non-nsaid oral approaches to inflammation · the higher the power…! the lower the treatment...

Delaware Valley Academy of Veterinary Medicine October 9, 2013

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Chronic Pain: Beyond NSAIDs

James S. Gaynor, DVM, MS, DACVA, DAAPM Colorado Springs, CO USA 719-266-6400 800-791-2578 www.PeakVets.com

Alleviation of Pain Associated With OA - Multi-modal approach •  Weight loss •  Controlled

exercise •  Pain relievers •  Structure modifiers •  Adjuncts •  Nutrition •  Hyaluronic acid •  Microlactin

•  Elk velvet antler •  Acupuncture •  Massage •  Physical

rehabilitation •  Therapeutic laser •  Pulsed

electromagentic field therapy

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Non-NSAID Oral Approaches

to Inflammation

Dasuquin •  Glucosamine •  Chondroitin •  ASU

–  Avocado –  Soybean –  Unsaponafiables

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Dasuquin® •  Combination

inhibits expression & production of many inflammatory and degradative mediators

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Dasuquin® •  Effects extend

across species –  Canine –  Feline –  Equine –  Human cells

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What is MicroLactin?   Milk - derived protein   Hyper-immunized cows   Anti-inflammatory effect   Inhibits neutrophil migration

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8 4 0 55

60

65

70

75

80

Placebo, n=17 Active Duralactin, n=18

Improvement in Orthopedic Disability Index in Dogs

Time, weeks

Ort

hope

dic

Scor

e (0

-100

, mea

n ±

sem

)

p<0.001

• Overall improvement noted in – 68% of therapeutic group – 35% of placebo group

CanEVA™ Elk Velvet Antler

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Elk Velvet Antler (EVA) Contains •  Glucosamine •  Chrondroitin •  Hyaluronic acid •  Omega 3 & 6 •  Calcium •  Phosphorus

•  Growth factors •  Magnesium •  Copper •  Zinc •  Selenium •  Collagen


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The Canadian Veterinary Journal A reprint of:

Clinical evaluation of a powder of quality elk velvet antler for the��

treatment of osteoarthrosis in dogs

Maxim Moreau, Jacques Dupuis, Norbert H. Bonneau, Manon Lécuyer

2004, Volume 45, No. 2, pages 133-139

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Dogs EVA Treated Dogs

–  Improves their weight bearing and executed the stride in a comfortable manner.

–  Could be attributed to: •  Increased muscular strength or •  Decrease in joint inflammation or •  A combination

–  Investigators speculated that palpation of muscle mass revealed a significant reduction of atrophy, suggesting a myotropic effect, rather than simple anti-inflammatory effect

The Canadian Veterinary Journal 2004, Volume 45, No. 2, pages 133-139

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Parenteral Structure Modifying Drugs •  Polysulfated

glycosaminoglycans •  Decreases cartilage

catabolism and prevents adverse joint changes

•  Change in pain? •  YES: based on

clinical improvement

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Cosequin •  Glucosamine HCl* •  Low molecular

weight chondroitin*

•  Manganese*

•  *Documented efficacy in the target species

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Stem Cell Therapy •  Anesthesia and surgery •  Send adipose to lab •  2 days later

– Sedation –  Inject stem cells into joints

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Feb 13, 2008

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Stem Cell Therapy •  A dog’s own adult mesenchymal

stem cells •  Intravenous or intra-articular •  Mechanisms of action

– Cartilage regeneration – Anti-inflammatory – Centrally mediated analgesia – Others?

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Cinnamon •  10 yo MC Std Poodle •  Bilateral Hip DJD •  Unable / unwilling to

take meds •  Euthanasia list - new

dog in family •  IA stem cells •  1-40 months - playing,

jumping running, walks

Cinn photot

Macha: 6 year old FS Labrador Retriever •  Trouble keeping up

hunting •  Crying going up

stairs •  Arthritis of bilateral

hocks, Shallow L acetabulum

•  NSAID / tramadol

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Macha – 30 days •  The owners noticed improvement in

about 10 days, She is now going up hills, snow banks, chasing the retriever dummy with great enthusiasm, puts her paws up to get into the truck, has an improvement in attitude, wags her tail more and no longer has a RF lameness

•  75% normal ©PPVG 2013

Macha – 60 days post •  Not hunting yet… •  I took her out last Friday for the last

day of pheasant season at my bird club, and she must have covered at least 15 miles. No ill effects. She caught two birds on her own that foolishly elected to hide rather than fly. If they had flown, I might have missed. Macha never misses.

•  She is outrunning the 3 yr olds. ©PPVG 2013

Macha – 6 months after IA therapy •  She still seems entirely normal (and

still remarkably improved over her pre-therapy condition) in normal activity (stairs, getting up from bed, etc.). She is, of course, also eight months older than when she was treated. If there has in fact been any deterioration is it minimal. She still launches herself into ponds when retrieving.

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Real World Dog Cases

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Average Veterinary Scores of Dogs in Regards to Pain, Lameness, and Range of Motion

2008 Commercial Clinical Data*

1.0

1.5

2.0

2.5

3.0

3.5

Pain(N=141, pre-tx)

Lameness(N=146, pre-tx)

Range Of Motion(N=141, pre-tx)

Vete

rinar

y Sc

ore

Veterinary Scale:5=Extreme (considering euthanasia)4=Severe3=Moderate2=Mild1=Normal

*Voluntary responses from commercial cases.

Day 0 30 60 90 Day 0 30 60 90 Day 0 30 60 90

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% of Dogs With Quality of Life Change

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Change in NSAID Usage After Stem Cell Therapy

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Other Uses of Stem Cells •  IBD – immune

mediated bowel disease –  2 treatments –  Remission for 36+

months •  Immune mediated

polyarthropathy –  5 dogs –  Return to normal

activity

•  Acute hepatopathy –  IV –  Fast return to

normal liver enzyme values

•  Skin

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Targeted PEMF

•  Proprietary signals (tPEMF) •  A priori targeting of

electrochemical activity •  Decreased power, increased

efficacy compared to PEMF •  Treats through dressings,

clothing, casts, etc.

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Specific effects of tPEMF  Targeting Calcium/Calmodulin Binding (Ca/

CaM)  Anti-inflammatory cascade  Signal configuration couples to Ca2+ binding

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tPEMF Mechanism of Action

Ca2+ + CaM Ca2+CaM

PEMF increases Ca2+ binding to CaM (in milliseconds)

Ca2+CaM + cNOS NO Ca2+CaM binds to cNOS, which catalyzes NO release (in

seconds) Anti-inflammatory: increased Blood and Lymph Flow Pain/Edema Decrease (in seconds)

NO cGMP Growth Factors (in hours/days) VEGF Angiogenesis (in hours/days) FGF Collagen/Granulation (in days) TGF-β Remodeling (in days/weeks)

Voltage dependent

PEMF induced current

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Osteoarthritis Study Results

PEMF Treatment Days

0 5 10 15 20 25 30 35 40 45

Mea

n M

axim

um V

AS

2

3

4

5

6

7

8

9ActiveSham

•  33 patients •  Working people with

OA –  In OA clinic –  TX: bid 15 minutes.

•  Active group showed an immediate (within 2-3 treatments) 45% decrease in pain and slowly over time showed a 55% decrease in pain.

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An acronym for

Light Amplification

by Stimulated Emission of Radiation

Laser Science

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Class 1

Laser Printers

CD Players

Class 2

Low Power

Diffuse output

Laser Classification

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Class 3a

LLLT Lasers Laser Pointers

Class 3b

LLLT <500 mW

Laser Classification

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Surgical Lasers: Used to cut, coagulate and evaporate tissues. This type of laser replaces the scalpel.

Therapeutic Lasers: !Used for the stimulation of cell function. The biological effect is photochemical not thermal, unlike surgical lasers. !

Class IV Lasers in Medicine

PHOTOBIOMODULATION ©PPVG 2013


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Important Parameters •  The right

wavelength for absorption

•  The right depth of

penetration

•  The right amount of light or dosage

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The higher the power… The lower the treatment time!

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Photobiomodulation & Pain

•  Increase in beta endorphins

•  Blocked depolarization of C-fiber afferent nerves

•  Localized anti-inflammatory effect

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Canine Applications

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Data •  Physiologic •  Human

–  Arthritis pain –  Healing

•  Veterinary - Pending

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Hyaluronic acid •  Most abundant

lubricant in body •  Injectable

formulation-approved for humans and horses in US

•  Not all oral formulations are created equal

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Oral Hyaluronic Acid (HA) •  High molecular

weight HA - bioidentical

•  Proven results? •  Apparent efficacy •  Testimonials •  No published data

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Conclusions •  Believe the owner that the animal

hurts •  Be flexible with the treatment options •  Try until there is nothing else •  Get help before committing to

euthanasia

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Further Information

For Consultation

719-266-6400 800-791-2578

www.PeakVets.com

How to Request an Anesthesia or Pain Management

Consultation

©PPVG 2013

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non-nsaid oral approaches to inflammation · the higher the power…! the lower the treatment...

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