Over the couple of years of producing this blog, I have written about many different subjects. Some have come up repeatedly, and because they represent common and important issues, I thought it might be useful to collect related posts I’ve done into quick reference lists for some of these subjects. Maintaining an exhaustive and up-to-date list of resources on any one subject isn’t really feasible for a “spare time” project like this blog, but I will try to create and update some of these topic-based references as far as is practically possible.
SkeptVet Arthritis Treatment Reference List
Arthritis is a painful and potentially debilitating disease that commonly affects our animal companions. It is most often seen in older animals as a result of the normal wear and tear of living. However, certain congenital or developmental orthopedic abnormalities, such as hip dysplasia, as well as trauma, obesity, and other health problems, can create arthritis in younger pets as well. There are a number of well-supported conventional therapies for arthritis, including weight loss and non-steroidal anti-inflammatory drug therapy. There are also plausible and potentially useful treatments that have not yet been adequately studied, such as physical therapy and some supplements. And finally, there are implausible, unproven, and even demonstrably useless therapies, such as homeopathy and glucosamine. I have written about many of these therapies, and below are links to relevant articles along with brief summaries. I will try to update this reference list as I continue investigate and write about these and other arthritis therapies.
The historical theories behind the use of acupuncture are unscientific and almost certainly false. And most of the marketing of acupuncture involves misleading and untrue claims about its historic origins and use. There is, however, very limited data concerning its use for arthritis in dogs and cats, and not much more for other conditions. What veterinary research there is is of poor quality and does not strongly suggest a benefit.
The research is much more extensive for humans and does suggest a subjective improvement in comfort when acupuncture is used to treat pain. However, the details of the research suggest this is almost certainly accomplished through psychological mechanisms and possible through very non-specific mechanisms. So while the benefit is small but real for some patients, it probably does not involve any actual change in the underlying disease. Whether such a “placebo” benefit would meaningfully help pets with arthritis is uncertain, but it does not seem likely.
The theoretical foundations of chiropractic are vitalist pseudoscience and almost certainly false. There is no evidence that the “vertebral subluxation” chiropractors often claim to treat exists at all, and even many chiropractic professional organizations are beginning to distance themselves from this historical concept. There is virtually no controlled scientific research on the subject of chiropractic for arthritis in pets, though it is commonly recommended by chiropractors and some veterinarians. The research in humans shows some likely benefit for uncomplicated lower back pain, essentially equivalent to standard therapies such as physical therapy, stretching and exercise, massage, and non-steroidal anti-inflammatory medications. The evidence does not support the use of chiropractic for any other conditions.
The theoretical foundations of homeopathy are completely incompatible with well-established scientific understanding of physics, chemistry, and biology. The extensive research in humans shows no convincing evidence of any benefit for any condition beyond placebo effects. The research in animals is sparse and of poor quality and does not support the use of homeopathic remedies in the treatment of arthritis.
4. Glucosamine and Chondroitin
Glucosamine and chondroitin are chemicals found naturally in joints and cartilage. There was once good reason based on sound scientific reasoning and in vitro studies to think that oral supplementation of these chemicals would be useful in the prevention or treatment of arthritis. However, the research in companion animals, which is quite limited and of variable quality, has not shown convincing evidence that this is actually true in the real world. And the extensive research in thousands of humans over decades pretty clearly shows that these products have no benefit beyond placebo. They are almost certainly safe, and very likely useless for most pets.
5. Fish Oil
Essential fatty acids from fish, including EPA and DHA, have many potential benefits based on sound theoretical and in vitro work showing their potential to reduce inflammation. There have been very few studies in companion animals on their usefulness for arthritis, and these do not seem to show much if any benefit, though the work is preliminary. The research in humans is also variable in quality and in results. Fish oils are very likely safe for most pets, and they may or may not have any beneficial effects on arthritis, but the data so far is not encouraging.
5. Electromagnetic Therapy (PEMF)
Various devices that expose arthritis joints to electromagnetic fields as a treatment for arthritis are available and in use for humans and animals. There is some in vitro evidence that electrical fields certainly have effects on living cells, but this says nothing about exactly what these effects are and if they are helpful, harmful, or insignificant in living animals. Much of the marketing of these devices uses misleading pseudoscientific language to talk about mystical vitalist notions of “energy” as if they were established scientific principles. There is so far no reliable scientific research on the use of these devices for treatment of arthritis in dogs and cats. The limited research in humans is variable in quality and results and is so far inconclusive.
6. Cold Laser Therapy
Non-cutting laser therapy is widely used by chiropractors and some other CAM practitioners to treat pain and many other conditions. While laser light does have measurable effects on cells in vitro, this says nothing about potential clinical uses of laser light. Much of the marketing of these devices uses misleading pseudoscientific language to talk about mystical vitalist notions of “energy” as if they were established scientific principles. There is so far no reliable scientific research on the use of these devices for treatment of arthritis in dogs and cats. The limited research in humans is variable in quality and results and is overall very weak.
7. Stem Cell Therapy
One of the hottest, most fashionable new therapies for a wide range of ailments is autologous stem cell therapy, in which fat is taken out of an animal, stem cells are extracted from it, and then these cells are injected back into the patient. There is extensive theoretical and laboratory work in animals and humans to indicate a variety of effects of these cells, and there is good reason to believe that clinical benefits may be possible. Unfortunately, there is no agreement about what these cells do in living animals and how they do it, and there is very little clinical research evidence to support any one of the many different commercial stem cell therapies marketed for arthritis in dogs and cats. Leading researching in human and veterinary stem cell therapies caution that our knowledge about these cells and what they do is too preliminary to justify claims that they are safe or effective in real patients. I am hopeful that safe and effective stem cell therapies will one day be available, but so far none have proven themselves and using them is still a gamble.
8. Non-steroidal anti-inflammatory drugs (NSAIDs)
There is a huge group of NSAIDs license for treatment of arthritis in dogs, and the evidence from the theoretical and in vitro level through multiple clinical studies is unequivocal that they have a significant positive effect on arthritis. There is no doubt that they have potential side effects, as all effective medicines due. But these are mostly well-understood, and with proper use of the medicines and proper monitoring of the patient the risks are far less than the benefits, or than the propaganda of alternative medicine proponents often suggests.
Prolotherapy is a purported treatment for connective tissue and joint pain and disability. It involves injecting substances which induce inflammation and other chemical and cellular reactions into affected tissues. These reactions are theorized to relieve pain and improve function. The logic of this theory is questionable, and no clear mechanism for beneficial effects from prolotherapy has been described, but it is possible that the theory could be valid.
The clinical research on prolotherapy in humans is generally of low quality and results have been mixed. There is great variation in the techniques used by different investigators, so it is difficult to compare or generalize between studies.
There is virtually no controlled research investigating prolotherapy in companion animals, and all claims made for safety and efficacy in these species are based solely on anecdotal evidence.
The use of proltherapy in pets should be viewed as experimental with unknown risks and benefits. Such treatments should be reserved for patients that have significant symptoms that have failed to respond or cannot be treated by conventional means.
10. Autologous Platelet Therapy
11. Other Supplements
12. Other Reviews