In this episode of Canine Arthritis Matters, Dr. Hannah Capon is joined by Dr. Mark Epstein, a leading voice in veterinary pain management and co-owner of Total Bond Veterinary Hospitals in the US. Together, they dive deep into the complexities of recognising, assessing, and managing chronic pain in dogs and cats. From validated clinical metrology instruments (COAST, LOAD, CBPI, CSOM) to the promise of anti-NGF monoclonal antibodies, Mark shares insights from both research and everyday practice.

The discussion also touches on the potential role of AI in the near future, the importance of multimodal management beyond pharmaceuticals, and the need for better caregiver communication. With candid reflections on successes, challenges, and the risk of polypharmacy, this episode offers both practical advice and thought-provoking perspectives for anyone involved in chronic pain management.

Guest Bio

Dr. Mark E. Epstein is a board-certified diplomate of the American Board of Veterinary Practitioners in canine and feline practice. He serves as medical director and co-owner of Total Bond Veterinary Hospitals in North Carolina. With decades of experience in companion animal pain management, he is a founding fellow of the ABVP’s Companion Animal Pain Management and the International Veterinary Academy of Pain Management.

Mark is a certified veterinary pain practitioner, frequent lecturer, and author of peer-reviewed journal articles and book chapters. He has chaired the American Animal Hospital Association’s Senior Care Guidelines and Pain Management Guidelines Task Force. Despite his global reputation, Mark emphasizes that most of his work is still first-opinion general practice — making his insights directly relevant to everyday clinicians.

Key Takeaways

1. Pain recognition and assessment remain the biggest challenges in chronic pain management; validated tools like COAST, LOAD, CBPI, and CSOM can help but each has strengths and weaknesses.

2. COAST staging provides a common language for veterinarians, particularly useful for early identification (Stage 1 dogs at risk).

3. Multimodal care must go beyond drugs — weight management, exercise, client education, and lifestyle changes are essential.

4. Polypharmacy requires caution; gabapentinoids in particular may contribute to sedation and proprioceptive issues that are misinterpreted as disease progression.

5. The future of pain management includes monoclonal antibody therapies and potentially AI-based assessment tools, but empathetic caregiver communication will always be central.

Relevant links

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https://www.caninearthritis.co.uk/member-zone/

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Stay tuned to learn how early detection can make a significant difference in managing OA in younger dogs.