Integrative medicine has earned a place as first-line treatment for veterinary patients, especially older animals with pain, neurological compromise or debilitating arthritis.
When clients complain that their older animals are refusing to go on walks, that they sleep all the time or have even become aggressive, we need to think about problems centering on mobility and pain. In so doing, however, we should reconsider the “easy fix” of gabapentin, tramadol or non-steroidal anti-inflammatories, and seek to do more to help these patients.
Each of the aforementioned medications can cause its own set of problems, such as oversedation, inappetance and organ injury. Furthermore, they do little to directly treat the causes of mobility impairment, whether due to osteoarthritis, chronic spinal cord injury, myofascial dysfunction or pain.
Issues in aging animals
The problem may extend beyond musculoskeletal and neurologic systems, so a whole patient examination and lifestyle analysis is indicated. Taking the time to gently palpate the myofascia and examine neurologic status yields vital differential diagnostic information about the nature and location of discomfort and/or compromise, without having to force the neck or back into extreme and unnatural ranges of motion.
Geriatric animals may need more readily digestible food, anti-aging nutrients, and caloric intake adjustment. Overweight animals are at greater risk of joint disease and inflammation, while underweight individuals may have difficulty procuring, chewing or digesting food. Both states can cause muscles to weaken and strength to further decline.
Time may also rob our patients of vision, audition and overall vitality. Perceived cognitive changes such as disorientation, diminished activity, reduced social interactions, behavioral shifts and incontinence may actually stem from undiagnosed pain and neuromuscular impairment. Furthermore, many common geriatric afflictions, such as neoplasia, infections, immune-mediated illness, organ dysfunction and endocrinopathy can also change the way a dog or cat behaves.
Science-based integrative medicine supports movement and reduces pain
After appropriately assessing an animal and identifying the source of his reluctance to rise, walk or otherwise engage in the activities he used to enjoy, the next step is to discuss with the client the pros and cons of conventional and integrative treatment. The latter may involve medical acupuncture, massage, photomedicine (i.e. therapy with laser or light-emitting diodes) or even the cautious inclusion of botanical agents.
Each of these techniques, when performed safely and correctly, allows for non-drug and non-surgical options that work on several levels to improve health and restore function. The aforementioned physical medicine approaches yield overlapping benefits through unique mechanisms of action.
Despite their differences, laser, acupuncture and massage all share the common mechanism of neuromodulation. That is, each activates somatic afferent fibers in the periphery; peripheral nerves then deliver impulses to the spinal cord and brain to help normalize central, autonomic and peripheral nervous system function. All three also have the capacity to beneficially impact local tissue, promoting blood flow, reducing pain and working in an anti-inflammatory manner.
The versatility and acceptability of these approaches to patients make them suitable for both in-hospital and outpatient care. Healthcare providers can introduce short, supportive treatments throughout the day to help in-patients relax and recover. Motivated clients can learn easy and safe home care techniques involving touch and light-emitting diodes that aid in keeping their animals active and healthy.
Acupuncture incites its somatic afferent stimulation by inducing slight mechanical traction on the tissues near the needle shaft. The metal needle engages with muscle and collagen fibers, leading to a small amount of local tissue deformation capable of causing wide-ranging results. Fascia extending out from the needle begins to relax, and blood flow within the muscle normalizes. Nerve endings and axons in the vicinity issue action potentials and reflexes that cause re-regulation of firing patterns in peripheral, autonomic and central nervous system pathways.
Photomedicine provokes alterations in cellular physiology and neural activity through photonic means. Photoacceptor enzymes within the mitochondria, such as cytochrome c oxidase, absorb photons which then alter the enzyme’s binding patterns with nitric oxide and oxygen. Mitochondrial metabolism increases, as does ATP synthesis. The cavalcade of photochemical events that ensue benefit cellular physiology, intercellular signaling, and tissue repair. What makes laser therapy stand out is this capacity to “kickstart” cellular energy production needed for tissue cleanup and repair.
The mechanical effects of massage activate pressure-sensitive mechanoreceptors in the skin and subcutaneous tissue. Massage can calm or stimulate the nervous system depending on techniques, and it facilitates fluid flow through the interstitium. Signals from treated tissue travel to the spinal cord and brain to normalize nervous system balance within central, peripheral and autonomic networks. The movements of massage encourage the flow of fluids (lymphatic, arterial, venous and interstitial) through the body. This improves the health of not only somatic structures but also visceral function.
The problem of intervertebral disc disease (IVDD)
A common condition affecting older dogs is intervertebral disk disease (IVDD). It causes pain, weakness, muscle tension, inflammation, circulatory compromise and even paralysis. Clients facing the expense, fear and psychological trauma of having their dogs undergo surgery need to be educated on what non-surgical alternatives can offer based on science and research, along with appropriate anti-inflammatory pharmaceuticals and analgesics, if indicated. In contrast, weeks-long cage confinement, which is a commonly-recommended mandate, has no supportive scientific research and can lead to negative long-term neurologic and orthopedic consequences.
Even if a client seeks surgery for a dog with IVDD, the process of removing extruded disc material does little to directly address changes that take place within the spinal cord in the secondary injury phase, which occurs in the days after injury takes place. It may even worsen the inflammatory cytokine responses in the cord and surrounding tissue, and precipitate biochemically-mediated neuronal death and spinal cord inflammation.
In contrast, modalities such as photomedicine and acupuncture stimulate recovery by controlling pain, inflammation and edema. They work to promote neural regrowth and functional restoration through stem cell activation and the encouragement of more normalized neural firing patterns. Massage aids the myofascia in relaxing and provides its own form of neuromodulation.
How do you know the treatment is working?
Acupuncture and massage provide immediate feedback through the delivery device; laser does not. A skillful practitioner inserting an acupuncture needle gauges the amount of resistance the needle encounters as it penetrates one or more layers of muscle. This mechanical information conducted through the needle informs the acupuncturist about the state of tone, tension and tenderness in a muscle. Reactions from the patient further advise the acupuncturist about the degree of stimulation taking place within the patient’s nervous system.
An experienced massage therapist develops palpatory techniques that convey other types of information. Feeling the tissues respond to touch and the myofascia melt under one’s palms during indirect release techniques provide moment-to-moment messages about how the patient’s body and mind are responding.
Laser, like other instrument-driven methods such as ultrasound therapy, limits the amount of tissue engagement by the practitioner unless s/he makes a point of palpating the patient during or soon after treatment. Despite this limitation, all three modalities can fit seamlessly into integrative pain medicine treatment plans. Blending them maximizes the benefits to the patient by multiplying the mechanisms of action at play.
How does the safety of each modality compare?
When practiced by a medical/veterinary professional, acupuncture is one of the safest interventional techniques available. As long as one uses sterile needles and avoids inserting a needle into an organ, the spinal cord, a joint or a major vessel, complications are mild and resolve quickly.
Similarly, properly-performed massage is relatively non-injurious as long as pressure is kept reasonable and the practitioner remains cognizant of any patient behavior that indicates discomfort or stress.
However, photomedicine with lasers, in contrast to LEDs, may cause problems. Higher-powered laser therapy devices (i.e those in the Class IV category, which deliver >500 mW of power) may cause retinal damage with direct ocular exposure (hence the need for protective and specifically designed laser goggles). Furthermore, the race to produce higher-powered devices in the Class IV category is elevating the number of anecdotal reports of thermal burns and patient pain during the procedure. Clearly, more caution is required for veterinary patients than is often recognized, and geriatric animals with impaired ability to escape a painful treatment, or even sense a thermal burn if they have nerve injury, warrant even more caution and care.
Scientific integrative medicine has earned a place as first-line treatment for veterinary patients across the board, especially for older animals with pain, neurologic compromise or debilitating arthritis. It is time for veterinary medicine to move from a disease-based to a health-supporting paradigm of treatment, and address dysfunction well before it manifests as illness. Performing quick neurologic and gentle myofascial palpation evaluations on patients at every visit will indicate whether and where the animal is developing dysfunction in myofascia, joints or other tissues.
We need to stop relying on artificial chemicals to keep animals moving, because their effects are limited and sometimes engender costly and damaging side effects. By working instead through neuromodulation, connective tissue remodeling and photobiomodulation (i.e. acupuncture, massage and photomedicine), the body’s endogenous self-healing mechanisms are engaged, and the patient regains the ability to recover from injury more fully and quickly.
10 homecare tips for clients
- Ensure adequate traction in the home (area rugs, carpet runners, non-slip stair treads); consider toe grips or high traction socks or booties for dogs.
- Keep nails well-trimmed and delicately trim matted or soiled fur.
- Give the animal access to warm or cool surfaces based on his individual needs and preferences; ensure access to fresh, clean air and exercise while avoiding exposure to taxing weather conditions.
- Provide clean and appropriately-cushioned surfaces for sleeping and relaxing. Many animals with mobility challenges may prefer firmer bedding that offers much-needed structural support.
- Keep animals with elimination problems clean and ensure they have dry bedding.
- Help severely impaired animals maintain adequate hydration and nutrition by ensuring they have ready access to food and water.
- Consider purchasing a light-emitting diode (LED) device for home treatment of pain and neurologic challenges. Longer exposure to the less intense light offered by LEDs may be safer and more beneficial for some animals than the short bursts of high-powered laser treatments that have become popular in many veterinary practices. Reports of thermal burns and discomfort during treatment are increasing as the hype around high-powered laser units grows.
- Encourage daily, appropriate exercise and environmental enrichment. Think about an assistive harness for animals that need help with rising and walking. Purchase a ramp for dogs who enjoy car travel.
- Learn simple, safe and supportive massage techniques to improve circulation, digestion, nerve health and pain control.
- Examine the pros and cons of botanical medicines such as boswellia, turmeric and cannabidiol to help with pain and inflammation. Consult a veterinarian educated in science-based integrative medicine about options based on facts and research.