Multimodal Therapy for Chronic Pain in Dogs with Orthopedic Diseases

Chronic pain in dogs with orthopedic diseases represents one of the greatest challenges in clinical management, both because of its impact on the patient’s well-being and the difficulty in achieving adequate and sustained control.

Conditions such as hip dysplasia, secondary osteoarthritis, cranial cruciate ligament rupture, patellar luxation, and spinal disorders often result in persistent pain associated with inflammation, biomechanical changes, and peripheral and central sensitization.

For this reason, the most widely accepted approach today is multimodal pain therapy, which combines different drugs, techniques, and non-pharmacological measures to target multiple pathophysiological pathways of pain.

From a pharmacological perspective, non-steroidal anti-inflammatory drugs (NSAIDs) remain the foundation of treatment, providing both analgesic and anti-inflammatory effects by reducing prostaglandin production. However, their isolated use is often insufficient in chronic cases and limited by potential gastrointestinal, renal, and hepatic side effects. For this reason, adjuvant drugs are essential.

Gabapentin, for example, is used in cases of neuropathic pain or hypersensitivity, blocking voltage-gated calcium channels; amantadine can be used as an NMDA receptor antagonist, reducing central sensitization; and tramadol, although with variable efficacy in dogs, may have a synergistic effect in combined protocols. In some cases, short-term opioids may also be considered during periods of acute exacerbation.

Nutraceuticals and supportive therapies also play an important role. Compounds such as chondroitin, glucosamine, oral hyaluronic acid, and PEA (palmitoylethanolamide) have gained ground as inflammation modulators and cartilage protectors.

Essential fatty acids, especially omega-3 (EPA and DHA), show consistent evidence in modulating inflammatory responses and aiding in the control of chronic pain. Continuous supplementation may enhance the effects of pharmacological therapy and reduce the need for higher drug doses.

Among non-pharmacological strategies, veterinary physiotherapy is central. Modalities such as hydrotherapy, electrostimulation, therapeutic ultrasound, laser therapy, and targeted exercise not only help control pain but also improve functional recovery, range of motion, and muscle strength, while preventing compensations that can worsen the condition.

Acupuncture and, in selected cases, gold bead implantation at joint sites have also shown additional benefits as adjuncts. Weight management is equally indispensable, since obesity increases joint overload and reduces treatment effectiveness.

Finally, client education is an integral part of multimodal therapy. Guidance on environmental modifications, the use of non-slip surfaces, ramps or stairs, as well as the importance of treatment adherence and regular re-evaluations, ensures more consistent results.

Chronic pain management should be regarded as a continuous process, adapted to the patient’s response over time, with gradual adjustments in pharmacotherapy, rehabilitation, and supportive care.

Thus, multimodal therapy not only enhances analgesic effectiveness but also improves quality of life and prolongs functionality in dogs with orthopedic diseases. It reflects the modern understanding that chronic pain is multifactorial and therefore can only be successfully managed through combined strategies.

References:

Mathews, K. A., Kronen, P. W., Lascelles, D., Nolan, A., Robertson, S., Steagall, P. V., Wright, B., & Yamashita, K. (2014).

Guidelines for recognition, assessment and treatment of pain. Journal of Small Animal Practice, 55(6), E10–E68.Johnston, S. A. (2017).