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ANESTHESIA - 2 > 37 – Nutritional Therapies for Chronic Pain > Flashcards

37 – Nutritional Therapies for Chronic Pain Flashcards

1
Q

Chronic pain can present with a myriad of clinical signs

A
  • 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
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2
Q

Where do chronic pain and nutrition intersect?

A
  • Inflammation
  • Nutritional deficiencies: drugs may dimmish or have impaired function
  • Some chronic painful disease can benefit from nutritional management
  • Body and muscle condition
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3
Q

Inflammation: intersect of chronic pain and nutrition

A
  • diet can cause pro-inflammatory or anti-inflammatory
    Ex. fish oil: anti-inflammatory effect
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4
Q

Nutritional deficiencies: intersect of chronic pain and nutrition

A
  • efficacy of drugs may be diminished, impaired function or lethargy
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5
Q

What are some chronic painful diseases that benefit from nutritional management?

A
  • *osteoarthritis
  • Pancreatitis
  • Urolithiasis
  • Chronic GI diseases
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6
Q

Body and muscle condition: intersect of chronic pain and nutrition

A
  • 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
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7
Q

What are the aspects of a nutritional assessment?

A
  • 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)
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8
Q

What are the goals with changing diet for pain management? (3)

A
  1. Prevent disease
  2. Slow progression
  3. Alleviate clinical signs
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9
Q

Developmental Orthopedic Diseases (DOD)

A
  • Large/giant breed puppies: increased hip/elbow dysplasia, OCD, HOD
  • *nutritional management plays a MAJOR role in prevention
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10
Q

Osteoarthritis

A
  • 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
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11
Q

What are 3 key nutritional factors that increase risk of DOD? (large/giant breed puppy)

A
  1. Excessive calories (NOT protein)=growth is too rapid
    a. Excess stress on developing (soft) joints: even if not too ‘fat’
  2. Calcium intake: deficiency or excess (puppies can’t regulate intestinal uptake of Ca2+)
  3. Unbalanced diets negatively affect growth
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12
Q

What are the recommendations to minimize DOD (large/giant breed puppy)?

A
  1. Maintain lean BCS (4/9) AND follow normal growth curve (within 1 centile during growth)
  2. Diet for large breed puppies. NO vitamin/mineral supplements
  3. Feed large breed GROWTH diet until skeletal MATURITY complete
    a. Recommended for at least 18-24 months
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13
Q

What is the difference in puppy foods?

A
  • 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)
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14
Q

Excess body fat: in pets

A
  • Common, but detrimental
  • 50% in NA are overweight
  • Increases biomechanical stress
  • Increases systemic inflammation (adipose tissue releases adipo(cyto)kines
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15
Q

What does excess body fat contribute to? (3)

A
  • Development of ORTHOPEDIC DISEASES during growth
  • Development and/or exacerbation of joint injuries and OSTEOARTHRITIS
  • Increased incidence or severity of MULTIPLE OTHER DISEASES
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16
Q

Prevention and treatment of excess fat is key to the quality of life and consists of

A
  • Calorie intake
  • Nutritional adequacy
  • Activity
  • Environment
17
Q

KNOW: what was seen in the lean group (BCS: 4.6 +/-0.2)?

A
  • 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
18
Q

KNOW: what was seen in the overweight group (BCS: 6.7 +/- 0.2)?

A
  • 83% developed osteoarthritis
  • 11.2 year life span (vs. 13 years in lean)
19
Q

Osteoarthritis requires a multimodal approach (6 areas)

A
  1. Owner education and counselling
  2. Nutrition
  3. Modification of environment and activities
  4. Pharmaceuticals
  5. Rehabilitation therapy and customized exercise plans
  6. Other: platelet rich plasma (PRP), stemcell therapy, others?
20
Q

3 big areas for treatment of osteoarthritis?

A
  1. Client education
  2. Nutritional counselling and plan
  3. Regular (controlled) exercise
21
Q

Nutrition counselling and plan: core recommendations include

A
  • Weight optimization
  • Adequate EPH+DHA (omega-3s)
  • Overall diet should be complete and balance
  • *secondary options: other nutraceuticals and supplements
22
Q

What is the MOST EFFECTIVE therapy to improve mobility? (humans and dogs, likely cats)

A
  • **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
23
Q

What are the multiples reasons for muscle loss?

A
  • 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
24
Q

What are some preventative therapies or steps to reduce muscle loss?

A
  • Exercise
  • Diet
  • Nutraceuticals
    o *EPA+DHA
25
Q

What is the conclusion of chondroitin-glucosamine supplements (meta-analysis)?

A
  • Lack of efficacy (lots showed NO-EFFECT)
26
Q

Omega 3 PUFAs: EPA+DHA

A
  • Best overall evidence as nutraceutical
    o Multiple studies, double-blinded, controlled clinical trials
  • *anti-inflammatory action
27
Q

Anti-inflammatory action of EPA+DHA

A
  • When EPA is degraded=get PGs that are less inflammatory
    o *increases in resolvins and protectins
  • When AA degraded=pro-inflammatory cytokines and PGs
28
Q

What did canine studies with EPA+DHA show decreases in?

A
  • Plasma PGE2
  • Synovial MMPs (proteases)
  • IL-1, IL-2, TNF-alpha in cartilage/joint
29
Q

Dogs and EPA+DHA

A
  • 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)
30
Q

Cats and EPA+DHA

A
  • Only 1 study
  • Increased activity compared to controls (but placebo effect not controlled)
  • SUL=<75mg x BW (kg)?
31
Q

Does flax seed work?

A
  • Lots of omega 3s, but most do NOT have anti-inflammatory effect
32
Q

Vet joint support diets

A
  • Include EPA+DHA, but vary in concentrations
  • May have other nutraceuticals included
33
Q

Vet weight loss diets

A
  • More effective/safe than join diets to support weight loss
  • BUT not all contain EPA+DHA
    o Maybe add a fish-oil supplement?
34
Q

Vet multi-functional joint + weight loss diets

A
  • Effective and safe for supporting weight loss
  • Contains EPA+DHA
  • *more cost effective than adding equivalent fish oil
35
Q

What are the advantages of vet therapeutic diets?

A
  • 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
36
Q

What are the disadvantages of vet therapeutic diets?

A
  • Higher cost compared to average maintenance diet
  • May still need to supplement
37
Q

If therapeutic diets are not an option are there possible pet store diets?

A
  • 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

ANESTHESIA - 2 (17 decks)

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