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A. Weight Control
· The most important element in the treatment of OA is weight control.
· Overweight or obesity may contribute to the devel- opment and progression of OA because of excess forces placed on joints and articular cartilage, which may lead to inactivity and further development of obesity.
· Adipose tissue is recognized as being metabolically active and proinflammatory; therefore, obesity may potentiate the systemic and local effects of inflamma- tion
· Maintaining optimal or slightly lean body condition may be associated with lower risk of developing OA, development of less severe OA if it occurs, and delay of onset of clinical signs of OA in dogs.
· Several commercially available diets formulated for management of dogs with OA. These diets contain higher levels of omega-3 fatty acids and may contain chondromodulators and antioxidants.
B. Acupuncture
· Gate control theory: pain signals are transmitted by small cutaneous A-δ and C fibers. If a TENS current is applied, the large cutaneous (A-β) fibers are stimu- lated. The signals from the A-β fibers activate inhibi- tory neurons in the spinal cord dorsal horn and block the transmission of pain impulses from the periphery to the brain.
· Release of endogenous opiates. These endorphins are released from the pituitary in response to low frequency (<10 Hz), high pulse duration (>100 μsec)
stimulation, and they produce analgesia when released.
E. Therapeutic Ultrasound (US)
· US is a method of stimulating the tissue beneath
the skin’s surface using very high frequency sound waves, between 800,000 Hz and 2,000,000 Hz, which cannot be heard by humans. The sound waves to stimulate fibroblast activity, improves blood flow, increases protein synthesis and aids in soft tissue and bone healing. It also provides heat to injured body parts that lie deep within your body that are not able to be heated with a standard hot pack alone.
· Therapeutic US is considered an effective treatment modality for rehabilitating musculoskeletal conditions such as restricted range of motion (ROM) resulting from joint contracture, pain and muscle spasm, and wound healing.
F. Extracorporeal Shockwave Therapy (ESWT)
· ESWT is a new technology using shockwaves to treat chronic, painful conditions of the musculoskel- etal system. A shockwave is an intense, but very short energy wave traveling faster than the speed
of sound. ESWT may be beneficial as an ancillary treatment for OA as part of the multimodal approach to therapy of this condition. Improved weight bearing and passive range of motion are similar to results expected with NSAID use. In patients that are unable to tolerate the administration of NSAIDs, extracorpo- real shockwaves may serve as a useful, noninvasive alternative for treatment of osteoarthritic conditions. Anecdotally, treatment of conditions affecting the elbow, hip, or back may respond better than other joints.
· Mechanism:
· Gate control theory
· Induction of cell damage from shockwave appli- cation prevents appropriate membrane poten- tials required for transmission of signals.
· Production of cytokines and growth factors, endothelial nitric oxide synthase (eNOS) and up-regulation of bone morphogenetic protein
(BMP) expression resulting in a decline in in- flammation and swelling, with short-term analgesia.
· Acupuncture is defined as the insertion of thin, sterile needles into specific points, based on anatomical structures, which leads to a physiologic response. These physiologic responses are due to stimula-
tion of the nervous system and lead to a release
of endogenous substances such as β-endorphins, dynorphins, enkephalins, serotonin, epinephrine, gamma-aminobutyric acid (GABA), cortisol, and vari- ous hormones. Acupuncture has therapeutic clinical applications in rehabilitation and sports medicine such as pain relief, performance and endurance enhancement, and nerve regeneration.
· Acupuncture is a useful modality to integrate into a pain management due to its analgesic properties and nerve stimulation effects. It also has calming/se- dating effects which are useful for patients that need to be cage-rested.
C. Low Level Laser Therapy (LLLT)
· Laser is a light source treatment that generates light of a single wavelength that elicits photochemical reactions in cells to promote tissue regeneration, re- duce inflammation, relieve pain, increase fibroblasts and lymphocytes, and stimulates cartilage growth.
· The effect of laser therapy in OA include: inhibition of cyclooxygenase-2 enzyme and prostaglandins, reduces oxidative stress, endorphin release, and cartilage stimulation
D. Transcutaneous Electrical Stimulation (TENS)
· TENS is an electronic stimulus generator that trans- mits electrical impulses of various configurations
to electrodes on the skin for the purpose of pain management. TENS can be effective for pain relief, especially in cases of chronic musculoskeletal and postoperative pain.
Research suggests:
· Acute pain: 50-200 Hz, lower pulse width: relief is short-lasting
· Chronic pain: 2-4 Hz with higher pulse width pro- duces longer lasting pain relief (several hours)
· Mechanisms of TENS:
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