37 – Nutritional Therapies for Chronic Pain Flashcards
Chronic pain can present with a myriad of clinical signs
- Onset can be SUBTLE with SLOW progression
- Behaviour changes
- May not present the ‘expected’ response to pain
- May ONLY be evident in home-environment but masked at exam
- *need to question owners about ANY CHANGES OVER TIME (routine, presentation of food/ease of access)
- **NEED A MULTIMODAL AND HOLISTIC APPROACH
Where do chronic pain and nutrition intersect?
- Inflammation
- Nutritional deficiencies: drugs may dimmish or have impaired function
- Some chronic painful disease can benefit from nutritional management
- Body and muscle condition
Inflammation: intersect of chronic pain and nutrition
- diet can cause pro-inflammatory or anti-inflammatory
Ex. fish oil: anti-inflammatory effect
Nutritional deficiencies: intersect of chronic pain and nutrition
- efficacy of drugs may be diminished, impaired function or lethargy
What are some chronic painful diseases that benefit from nutritional management?
- *osteoarthritis
- Pancreatitis
- Urolithiasis
- Chronic GI diseases
Body and muscle condition: intersect of chronic pain and nutrition
- If frail (due to age but also conditions that cause cachexia contributes to pain and negative outcomes
- Pain: affect food intake, presence
- Excess body fat: systemic inflammation and metabolic abnormalities
- **influence on development and health
What are the aspects of a nutritional assessment?
- Diet history
- Key nutritional factors for patient (INDIIDUAL NEEDS)
- Appreciate and food intake (food preferences, intake and nutritional status)
- Body condition score: estimate body fat percentage
- Muscle condition (localized and generalized)
What are the goals with changing diet for pain management? (3)
- Prevent disease
- Slow progression
- Alleviate clinical signs
Developmental Orthopedic Diseases (DOD)
- Large/giant breed puppies: increased hip/elbow dysplasia, OCD, HOD
- *nutritional management plays a MAJOR role in prevention
Osteoarthritis
- Nutritional deficiencies contribute? Not fully sure (not enough studies)
- Think more middle to older ages
- Nutraceuticals: may modulate presentation and progression
- Body composition
o Excess fat: pro-inflammatory, increased physical stress
o Low fat: frailty=weakness, instability, decreased immune function
What are 3 key nutritional factors that increase risk of DOD? (large/giant breed puppy)
- Excessive calories (NOT protein)=growth is too rapid
a. Excess stress on developing (soft) joints: even if not too ‘fat’ - Calcium intake: deficiency or excess (puppies can’t regulate intestinal uptake of Ca2+)
- Unbalanced diets negatively affect growth
What are the recommendations to minimize DOD (large/giant breed puppy)?
- Maintain lean BCS (4/9) AND follow normal growth curve (within 1 centile during growth)
- Diet for large breed puppies. NO vitamin/mineral supplements
- Feed large breed GROWTH diet until skeletal MATURITY complete
a. Recommended for at least 18-24 months
What is the difference in puppy foods?
- Amount of Ca (upper limit is LOWER in diets for ‘growth of large sized dogs’)
- Large puppy food: don’t need to add Ca (would imbalance/add excess)
Excess body fat: in pets
- Common, but detrimental
- 50% in NA are overweight
- Increases biomechanical stress
- Increases systemic inflammation (adipose tissue releases adipo(cyto)kines
What does excess body fat contribute to? (3)
- Development of ORTHOPEDIC DISEASES during growth
- Development and/or exacerbation of joint injuries and OSTEOARTHRITIS
- Increased incidence or severity of MULTIPLE OTHER DISEASES
Prevention and treatment of excess fat is key to the quality of life and consists of
- Calorie intake
- Nutritional adequacy
- Activity
- Environment
KNOW: what was seen in the lean group (BCS: 4.6 +/-0.2)?
- Feed 25% fewer caloreis than overweight group
- *only 50% developed osteoarthritis
- *Clinical signs were delayed by up to 2 years!
- *average life-span increased by 1.8 years! (recent)
- **LIFE SPAN MOST IMPORTANT ASPECT FOR A PET OWNER
KNOW: what was seen in the overweight group (BCS: 6.7 +/- 0.2)?
- 83% developed osteoarthritis
- 11.2 year life span (vs. 13 years in lean)
Osteoarthritis requires a multimodal approach (6 areas)
- Owner education and counselling
- Nutrition
- Modification of environment and activities
- Pharmaceuticals
- Rehabilitation therapy and customized exercise plans
- Other: platelet rich plasma (PRP), stemcell therapy, others?
3 big areas for treatment of osteoarthritis?
- Client education
- Nutritional counselling and plan
- Regular (controlled) exercise
Nutrition counselling and plan: core recommendations include
- Weight optimization
- Adequate EPH+DHA (omega-3s)
- Overall diet should be complete and balance
- *secondary options: other nutraceuticals and supplements
What is the MOST EFFECTIVE therapy to improve mobility? (humans and dogs, likely cats)
- **Improving body composition (ex. losing body fat)
- Even partial improvement helps!
o Benefits observed as little as 6.1% weight loss - Do NOT just say “feed less” (Could be detrimental)
o Need to avoid inadequate protein or essential nutrient intake with calorie reductions
What are the multiples reasons for muscle loss?
- Age-related loss (sarcopenia)
- Disuse atrophy
- Dietary issues
o Inadequate total calories, protein or other nutrient inadequacy
o Rapid weight loss: loss of fat AND muscle - Other
What are some preventative therapies or steps to reduce muscle loss?
- Exercise
- Diet
- Nutraceuticals
o *EPA+DHA
What is the conclusion of chondroitin-glucosamine supplements (meta-analysis)?
- Lack of efficacy (lots showed NO-EFFECT)
Omega 3 PUFAs: EPA+DHA
- Best overall evidence as nutraceutical
o Multiple studies, double-blinded, controlled clinical trials - *anti-inflammatory action
Anti-inflammatory action of EPA+DHA
- When EPA is degraded=get PGs that are less inflammatory
o *increases in resolvins and protectins - When AA degraded=pro-inflammatory cytokines and PGs
What did canine studies with EPA+DHA show decreases in?
- Plasma PGE2
- Synovial MMPs (proteases)
- IL-1, IL-2, TNF-alpha in cartilage/joint
Dogs and EPA+DHA
- Reduced signs and progression OA
o Improved lameness and weight bearing within 2 months of use - *safe upper limit (SUL)=<370 mg x BW (kg)
Cats and EPA+DHA
- Only 1 study
- Increased activity compared to controls (but placebo effect not controlled)
- SUL=<75mg x BW (kg)?
Does flax seed work?
- Lots of omega 3s, but most do NOT have anti-inflammatory effect
Vet joint support diets
- Include EPA+DHA, but vary in concentrations
- May have other nutraceuticals included
Vet weight loss diets
- More effective/safe than join diets to support weight loss
- BUT not all contain EPA+DHA
o Maybe add a fish-oil supplement?
Vet multi-functional joint + weight loss diets
- Effective and safe for supporting weight loss
- Contains EPA+DHA
- *more cost effective than adding equivalent fish oil
What are the advantages of vet therapeutic diets?
- Increase ease of compliance for pet owner
- Higher quality control compared to many supplements
- More cost effective than adding equivalent supplements
- Clinical trials support beneficial effects
What are the disadvantages of vet therapeutic diets?
- Higher cost compared to average maintenance diet
- May still need to supplement
If therapeutic diets are not an option are there possible pet store diets?
- Use reputable manufactures only
- Look for food options providing more EPA+DHA
o Must be able to access actual typical concentrations in food - *no clinical trials to support efficacy
