Spinal Arthritis / Spondylosis
Definition and cause
Spinal arthritis / spondylosis is a degenerative condition of the bony spinal column with associated osteophytic activity between vertebrae. It occurs in both dogs and cats and is believed to have an inherited predisposition or be the result of continual localized trauma and secondary inflammation to the bony vertebrae (see Arthritis). Spondylosis is often discovered radiographically with no associated clinical signs.
Medical therapy rationale, drug(s) of choice, and nutritional recommendations
Once clinical signs of pain, inflammation, and reduced mobility become evident, the treatment is corticosteroids or NSAIDs such as carpofen, deracoxib, meloxicam, or aspirin. Nothing has been reported to prevent progression of the condition.
The prognosis depends upon the extent of the arthritis and the resultant pain and impact upon the spinal cord. Pain and inflammation control offer good control of the signs. When the disease is progressive and has impacted the spinal cord and is causing neurological symptoms, the prognosis is more guarded.
Integrative veterinary therapies
Spinal arthritis occurs at the articular surfaces and has the same underlying mechanism as degenerative arthritis of the limbs. Medical treatment is directed toward the pain and inflammation, while integrative therapies are directed at the underlying cause of the inflammation and the associated degeneration that leads to the osteophytic process and potential compression of spinal nerves. Conventional medications address the inflammation and pain; however, they do not correct the underlying initiating inflammatory process.
General considerations / rationale
Nutritional and gland support are directed at reducing inflammation, protecting cells and tissue, and slowing the degenerative process.
Nutrition / gland support: Several studies have demonstrated the effectiveness of glucosamine and chondroitin in the management of arthritis in dogs. Setnikar et al (1986) has described how these compounds actually stimulate the body’s own repair mechanism and help in the process of developing new cartilage. Numerous double-blind studies have compared the effectiveness of glucosamine against various NSAIDs, resulting in as good or, in many cases, even better pain control and removal of the clinical signs associated with osteoarthritis.
Fatty acids: In a double-blind study of people with rheumatoid arthritis, Joe (1993) showed that a number of people had significant benefits from the addition of evening primrose oil (EPO). Kremer (1995) has shown that fish oil helps to reduce inflammation in people with arthritis.
Botanical cox2 inhibitors: Botanical Cox2 inhibitors have been shown to have antioxidative and antiinflammatory effects. Botanical Cox2 inhibitors offer the benefit of inflammation reduction without the inherent side effects of Cox2 medications.
Vitamin C: Vitamin C has been studied clinically in animals. Brown (1994), Berg (1990), and Newman (1995) reported on the benefits of vitamin C in the treatment of degenerative joint disease and movement in dogs and horses. Belfield (1981) reported on the beneficial effects of using vitamin C in treating and preventing hip dysplasia in dogs.
Lecithin / phosphatidyl choline: Lecithin / phosphatidyl choline is a phospholipid that is integral to cellular membranes. Lecithin / PC is an essential nutrient for the membranes of nerve cells and is essential for the proper conduction of nervous impulses.
Chinese herbal medicine / acupuncture
General considerations / rationale
Spinal arthritis is due to Wind, Damp, and Cold invading the body. This causes Kidney Qi and Yang deficiency, and Qi and Blood stagnation. Wind both blows the pathogen into the body and blows it around the body so the pain may wander from joint to joint. Damp causes stiffness and Cold implies that the condition tends to respond well to heat. Most people with degenerative skeletal conditions report that heat soothes the pain. Qi and Blood stagnation cause pain. The Kidney is charged with controlling bones, so when the Kidney suffers deficiency, arthritis may result. Again, as Yang is heat, a Kidney Yang deficiency may result in a sore skeletal lesion that responds well to heat therapy. Older patients are more likely to have degenerative spinal conditions and they are also more likely to have Kidney Yang deficiency. The Yang of the Kidney is used over the life of the individual.
Treatment options are designed to increase mobility and decrease pain and inflammation.
Appropriate Chinese herbs
Atractylodes (Cang zu): Increases the pain threshold. In addition, it can counteract xylene-induced ear swelling and carrageenin-induced foot swelling, which indicates that it may be useful in decreasing inflammation at the site of degenerative changes.
Aconite root (Fu zi): Reduces swelling and inflammation in joints. It has been shown to have analgesic properties.
Angelica (Bai zhi): Has been shown to have antiinflammatory and analgesic effects in mice.
Angelica root (Dang gui): As strong as aspirin at decreasing inflammation and is 1.7 times as strong as aspirin for pain relief.
Astragalus (Huang qi): Has demonstrated mild analgesic effects in mice.
Cinnamon twigs (Gui zhi): Have analgesic properties. Cinnamon twigs were part of a formula used in 30 patients with arthritis. There was complete recovery in 50% of those treated, marked improvement in 20%, and some improvement in 17%. Thirteen percent did not respond.
Coix (Yi yi ren): Has analgesic and antiinflammatory effects. It suppresses dimethylbenzene-induced auricular swelling and carrageenin-induced foot swelling in mice. It was shown to help women with severe menstrual cramps, which may indicate that it would be useful in treating the pain associated with spinal arthritis and spondylosis.
Earthworm (Di long): Has a significant analgesic effect.
Jujube fruit (Da zao): Decreases inflammation. It was shown to reduce dimethylbenzene-induced auricular inflammation in mice and egg-white-induced toe swelling in rats. This implies that it may be useful for decreasing the inflammation involved with degenerative vertebral conditions.
Licorice (Gan cao): Contains glycyrrhizin and glycyrrhetinic acid, which have antiinflammatory effects. They have approximately 10% of the corticosteroid activity of cortisone. They decrease edema and have antiarthritic effects. Licorice has demonstrated analgesic effects in mice, especially when combined with white peony (Bai shao).
Notopterygium root (Qiang huo): Has antiinflammatory and analgesic effects. In mice it was shown to decrease xylol-induced ear lobe swelling and carrageenin-induced foot pad edema, and increase the thermal pain threshold.
Sichuan aconite (Chuan wu): Seems to have a centrally mediated analgesic effect. In mice it was shown to be effective at decreasing inflammation and pain. It is stronger than aspirin at reducing inflammation. It controlled the signs in 92% of 150 human patients with arthritis when given in combination with Cao wu, Qiang huo, Du hua, Fu zi, Mo yao, Ru xiang, Dang gui, Chuan niu xi, Ma huang, Gui zhi, Wu gong, Chuan xiong, and Ma qian zi.
White peony (Bai shao): Contains paeoniflorin, which is a strong antiinflammatory. It has demonstrated specific effects on pain in the lower back.
The World Health Organization (2006) lists lower back pain as one of the indications for acupuncture. One study looked at the use of abdominal acupuncture and electroacupuncture for treatment of prolapsed lumbar intervertebral discs. In this study there was complete relief from symptoms in 35% of the patients, significant improvement in 45% of the participants, slight improvement in 16%, and no response in 4%.
General considerations / rationale
Arthritis is a Deposition Phase disorder wherein material accumulates and eventually impedes the function of the joint. True arthritis of the spine occurs on the articular surfaces of the vertebral facets and is potentially painful. Spondylosis indicates degeneration of the spinal anatomy and is classified as a Degeneration Phase homotoxicosis. Spondylosis must be differentiated from spondylitis, and appropriate diagnostics conducted to rule out infectious agents.
Appropriate homotoxicology formulas
Also See Arthritis protocols, above, for a more detailed discussion of these remedies.
Atropinum compositum: Used for muscle spasm and pain. Currently only available in the United States as a tablet, but is extremely useful for acute, severe back pain.
BHI-Back: An important and commonly used formula supportive of the spinal column, and particularly the lower back. The component Colocynthis is indicated for sharp, tearing pain in the back that improves with warmth and deep pressure. Anger may be involved in these cases, and colitis may be an associated sign as well. Gnaphalium polycephalum is included for pain and / or numbness of the back and pelvis. Gelsemium sempervirens is included for neurologic weakness and muscle stiffness. Rhus toxicodendron is an important classical remedy for pain in tendons, ligaments, and soreness of condyles. Arsenicum album and Chamomilla complete this formula, with indications for cramps and neuralgia.
BHI-Sciatic Rx: Used for sciatica and neuralgia of the legs.
BHI-Spasm-Pain: Treats muscle spasm and back pain. Components of this formula help with sharp pains and spasms. This is a good alternative due to Atropinum compositum. Febrile conditions with back pain may respond due to Aconitum nepellus. Treats inflammation of other serosal membranes (joints and the abdomen) due to Bryonia alba. Colocynthis and Cuprum sulfuricum are included for sharp pains and menstrual-like cramps and other muscle spasms.
Cimicifuga homaccord: Treats pain and spasm of the cervical spine.
Coenzyme compositum: Supports energy metabolism.
Colocynthis homaccord: Treats lower back pain.
Discus compositum: Supports connective tissue that is associated with the spine.
Neuralgo-Rheum-Injeel: Contains Silicea, which is a major remedy for vaccinosis. Silicea is also contained in BHI-Alertness, BHI-Migraine, BHI-Neuralgia, Crurobeel, Discus compositum, Spigelon, Strumeel, and Zeel.
Osteoheel: Stimulates bone healing.
Spascupreel: Indicated for muscle spasm and pain. Compare its use to that of Atropinum compositum and BHI-Spasm-Pain. Contains Agaricus, a toxic mushroom indicated in homeopathic dilution for seizures, excitable conditions, motor tics, and sensitivity to cool air, among many other signs. It is helpful for migraine headaches and a wide variety of muscular spasmodic issues.
Testes compositum: Used for strengthening and draining the matrix in male patients with weakness. Contains Conium maculatum, which is useful in ascending hind-limb ataxia, weakness, and hemiplegia. Conium is also possibly useful in an older dog, and is also found in Cerebrum compositum, Cocculus compositum, Ginseng compositum, Rauwolfia compositum, Tbyroidea compositum, Tonsilla compositum, Ubichinon compositum, Vertigobeel, BHI-Circulation, BHI-Dizziness, BHI-Ligbtbeaded, and BHI-Stramonium complex. This remedy may cause detoxification / vicariation reactions and should be given with good observation and client education. It is highly useful in geriatric, male patients.
Traumeel S: A critically important formula that activates blocked enzymes. It is a nonsteroidal antiinflammatory agent (See the homotoxicology) for more extensive citations).
Zeel: A commonly used antiinflammatory that reduces pain and improves mobility (see the homotoxicology chapter for more extensive citations).
Authors’ suggested protocols
Cartilage / ligament / muscle / skeletal support and brain / nerve support formulas: 1 tablet for every 25 pounds of body weight BID.
Eskimo fish oil: One-half to 1 teaspoon per meal for cats. 1 teaspoon for every 35 pounds of body weight for dogs.
Evening primrose oil: 1 capsule (500 mgs) per 25 pounds of body weight daily.
Zyflamend: One-half dropper for each 25 pounds of body weight BID.
Lecithin / phosphatidyl choline: One-fourth teaspoon for every 25 pounds of body weight BID.
Chinese herbal medicine
Formula H39 Backrelief: 1 capsule per 10 to 20 pounds twice daily. It can be combined with NSAIDs and nutraceuticals if desired. It generally takes 2 to 4 weeks to see a response. In addition to the herbs listed above, Backrelief also contains aconite / cao (Cao wu), allium (Cong bai), carthamus (Hong hua), papaya (Mu gua), poria (Fu ling), and siler (Fang feng). These herbs increase the efficacy of the formula.
Recommended acupuncture points include BL23, BL40, GV4, ST36, Baihui, and GV3 (Handbook of traditional Chinese medicine Practitioners).
Symptom cocktail: Traumeel, Aesculus compositum, Cimicifuga homaccord (neck) or Colocynthis homaccord (lower spine), and Zeel, and / or BHI-Back mixed together and given orally BID to TID. Discus compositum given initially by injection and then orally 1 to 3 times weekly. Spascupreel, as an initial injection, then Atropinum compositum PRN (if available). Consider Dulcamara homaccord and Causticum compositum, if indicated, and Rhododendroneel, particularly if condition is worse with weather changes. Give Atropinum compositum tablets PRN.
Deep detoxification formula: Galium-Heel, Lymphomyosot, Hepar compositum, Solidago compositum, Thyroidea compositum, Coenzyme compositum, and Ubichinon compositum mixed together and given orally twice weekly for 2 to 4 weeks and then every other day. Adjust dosing based upon detoxification reactions observed.
Cartilage / ligament / muscle / skeletal and brain / nerve support formulas: Animal Nutrition Technologies.
Alternatives: Cosequin — Nutramax Labs; Glycoflex — Vetri Science; Musculoskeletal support — Standard Process Veterinary Formulas; Nutriflex — Vet Rx Vitamins for Pets; Arthragen — Thorne Veterinary Products.
Evening primrose oil: Jarrow Formulas.
Eskimo fish oil: Tyler Encapsulations.
Zyflamend: New Chapter. Alternative: Botanical Treasures — Natura Health Products.
Lecithin / phosphatidyl choline: Designs for Health.
Chinese herbal medicine
Formula H39 Backrelief: Natural Solutions, Inc.
BHI / Heel Corporation