Cold Therpay for Pain???

Hello, Summarians!

OK … It is officially hard to believe that it is the end of 2023. Thank you for your support this past year. Our team is looking forward to a fantastic 2024.

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Apoquel and Antinol

The study discussed here explores the treatment of canine atopic dermatitis (cAD), a complex and chronic skin condition in dogs. Traditional treatments have included new-generation medications like oclacitinib and lokivetmab, which target specific proinflammatory cytokines and are effective but still require a multimodal therapeutic approach. The study specifically examines the use of PCSO-524 (Antinol), a patented marine oil extract from the New Zealand green-lipped mussel, in combination with oclacitinib. 

PCSO-524 contains a variety of lipids, including a high concentration of omega-3 fatty acids like DHA and EPA, and furan fatty acids known for their potent anti-inflammatory properties. This combination was hypothesized to offer a synergistic effect, particularly in reducing the dose of oclacitinib required for dogs with cAD. 

The clinical trial conducted was randomized, double-blinded, and controlled. It compared the efficacy of oclacitinib combined with PCSO-524 against a control group receiving oclacitinib and sunflower oil. The results showed significant improvement in dogs treated with the combination of oclacitinib and PCSO-524 in terms of pruritus, clinical signs, and Transepidermal Water Loss (TEWL). 

Oclacitinib, an immunomodulatory drug, when reduced from twice daily to once daily, often leads to a rebound in pruritus. However, in this study, dogs receiving PCSO-524 with oclacitinib showed well-controlled symptoms even after the dosage reduction. Additionally, the CADESI-04 scores, a clinical measure for dermatitis severity, remained stable in the PCSO-524 group, contrasting with the control group. 

The study also discusses the broader context of using fatty acids in treating cAD, mentioning past studies that have explored various commercial fatty acid supplements. TEWL, a parameter for evaluating skin barrier function, was another focus, though its interpretation can be challenging due to methodological variations across studies. 

In conclusion, the study posits that PCSO-524 can effectively counteract the rebound effect often seen with reduced oclacitinib dosing and can improve skin barrier function in dogs with cAD. The study, however, acknowledges its limitations, including a small sample size and the short duration of the trial. 

Nishiyama T, Kusakabe M, Imanishi I, Hisano T, Fukamachi T, Taguchi N, et al. A randomised, double-blinded, controlled trial to determine the efficacy of combined therapy of oclacitinib and marine oil extract PCSO-524 in dogs with atopic dermatitis. Vet Dermatol. 2023; 34: 523–531. https://doi.org/10.1111/vde.13193 

Bottom line — It seems to help with the Apoquel rebound effect.

Cold Therapy for Pain in Dogs

The awareness of chronic pain in animals, particularly dogs, has grown significantly in recent years. This is partly due to the changing perception of companion animals as they are increasingly seen as family members. Consequently, understanding and addressing the behavioral and physiological impacts of chronic pain in dogs have become important concerns for their owners. Chronic pain can lead to conditions like central and peripheral sensitization if not properly managed. 

In human medicine, a method called Quantitative Sensory Testing (QST) is employed to assess changes in somatosensory function such as loss of sensation, allodynia, or hyperalgesia, which are indicative of peripheral or central sensitization. The QST battery in humans combines various tests to measure different sensory thresholds and pain responses. 

Creating a similar QST battery for companion animals, especially dogs, is a valuable goal. Although some QST protocols for testing mechanical and heat thresholds in dogs exist, cold stimulation is less commonly used. However, cold sensitivity or changes in cold pain threshold can be crucial indicators of nerve injury, as shown in studies with other species. In dogs, different cold stimulation techniques have been used with varying success rates, but there is limited information on how different cooling rates affect temperature threshold and response rates. 

To better understand and utilize cold stimulation protocols in dogs, a suitable device is required. The Somedic MSA thermal stimulator, used in human studies, is a potential candidate. This device allows for precise and adjustable temperature output, making it suitable for various studies and clinical applications. However, its effectiveness and applicability in dogs have not been fully evaluated yet. 

Our study focused on assessing the use of the Somedic MSA thermal stimulator for cold stimulation in healthy dogs. We aimed to determine aversive threshold values for different cooling protocols and evaluate the repeatability and applicability of this method. The study found that faster cooling rates did not significantly increase response rates, and the overall aversiveness of different cooling protocols was low. This result contrasts with human studies where faster cooling rates led to more intense cold sensations. 

The repeatability of cold stimulation in dogs varied, with lower response rates observed in later experiments, possibly due to habituation. The study also noted the difficulty in differentiating between cold sensation and cold nociception in dogs, as their responses are not as nuanced as those of humans, who can verbally express their sensations. 

In conclusion, while the method was easy to apply and well-tolerated by dogs, the response rates and effectiveness of different cooling protocols were not conclusive. The study suggests that further research, particularly in dogs with chronic or neuropathic pain, is necessary to determine the effectiveness of cold stimulation protocols in clinical settings. The potential influence of breed or genetics on the results, due to the use of Beagle dogs from two litters, is also an area for future exploration. 

Wittenberg-Voges, L., Delarocque, J., Kästner, S. B., & Schütter, A. (2023). Cold stimulation is feasible and has limited aversiveness in healthy, pain-free dogs. American Journal of Veterinary Research https://doi.org/10.2460/ajvr.23.07.0169 

Bottom line — Early results show that it seems to be well tolerated.

Undiagnosed Malignancy Rate in Older Dogs

This study aimed to determine the prevalence of undiagnosed malignant tumors in a group of 913 healthy, middle-aged to older dogs, who were potential participants in the Vaccination Against Canine Cancer Study. The dogs selected were either mixed breed or from breeds with a higher risk of developing cancer. They underwent extensive screening, including physical examinations, blood tests, urinalysis, thoracic radiographs, and abdominal ultrasound. 

The results revealed that 23 dogs (about 2.5%) were diagnosed with cancer, and an additional 11 dogs (around 1.2%) were highly suspicious for cancer, though not definitively confirmed. This indicates a total prevalence of 3.7% for undiagnosed cancer in this specific dog population. Most of these cancers (65%) were identified through physical examination and aspiration of cutaneous or subcutaneous masses, with mast cell tumors being the most common type diagnosed. 

In conclusion, the study found that while the prevalence of undiagnosed cancer in this group of middle-aged to older dogs of higher risk breeds was relatively low, routine physical examinations were effective in detecting most of these malignant tumors. This underscores the clinical importance of regular check-ups in early cancer detection for dogs in similar demographics. 

2023 ACVIM Forum Research Report Program. J Vet Intern Med, 37: 2638-2660.https://doi.org/10.1111/jvim.16902 

Bottom line — The malignancy rate is fairly low and physical exam was effective in detecting most problems.

Just putting things in perspective …