The first step is C, control the pain. Without controlling pain first, it will be difficult to follow the other steps of the protocol. A painful dog won't want to move, and movement is critical to my protocol. If you are going to control pain, then you must know the signs of pain in your dog so that you can tell when he hurts and when he feels good. We already discussed some of these signs of pain earlier, but it pays to educate yourself on the subtler signs of pain, so you can intervene early.
A simple Google search on signs of pain in dogs will bring up several educational websites where you can learn more. If your dog is painful, then you are going to need pain medication, at least at the start. I always start my patients on pain medication, and then, as they work through the protocol, owners will find that they can reduce dosages and, in some cases, eliminate the need for pain medications altogether. Carprofen is the most common pain medication prescribed in dogs. It comes under the brand name Rimadyl, but there are many generic formulations available online for less money. Galliprant is another medication. It's new, and it is available. It's supposed to specifically target inflammation associated with joint pain. It is not generic, but one benefit of Galliprant is it doesn't require annual blood work monitoring, which is required if you give Rimadyl or carprofen consistently. Deramaxx is another nonsteroidal anti inflammatory that is available, but I prescribe that one a lot less often. I usually will give that one to patients that can't tolerate Rimadyl. Some dogs have neuromuscular pain that is associated with hip dysplasia, and, for these dogs, gabapentin can be beneficial. It is a muscle relaxant, and it can cause sedation, which can make it a nice edition at night to help your dog sleep better. Tramadol doesn't work for arthritis pain. A study published this year in the Journal of the American Veterinary Medical Association showed that it doesn't work, so I advise my clients to stop giving it for arthritis pain.
A new, exciting alternative pain medication that is getting a lot of attention is CBD oil from industrial hemp. A study this year, out of Cornell, on Ellevet CBD oil showed that twice daily dosage of two milligrams per kilogram of CBD oil reduced pain in dogs with osteoarthritis. That is great news! I have patients that have been able to stop their prescription pain meds after using CBD oil. The products I recommend are made by Cannapet, Ellevet, and Phytovet. You can buy any of these products online. In addition to prescription pain meds and CBD oil, there are a wealth of other alternative therapies that help dogs with hip pain.
Acupuncture provides temporary relief, as does photobiomodulation, which is a fancy new way of saying therapeutic laser treatment. TENS therapy, which is transcutaneous electrical nerve stimulation, helps, as well as massage and traditional ice and heat. The picture to the right is a dog receiving photobiomodulation therapy, which I recommend to my clients all the time. Dogs love the treatment. It feels good. It is relatively inexpensive, and if you are diligent about getting the treatments as recommended on the veterinarian schedule, dogs can often decrease or discontinue pain medication altogether. I had a patient that had a terrible back, hip, and knee arthritis. The owners elected to start laser therapy, and they were shocked at how much the dog improved over time. With pain control, it isn't one-size-fits-all. What might work for one dog may not work at all for another dog. You have to have some trial and error to get it right, but your first step in the COMFY protocol is the most important: control the pain.