Double-blind evaluation of implants of gold wire at acupuncture points in the dog as a treatment for osteoarthritis induced by hip dysplasia

Current evidence for non-pharmaceutical, non-surgical treatments of canine osteoarthritis

Osteoarthritis is a progressive degenerative disease process that affects a significant proportion of the canine population, impacting these animals' quality of life. Currently, there is no cure and treatment consists of managing the clinical signs of pain and reduced mobility. There are many treatments for canine osteoarthritis and in this review we discuss the evidence base behind non-pharmaceutical, non-surgical treatments of this disease. These treatments include weight management, nutraceuticals, acupuncture, physiotherapies such as therapeutic exercise, hydrotherapy as well as other therapeutic modalities including photobiomodulation therapy, electromagnetic field therapy and others.

Acupuncture in Zoological Companion Animals

Over the past years, the concept of pain management in veterinary medicine has evolved and led to the establishment of a new concept of multimodal approach to pain management, as the current standard of care. The use of multimodal analgesia combining pharmacologic and nonpharmacologic techniques not only helps optimize the quality and efficacy of analgesia but also may prevent the development of chronic or persistent pain. During the past decade, acupuncture has become more popular and evolved into one of the most used forms of integrative medicine interventions and nonpharmacologic therapeutic options for pain management in humans and animals in North America and Europe. There is ample evidence from basic and clinical research for acupuncture is effective in the treatment of acute and chronic pain by influencing neural networks of the nervous system. While in the modern days' veterinary acupuncture has been predominantly used in horses and dogs, its popularity in zoologic companion animals (ZCA) has increased in recent years as an adjunct therapy for treating musculoskeletal, neurologic, and gastrointestinal disorders due to its minimal invasiveness and low risk of adverse events. The integrative use of acupuncture has become even more important with the increasingly limited use of opiates in veterinary medicine due to the opiate crisis. The purpose of this article aims to provide guidance for using acupuncture for pain management in ZCA in clinical practice, based on available information and recommendations from experienced veterinary acupuncturists.

Evidence-Based Complementary and Alternative Orthopedic Veterinary Medicine

The use of complementary and alternative veterinary medicine (CAVM) continues to become more widespread, especially for the management of chronic pain conditions such as canine osteoarthritis. Many patients have comorbidities that preclude traditional medical options, have not adequately responded to conventional therapies, or have owners interested in pursuing a complementary approach. Evidence-based CAVM can serve as a safe and effective adjunct to manage chronic pain conditions. There is growing evidence in the veterinary literature for the use of acupuncture and some herbal supplements in the multimodal management of canine osteoarthritis. The majority of evidence supporting chiropractic is limited to equine and human literature.

A Systematic Review of Complementary and Alternative Veterinary Medicine: "Miscellaneous Therapies"

Simple Summary

Complementary and alternative veterinary medicine (CAVM) is commonly used in animals. However, there is limited knowledge of how the methods affect the animal. Therefore, this study reviews the scientific literature of 24 different CAVM therapies used in cats, dogs, and horses. Three core bibliographic sources were used. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 982 unique publications screened, 42 were eligible for inclusion, representing nine different CAVM therapies, which were aromatherapy, gold therapy, homeopathy, leeches (hirudotherapy), mesotherapy, mud, neural therapy, sound (music) therapy, and vibration therapy. For the other 15 predefined therapies, no study was identified. The risk of bias was assessed as high in 17 studies, moderate to high in 10, moderate in 10, low to moderate in four, and low in one study. In those studies where the risk of bias was low to moderate, there was considerable heterogeneity in reported treatment effects. Therefore, the 24 CAVM therapies do not have scientific documentation of sufficient quality to draw clear conclusions regarding their clinical effect.

Abstract

There is an increasing interest in complementary and alternative veterinary medicine (CAVM). There is, however, an uncertainty of the efficacy of these methods. Therefore, the aim of this systematic literature review is to assess the evidence for clinical efficacy of 24 CAVM therapies used in cats, dogs, and horses. A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 982 unique publications screened, 42 were eligible for inclusion, representing nine different CAVM therapies, which were aromatherapy, gold therapy, homeopathy, leeches (hirudotherapy), mesotherapy, mud, neural therapy, sound (music) therapy, and vibration therapy. For 15 predefined therapies, no study was identified. The risk of bias was assessed as high in 17 studies, moderate to high in 10, moderate in 10, low to moderate in four, and low in one study. In those studies where the risk of bias was low to moderate, there was considerable heterogeneity in reported treatment effects. Therefore, the scientific evidence is not strong enough to define the clinical efficacy of the 24 CAVM therapies.

The Emperor's New Clothes-An Epistemological Critique of Traditional Chinese Veterinary Acupuncture

Simple Summary

Complementary and alternative medicines have gained increased popularity in the veterinary field. Among them, Traditional Chinese Veterinary Medicine, including acupuncture, has emerged as one of the main alternatives to conventional veterinary medicine. This paper relies upon an epistemological approach to investigate conceptual, historical and scientific assertions about veterinary acupuncture made by their advocates. Argument by analogy is used to demonstrate that Traditional Chinese Veterinary Medicine is based on pre-scientific principles, similar to those of humoral medicine and bloodletting, and that acupuncture is, in effect, a placebo. The paper concludes with recommendations for veterinary regulators and colleagues.

Abstract

Within the last few decades, complementary and alternative medicines have gained increased popularity in the veterinary field. Although many authors have exposed the scientific fallacies and historical misconceptions used to justify such therapies, those efforts have not succeeded in detracting veterinary practitioners from embracing them. Notably, Traditional Chinese Veterinary Medicine (TCVM), including acupuncture, has emerged as one of the main alternatives to conventional veterinary medicine. In this paper, analogical reasoning is used to investigate conceptual, historical and scientific assertions made by the advocates of TCVM. The paper is divided into two parts: The first aims to appraise conceptual and historical claims made by veterinary acupuncturists. I defend that TCVM is a pre-scientific construct, similar to humoral doctrine, and that acupuncture is analogous to bloodletting. The second part is focused on scientific evidence of clinical application of acupuncture in the dog, showing how science is yet to validate veterinary acupuncture and defending that claims of efficacy are due to placebo effect. It is suggested that veterinary acupuncture needs to abandon Traditional Chinese Medicine and embrace science-based medicine tout court. On the other hand, high quality scientific studies, including randomized controlled trials, need to be presented. Veterinary regulators must bring the issue of non-conventional therapies into their agendas.

Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture

OBJECTIVE To evaluate pain intensity and kinetic variables in dogs with hip dysplasia (HD) treated with acupuncture, carprofen, or a placebo. DESIGN Randomized, controlled clinical study. ANIMALS 54 HD-affected dogs and 16 healthy dogs. PROCEDURES Seven HD-affected dogs were removed from the study. Dogs with HD were treated in a blinded manner for 30 days with acupuncture (once weekly for 5 sessions; n = 15), carprofen (4.4 mg/kg [2.0 mg/lb], PO, q 24 h; n = 16), or placebo capsules containing lactose (1 mg/kg [0.45 mg/lb], PO, q 24 h; n = 16). Dogs were evaluated 2 weeks and immediately before (baseline) and 2, 4, and 6 weeks after the onset of treatment. Owners evaluated the dogs' pain intensity with 2 validated questionnaires and a visual analogue scale (VAS) for pain and evaluated degree of lameness with a VAS for locomotion. Kinetics of the hind limbs were also evaluated. Sixteen HD-free dogs were used to assess the evaluation protocol. RESULTS Owners' assessments revealed that outcomes of the 3 treatments did not differ significantly. The Canine Brief Pain Inventory and VAS pain intensity assessments were decreased from baseline at weeks 4 and 6, respectively, but only in acupuncture-treated dogs. The locomotion VAS values were decreased at week 4 in acupuncture-treated and carprofen-treated dogs. Kinetic evaluation findings did not differ among the groups or over time. CONCLUSIONS AND CLINICAL RELEVANCE Neither acupuncture nor carprofen was significantly different from placebo. Acupuncture and carprofen reduced the degree of subjectively evaluated lameness, and acupuncture was associated with a decrease in validated chronic pain scores.

A randomised, blinded, crossover study to assess the efficacy of a feed supplement in alleviating the clinical signs of headshaking in 32 horses

REASONS FOR PERFORMING STUDY

Feed supplements are commonly used by owners to alleviate headshaking; however, randomised, controlled trials are required to assess their efficacy.

OBJECTIVE

To determine the efficacy of a feed supplement for alleviation of the clinical signs of headshaking using a randomised, blinded, placebo-controlled trial.

METHODS

Using a crossover design, 44 horses previously diagnosed with chronic idiopathic headshaking received both the supplement and a matching placebo per os for 28 days with a washout period between of 14 days. Video recordings were taken at rest and exercise prior to the study and at the end of both periods of treatment. The degree of headshaking was assessed in a blinded, randomised manner by 2 veterinary surgeons. At the same time points, owners completed a questionnaire to assess the severity of headshaking signs. A Wilcoxon signed rank test was used to compare the scores while on supplement and placebo.

RESULTS

Using the video assessments, there was no significant difference between scores while on supplement compared with placebo (P = 0.7). Using the questionnaire responses, there was no significant difference between scores for any activity when the placebo and the supplement were compared with each other. However, owners reported significant improvement during all activities for both placebo and supplement compared with pretreatment scores.

CONCLUSIONS AND POTENTIAL RELEVANCE

The supplement offered no benefit over a placebo in alleviating the clinical signs of headshaking. There appeared to be a significant proxy placebo effect when the outcome was based on subjective owner perception of clinical signs. This study demonstrated no beneficial effect of this supplement on the clinical signs of headshaking. The study did show a significant placebo effect, thereby highlighting the necessity of properly conducted, randomised controlled trials, with blinding, to assess true treatment effects in trials in animals.

Gold Bead Implantation in Acupoints for Coxofemoral Arthrosis in Dogs: Method Description and Adverse Effects

Simple Summary

Traditional acupuncture uses needles inserted at certain acupuncture points. Gold bead implantation at acupuncture points is used in acupuncture intended to relieve pain in certain diseases. The method of gold implantation is not well described in the literature. We describe the technique of implanting 24-karat gold beads around the joints of dogs with degenerative joint disease due to chronic hip dysplasia. The method is safe and fairly easy to perform under anesthesia. It has few serious side effects, as long as bead-deposition within the joint is avoided. There is some aggravation of discomfort during the first two weeks after treatment as well as bleeding and synovial leakage during treatment.

Abstract

Gold bead implantation has been used for years as an alternative method to improve function in chronic joint disease both in humans and dogs. The aims of the present study were to describe the technique of implanting 24-karat gold beads around the hip joints of dogs with chronic hip dysplasia, and to record any side effects or complications of such treatment. A prospective placebo-controlled double-blinded clinical trial was performed. Eighty dogs were randomly allocated to treatment or placebo, with 38 in the gold implantation group and 42 in the placebo group, and followed intensely for six months. The implantation technique was simple to perform, using fluoroscopy and with the dogs under inhalation anesthesia for about 30 minutes. Adverse effects, measured as pain or discomfort, were seen for a period of up to four weeks in 15 of the dogs in the gold implantation group, compared to six dogs in the placebo group. During implantation, a technical difficulty occurred as 82% of the dogs showed leakage of blood and/or synovia from the needles. The dogs in the gold implantation group were radiographed 18 months later. Of the 30 dogs that were radiographed at both inclusion and 24 months, 80% (24 dogs) showed a deterioration of the coxofemoral arthrosis, the other six had stable disease evaluated by radiography. Migration of gold beads was only observed in one dog.

Canine hip dysplasia: reviewing the evidence for nonsurgical management

OBJECTIVE

To systematically review the evidence available for nonsurgical management of hip dysplasia (HD).

STUDY DESIGN

Literature review.

METHODS

Databases (Pubmed, Veterinary Information Network) were searched for clinical studies on nonsurgical management of HD in dogs. The evidence in each study was reviewed and assigned a score (I-IV) based on previously reported levels of evidence.

RESULTS

Fourteen articles were identified that met the inclusion criteria, including 3 Level IV, 4 Level III, and 7 Level II studies. Methods of nonsurgical management reviewed included: activity restrictions, weight management, acupuncture, modulation of joint disease by polysulfated glycosaminoglycans, mesenchymal stem cell therapy, and extra corporeal shock wave therapy.

CONCLUSION

Weight management is an effective and important component of managing dogs with HD and associated osteoarthritis. Techniques that modulate the progression of joint disease may also be beneficial for treating dogs with HD. Further studies are needed to investigate other methods of managing HD such as hydrotherapy and physical rehabilitation.

Traditional Chinese veterinary medicine: the mechanism and management of acupuncture for chronic pain

Complementary and alternative medicine can be defined as the diagnosis, treatment, and/or prevention that complements mainstream medicine, satisfying a demand not met by orthodoxy and diversifying the conceptual framework of medicine. Acupuncture is being used much more commonly now as a sole or integrative modality in veterinary medicine and can play a large role in management of inflammation and chronic pain. Western medical etiology, pathophysiology, diagnosis, and treatment should be considered before applying acupuncture. This article describes the evolving biomedical basis of acupuncture analgesia and gives the practitioner an overview of how acupuncture can be performed in a medical setting.

Inflammatory response to therapeutic gold bead implantation in canine hip joint osteoarthritis

Inflammatory changes associated with periarticular pure gold bead implants were studied in dogs involved in a clinical trial investigating motor dysfunction and chronic pain owing to hip joint dysplasia and osteoarthritis. Gold beads were percutaneously implanted via a needle into different locations surrounding the greater trochanter of the femur. Nine dogs with implants were necropsied. In all examined animals, characteristic histologic lesions were observed in the tissue surrounding the gold implants--namely, a fibrous capsule composed of concentric fibroblasts intermixed with a variable number of inflammatory cells and a paucicellular innermost layer of collagen with a few fibrocyte-like cells in empty lacunae. Lymphocytes dominated the inflammatory infiltrate, with rarely observed macrophages present in close proximity to the implant site. No giant cells were observed. Immunohistochemistry showed mixed populations of lymphocytes, both CD3 positive (T cells) and CD79a positive (B cells), which in some cases formed lymphoid follicles. Diffuse inflammatory changes were present to a minor extent in the perimysium and surrounding fascia. The inflammation observed in dogs is similar to that observed with gold implants in humans. It is possible that the clinically beneficial effect of gold beads for chronic osteoarthritis depends on sustained localized inflammation with localized release of soluble mediators. The encapsulation of the implant by a paucicellular and poorly vascularized fibrous capsule may help prevent an exaggerated inflammatory reaction by sequestering the gold bead from the surrounding tissue.

Systematic review of the management of canine osteoarthritis

This review assesses the evidence for the efficacy of therapies used in the management of osteoarthritis in dogs on the basis of papers published in peer-reviewed journals in English between 1985 and July 2007. Sixty-eight papers were identified and evaluated. They considered four alternative therapies, one use of functional food, two intra-articular agents, six nutraceutical agents, 21 pharmacological agents, two physical therapies, three surgical techniques and two combinations of weight control. There was a high level of comfort (strong evidence) for the efficacy of carprofen, firocoxib and meloxicam, and a moderate level of comfort for the efficacy of etodolac in modifying the signs of osteoarthritis. There was a moderate level of comfort for the efficacy of glycosaminoglycan polysulphate, licofelone, elk velvet antler and a functional food containing green-lipped mussel for the modification of the structures involved in the disease. There was weak or no evidence in support of the use of doxycycline, electrostimulated acupuncture, extracorporeal shockwave therapy, gold wire acupuncture, hyaluronan, pentosan polysulphate, P54FP (extract of turmeric), tiaprofenic acid or tibial plateau levelling osteotomy.

An exploratory study of gold wire implantation at acupoints to accelerate ulnar fracture healing in rats

By causing long-term stimulation, gold wire implantation at acupoints has been used empirically to prolong the effects of acupuncture. This study shows that subcutaneous gold wire implantation at acupoints has long-term effects on bone regeneration in the rat ulna bone defect model.

Two years follow-up study of the pain-relieving effect of gold bead implantation in dogs with hip-joint arthritis

Seventy-eight dogs with pain from hip dysplasia participated in a six-month placebo-controlled, double-blinded clinical trial of gold bead implantation. In the present, non-blinded study, 73 of these dogs were followed for an additional 18 months to evaluate the long-term pain-relieving effect of gold bead implantation. The recently-published results of the six month period revealed that 30 of the 36 dogs (83%) in the gold implantation group showed significant improvement (p = 0.02), included improved mobility and reduction in the signs of pain, compared to the placebo group (60% improvement).

In the long-term two-year follow-up study, 66 of the 73 dogs had gold implantation and seven dogs continued as a control group. The 32 dogs in the original placebo group had gold beads implanted and were followed for a further 18 months. A certified veterinary acupuncturist used the same procedure to insert the gold beads as in the blinded study, and the owners completed the same type of detailed questionnaires. As in the blinded study, one investigator was responsible for all the assessments of each dog. The present study revealed that the pain-relieving effect of gold bead implantation observed in the blinded study continued throughout the two-year follow-up period.

Stratification, blinding and placebo effect in a randomized, double blind placebo-controlled clinical trial of gold bead implantation in dogs with hip dysplasia

The purpose of this study was to investigate the need for and choice of stratification factors, and the effects of blinding and placebo in a clinical experiment. Eighty dogs with canine hip dysplasia (CHD) were included in a randomized, placebo-controlled and double blind clinical trial with stratified parallel group design, in which body weight and degree of CHD were used as stratification factors. Thirty-eight dogs were allocated to gold bead implantation and 42 to placebo. After six months, 33 of the 42 placebo-treated dogs received gold bead implantation in an open study lasting a further 18 months. The main outcome variable in the study was change in pain signs of CHD as assessed by the owner. No significant difference in the main outcome variable, regardless of the treatment given, could be detected in the two chosen stratification factors. The only factor to influence the main outcome variable significantly was age. The blinding procedure used in the study, in which 60% of the owners correctly guessed the treatment given, was found sufficient. Of those who guessed the treatment erroneously, 88% believed the treatment given was gold bead implantation. The treatment efficacy after six months in the blinded treatment group was found to be significantly larger compared to the efficacy obtained in the open study. A significant placebo effect was therefore detected.

CONCLUSION AND CLINICAL RELEVANCE

The age of the dogs influenced the outcome of the CHD treatment, and is recommended as a stratification factor. A significant placebo effect has to be expected and an optimal blinding procedure is necessary in similar clinical studies.