placebo-treated cats had a mean decrease of 9.3%. Treatments were generally well-tolerated. The majority of adverse events included dermatitis/alopecia related to activity-monitor collars; these occurred in a higher percentage of frunevetmab, compared to placebo, treated cats.Conclusions and Clinical Relevance: Treatment with frunevetmab provided improvements in owner ratings of mobility over treatment with placebo; these results were supported by objectively measured accelerometry. Frunevetmab has the potential to address a critical gap in the treatment of chronic pain in cats.

Apportionment of Impairment from Meniscal Tears and Knee Arthritis

2013 ◽  
Vol 18 (5) ◽  
pp. 1-10 ◽  
Author(s):  
Charles N. Brooks ◽  
James B. Talmage
Keyword(s):  
Medial Meniscus ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Detailed Knowledge ◽  
Meniscal Tears ◽  
Knee Arthritis ◽  
Degenerative Arthritis ◽  
Study Results ◽  
Physical Findings ◽  
Causation Analysis

Abstract Meniscal tears and osteoarthritis (osteoarthrosis, degenerative arthritis, or degenerative joint disease) are two of the most common conditions involving the knee. This article includes definitions of apportionment and causes; presents a case report of initial and recurrent tears of the medial meniscus plus osteoarthritis (OA) in the medial compartment of the knee; and addresses questions regarding apportionment. The authors, experienced impairment raters who are knowledgeable regarding the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), show that, when instructions on impairment rating are incomplete, unclear, or inconsistent, interrater reliability diminishes (different physicians may derive different impairment estimates). Accurate apportionment of impairment is a demanding task that requires detailed knowledge of causation for the conditions in question; the mechanisms of injury or extent of exposures; prior and current symptoms, functional status, physical findings, and clinical study results; and use of the appropriate edition of the AMA Guides. Sometimes the available data are incomplete, requiring the rating physician to make assumptions. However, if those assumptions are reasonable and consistent with the medical literature and facts of the case, if the causation analysis is plausible, and if the examiner follows impairment rating instructions in the AMA Guides (or at least uses a rational and hence defensible method when instructions are suboptimal), the resulting apportionment should be credible.

3. Degenerative joint disease

2000 ◽  
Vol 81 (3B) ◽  
pp. s67-s72
Author(s):  
Victoria A. Brander ◽  
Darryl L. Kaelin ◽  
Terry H. Oh ◽  
Peter A.C. Lim
Keyword(s):  
Degenerative Joint Disease ◽  
Joint Disease
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