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Cortisone and NSAIDs

Cortisone is a steroid, a type of hormone that reduces inflammation and pain. It is very commonly given to animals to treat these problems. Rather too often in our opinion.

Long term cortisone has a lot of deleterious effects on the body. Many older dogs come in with pancreatitis, which can be life threatening and excruciatingly painful, after being given cortisone. Generally though, one sees a reduction in body energy and muscle mass. Joint surfaces are thinned with long term use of cortisone and so is the mucus layer protecting the stomach and bowel wall. The gums appear paler and the body looks as if it is struggling. There are also negative effects on body immunity.

A high proportion of the animals presenting at our clinic come here after long term cortisone use when the drug is no longer working or the animal is suffering side effects, or because the owners are choosing to move away from steroid use. We see overweight dogs with unhealthy skins every week and many infectious problems not dealt with effectively due to the use of cortisone as a pharmacological ‘band-aid’.

Cortisone is still used for arthritis where cost is a factor or the animal has reacted to the NSAIDS given. In the short term it is safe enough. Owners will report their pet hungry and drinking much more, sometimes to the point of losing bladder control.

The normal pain killers that are prescribed for dogs are not cortisone and fall into the category of nonsteroidal anti-inflammatories or NSAIDS. There are many, all claiming superiority. These drugs are used with and after operations, with any pain situation and of course with arthritic old dogs and cats. Our clinic uses them in all these situations but we use a lot less. The use of pain medications from several categories is much more widespread than it used to be. Forty years ago I think we were pretty blasé about pain and that was not good but the heavy use of pain killers as is normal in modern medicine has plenty of problems.

Rimadyl, Carprofen and Meloxicam are probably the most commonly used. There are plenty of cases of renal failure, liver damage and gut upsets following their use. The internet has disseminated sufficient deleterious information about these drugs to be a marketing asset for our clinic. Routinely new clients arrive requesting alternatives. We of course suggest acupuncture as a prime tool in pain management. A few months ago The Age ran a front page article about the trialling of acupuncture in the emergency department of the Alfred Hospital; they found it to be as potent as high potency pain medications! We support their findings.

When presented with an animal on these drugs, we normally start acupuncture and ask the client to halve the NSAIDs. Within a visit of two it is almost universal that the client comes back reporting that the animal is “ much happier”. The change is so fast that I personally think the NSAIDS are depressing the animal and that stopping them has an excellent effect. We then pursue a course of acupuncture and provide anti-inflammatory herbs. We only use the NSAIDS for short term treatment or trials to determine if there is pain affecting behaviour as they do work fast.