References
Incorporating a rehabilitation ethos into the management of canine osteoarthritis
Abstract
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.
A clinically reasoned approach toward pain management should be an overriding priority when managing degenerative joint disease. A clinician should advocate the employment of interventions to widen the treatment plan, addressing the joint dysfunction and compensatory impact on the rest of the musculoskeletal system. Consequences of adapted posture and movement must also be addressed to achieve optimal outcomes and improve quality of life long term. It is well known that simply reducing pain will not automatically promote a return to previous function, as a result of the chronic tissue remodelling, gait adaptation and subsequent neuromuscular adaptations that occur (Fox, 2016; Bockstahler et al, 2019). A staged approach, incorporating rehabilitation to address the consequences of chronic inflammatory somatic and neuropathic/neurogenic pain on the whole body, is required to promote maximal function (Fox, 2016). An approach to disease and dysfunction management that attends to long-term neuromuscular adaptations will inevitably have a positive influence on pain through physical, cognitive and emotional means.
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