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Written by a Medical Acupuncture for Veterinarians course graduate.  Author’s name available upon request.  Signed release obtained from client/author/4394.

Abstract

An American Staffordshire terrier/mixed breed dog with chronic pain due to osteoarthritis involving multiple joints was treated with acupuncture.  Improvements in comfort, activity and gait were noted, though duration of benefits appeared short following acupuncture therapy.

History

Georgia is a 12.5-year-old spayed female American Staffordshire terrier/mixed breed dog who presented for assessment and treatment of lameness due to moderate to severe, chronic osteoarthritis affecting bilateral elbows, stifles, and coxofemoral joints.  She was previously diagnosed with bilateral elbow dysplasia (fragmented medial coronoid processes; bilateral arthroscopy and debridement, 2004), hip dysplasia, and bilateral cranial cruciate ligament ruptures with prior surgical repair (extracapsular suture stabilization, left stifle, 2007; tibial tuberosity advancement, right stifle, 2008).

Georgia’s other medical concerns include a chronic but stable mild increase in several liver-related values on lab testing, and several subcutaneous lipomas.

Current treatment for Georgia’s osteoarthritis includes gabapentin (5.5mg/kg PO BID) and joint-supportive supplements: omega 3 fatty acids, glucosamine/chondroitin sulfate, curcumin and turmeric.  Previous treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was helpful at relieving joint pain, but repeatedly resulted in increased liver values on laboratory testing, and Georgia’s family declined further NSAID treatment and evaluation of her liver.  Tramadol was previously tried, without obvious clinical benefits.  Physical therapy/rehabilitation was also performed in the past, and a home exercise program is continued intermittently as time permits for Georgia’s family.

Physical Examination and Clinical Assessments

Georgia is bright, alert and responsive, though anxious during veterinary visits.  She weighs 36.6kg with a body condition score of 6/9.  Ambulation is difficult, and Georgia walks with intermittent assistance from her family using a Help ‘Em Up Harness.  Her gait is very stiff, with a shortened stride on all four limbs, and she stands with both elbows abducted.  Pain is noted on extension of both stifle joints, both coxofemoral joints, and both elbow joints with palpable, firm elbow joint thickening and reduced range of motion.  Elbow joints appear most severely affected.  Bilateral interdigital cysts are present between digits 4-5 of both forelimbs, likely resulting from abnormal friction due to Georgia’s abnormal stance.  She has bilateral generalized muscle atrophy in both pelvic limbs.  Neurologic examination is within normal limits.

Laboratory testing reveals mild increases in ALT (157; reference range 14-87) and alkaline phosphatase (345; ref. range 20-157), which have been chronic and remain stable.

On myofascial examination, Georgia exhibits areas of tautness in her mid-cervical region, bilateral triceps region, and discomfort in her lumbar region.

Previous radiographs have revealed bilateral mild hip dysplasia with subluxation of Georgia’s right coxofemoral joint, and degenerative changes of both coxofemoral joints, elbow joints (most severe pathology) and stifles. (See recent left and right elbow radiograph images, below.)

Medical Decision Making

Acupuncture has been shown to provide pain relief for human patients with chronic pain, such as pain due to osteoarthritis1,2.  Based on Georgia’s history and physical examination findings, she was deemed an ideal candidate for acupuncture treatment to help reduce chronic pain associated with osteoarthritis involving multiple joints.  Acupuncture points were chosen with the goal of providing neuromodulation to decrease pain via local points in her elbow, stifle, hip and lumbar areas. General homeostatic points were selected to help decrease stress, provide general analgesia and balance sympathetic/parasympathetic nervous system tone.  Additional points were chosen to treat spinal cord segments providing innervation to her painful limbs and joint structures.  Since she showed signs of tension in her triceps muscle, attention was given to selecting points affecting the radial nerve, which provides innervation to the triceps muscle.

 

Acupuncture Treatment

Dry needling was employed for Georgia’s acupuncture treatments, with visits recommended weekly for four weeks and then continuing based on her response thereafter. (Electroacupuncture was not available at the time of treatment.)  Acupuncture points chosen include:

  • General homeostatic points: GV20, GV 14, Bai Hui
  • Points to help treat local discomfort in the lumbar region: BL 20, BL 21, BL22, BL 23,

BL 25 (also treats spinal cord segment L5 which provides innervation to the pelvic limb)

  • Local elbow points: LU 5, LI 10, LI 11, SI 8, SI 9 (for more general forelimb pain)
  • Local hip points: GB 29, GB 30, BL 54
  • Local stifle points: ST 34, ST 35, ST 36, BL 40 (SP 9 and SP 10 were not easily available due to Georgia’s preferred position to lay during acupuncture sessions)
  • Regional thoracic limb point: GB 21
  • Distal points: Thoracic limb—SI 3, LI 4; Pelvic limb—BL 60

Massage was also employed to help reduce tension in Georgia’s cervical, triceps and lumbar regions, and her family has reduced her calorie intake to foster weight loss and, thus, reduce stress on her painful joints.  Georgia’s family is also considering intra-articular injections.

Outcomes and Discussion

After her first two weekly visits, Georgia’s family noted she was able to stand for longer periods of time, and she was also able to go for longer walks than she had previously.  In addition, she was intermittently able to use both thoracic limbs separately, with a longer stride when walking, rather than hopping with both thoracic limbs together.  She seemed subjectively more relaxed and comfortable at home on the day after her treatments. After completing her initial set of weekly visits, her family elected to continue acupuncture treatments on a less frequent basis.  Benefits were especially notable for the first few days after her treatments.  Although she has continued to receive acupuncture treatments at three-to four-week intervals following her initial weekly series, benefits Georgia derives from acupuncture seem short-lived (several days).

Studies to help determine the ideal frequency of treatments for patients with osteoarthritis, and duration of effects, would be desirable.  In addition, force plate studies to evaluate measurable effects of acupuncture for patients with chronic pain due to osteoarthritis would be beneficial.

References

  1. Vickers AJ, Cronin AM, Maschino AC, et al, Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012; 172 (19): 1444-1453.
  2. White A, Foster NE, Cummings M, et al, Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology 2007; 46: 384-390.