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

For more practical tools, resources, and ongoing education in osteoarthritis and chronic pain management, visit the CAM Member Zone:

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

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Have questions send them to: info@caninearthritis.co.uk

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

In this episode of Canine Arthritis Matters, Dr. Hannah Capon speaks with Dr. Tyler Carmack, Director of Hospice and Palliative Care at Caring Pathways. Dr. Carmack shares her journey from emergency medicine into dedicating her career to hospice and palliative care for companion animals. Together, they explore how end-of-life care can be approached with compassion, planning, and innovation, particularly in cases of chronic pain and osteoarthritis. From emergency kits to integrative therapies and caregiver communication, this conversation sheds light on an area of veterinary medicine that remains under-discussed but deeply impactful.

Guest Bio

Dr. Tyler Carmack is the Director of Hospice and Palliative Care for Caring Pathways. She founded Hampton Roads Veterinary Hospice in 2011 and has practiced exclusively in hospice and palliative care for over a decade. Dr. Carmack has served on the board of the International Association for Animal Hospice and Palliative Care (IAAHPC) since 2016 and lectures internationally on end-of-life care. She holds certifications in animal hospice, palliative care, veterinary acupuncture, Chinese food therapy, traditional Chinese veterinary medicine, and end-of-life care. Her professional passions include pain management and caregiver support during the most difficult stages of a pet’s life.

Key Takeaways

1. Hospice and palliative care are distinct yet complementary approaches—palliative can begin early in life to support comfort, while hospice typically refers to the final stages.

2. Emergency medication kits provide families with peace of mind and help manage crises until veterinary support is available.

3. Tools like quality-of-life and frailty scales can empower caregivers and improve communication with veterinary teams.

4. Simple lifestyle adjustments—traction mats, ramps, and planned mobility support—can dramatically improve quality of life in older or frail pets.

5. End-of-life care requires not only medical expertise but also time, compassion, and proactive planning for both pets and their families.

Relevant links

If you want to deepen your understanding of hospice and palliative care, explore resources at:

Caring Pathways – https://charlotte.caringpathways.com/meet-our-team/dr-tyler-carmack-director-of-hospice-and-palliative-care/

International Association for Animal Hospice and Palliative Care (IAAHPC) – https://iaahpc.org/

For veterinary professionals, further tools and handouts are available in our CAM Member Zone:

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

Learn more about CAM:

Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Have questions send them to: info@caninearthritis.co.uk

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

In this episode of Canine Arthritis Matters, Hannah Capon is joined by ACPAT veterinary physiotherapist Amy King to discuss one of the most common causes of pelvic limb lameness in dogs: cruciate disease. As the leading driver of stifle arthritis, cruciate ligament injuries demand careful management, whether surgical or conservative.

Amy explains the underlying causes and pathophysiology of cruciate disease, key interventions and why they matter, and practical rehabilitation approaches tailored for both post-surgical and conservatively managed dogs. With insights drawn from her clinical work and research, Amy highlights how physiotherapy supports recovery, reduces the risk of further joint deterioration, and helps maintain mobility and quality of life.

Guest Bio:

Amy King has worked as a physiotherapist since 2012 and earned her MSc in Veterinary Physiotherapy from Hartpury in 2018. She joined The Win Clinic in Somerset in 2019, where she treats a varied caseload including orthopaedic, neurological, and musculoskeletal conditions, as well as sporting dogs.

In 2021, Amy presented research on canine hypermobility at the ACPAT seminar, reflecting her interest in advancing evidence-based rehabilitation. At home, she enjoys training her Labrador, Tolly, in recreational gundog work.

Key Takeaways:

1. Cruciate disease is the leading cause of stifle arthritis and must be managed carefully to reduce long-term joint damage.

2. Surgery is generally the gold standard, but some cases can be managed conservatively with appropriate support.

3. Physiotherapy plays a critical role in both surgical and conservative cases, aiding recovery and preventing compensatory problems.

4. Rehabilitation should be tailored to the individual dog’s needs, age, activity, and concurrent conditions.

5. Early intervention and structured support can significantly improve long-term quality of life for cruciate patients.

Relevant Links:

Join the CAM Member Zone

Gain access to exclusive resources, webinars, and support materials for managing canine arthritis in clinical practice and at home.

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

Use the CAM Vet Nurse Flip Chart

The OA Flip Chart is a practical consultation tool designed to help veterinary nurses explain osteoarthritis and its management to owners clearly and confidently.

Find it here: https://www.caninearthritis.co.uk/product/oa-flipchart/

Learn more about CAM: Facebook: https://www.facebook.com/CAMarthritis

Instagram: https://www.instagram.com/canine_arthritis

Youtube: https://www.youtube.com/c/CanineArthritisManagement

LinkedIn: https://www.linkedin.com/company/canine-arthritis-management-ltd

Have questions send them to: info@caninearthritis.co.uk

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