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

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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.

In this episode of Canine Arthritis Matters, Hannah Capon is joined by Professor Natasha Olby of North Carolina State University to explore the emerging but under-recognised concept of frailty in companion animals. Frailty is widely studied in human medicine but rarely discussed in veterinary practice, despite its major implications for how we interpret behaviour, manage medications, and support quality of life in ageing dogs.

Together, they discuss how frailty differs from chronic pain, why misinterpreting one for the other can lead to over-medication or missed interventions, and how recognising frailty creates opportunities for prevention, lifestyle modification, and better caregiver guidance. Natasha also introduces her team’s newly developed frailty screening tool for dogs and explains how it can help veterinarians and owners identify pre-frail states and take action earlier.

Guest Bio:

Professor Natasha Olby is a veterinary neurologist at North Carolina State University. She earned her PhD in spinal cord injury, completed advanced surgical training in neurosurgery, and has received numerous awards, including the Faculty Achievement Award from the American Association of Veterinary Clinicians and the Dr. Kady M. Gjessing and Rahna M. Davidson Distinguished Chair in Gerontology.

She has authored countless publications and edited the BSAVA Manual of Companion Animal Neurology. Her current research focuses on ageing of the nervous system and frailty in dogs, with a landmark paper published in 2024:

Russell, K. J., Mondino, A., Fefer, G., Griffith, E., Saker, K., Gruen, M. E., & Olby, N. J. (2024). Establishing a clinically applicable frailty phenotype screening tool for aging dogs. Frontiers in Veterinary Science, 11. https://doi.org/10.3389/fvets.2024.1335463

Key Takeaways:

1. Frailty is not simply “old age” but a clinical syndrome of accumulated impairments across multiple systems, leading to increased vulnerability.

2. Frailty and chronic pain can look similar, but confusing the two risks over-prescribing medications or missing opportunities for lifestyle support.

3. Frailty is multidimensional: physical, nutritional, social, and cognitive domains all contribute.

4. Pre-frail states can be modified—early recognition allows exercise, nutrition, and environmental changes to slow progression.

5. Frailty screening tools can help veterinarians and owners identify risk, predict outcomes, and tailor interventions more effectively.

Relevant Links:

Join the CAM Member Zone

Gain access to exclusive resources, webinars, and a supportive community dedicated to improving life for dogs with chronic pain and frailty.

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

Access the Chronic Pain Symposium On-Demand

Missed it live? You can still watch all lectures and expert discussions through our Education Centre.

Access now: https://www.cameducation.co.uk/

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 speaks with Dr. Deborah (Deb) Torraca of Wizard of Paws, a pioneer in veterinary rehabilitation. Together they dive into one of the most overlooked challenges in managing osteoarthritis: comorbidities such as kidney disease, heart disease, or cancer that often overshadow pain management.

Deb shares her wealth of experience treating complex cases, showing how rehab, lifestyle modifications, and manual therapies can still transform quality of life—even when drugs like NSAIDs are limited or contraindicated. She emphasizes the importance of “baby steps” in building sustainable care plans, the overlooked role of enrichment and fun, and how simple tools like rugs, nail trims, and mobility aids can have life-changing impact.

This is a practical and inspiring discussion that calls for a cultural shift: osteoarthritis care should not be sidelined, and rehabilitation should be seen as a first-line option, not a last resort.

Guest Bio:

Dr. Deborah Torraca is the founder of Wizard of Paws Rehabilitation in the United States and a leading international educator in veterinary rehab. Originally trained as a human physical therapist, she shifted her focus to animals and has since authored and co-authored numerous textbook chapters, published research, and spoken at veterinary conferences worldwide.

Deb combines clinical practice with teaching, research, and industry collaboration, making her uniquely placed to comment on the real-world challenges of managing canine osteoarthritis and chronic pain. Her philosophy is rooted in practicality: use what’s available, start with the basics, and empower owners with realistic, effective steps to improve their dog’s life.

Key Takeaways:

1. Comorbidities should not eclipse pain management. OA is often deprioritised in favour of conditions like kidney or heart disease, but untreated pain worsens overall health and quality of life.

2. Rehab is a first-line treatment, not a last resort. Many dogs improve significantly through lifestyle adjustments, exercise, and manual therapies—sometimes avoiding surgery altogether.

3. Baby steps matter. Introducing gradual, sustainable changes is more effective and affordable than overwhelming dogs and caregivers with every possible intervention at once.

4. Practical tools make a big difference. Rugs, mobility aids, nail care, and enrichment activities can improve comfort and reduce stress on painful joints.

5. Quality of life includes joy. Beyond pain relief, ensuring enrichment, fun, and family connection is central to managing chronic conditions in dogs.

In this thought-provoking episode of Canine Arthritis Matters, Hannah Capon sits down with Vincent Hoogstad, a physiotherapist turned animal rehabilitation practitioner and educator. Together, they explore the complexities of pain: how animals and humans perceive it differently, the cultural drivers that shape our response to it, and why pain behavior is not always a reliable indicator of suffering.

The conversation dives into evolutionary perspectives, the distinction between emotions and feelings, and how caregivers’ expectations often complicate decision-making in veterinary practice. Vincent shares stories from his clinical work and his broader studies in ethology, primatology, and conservation, alongside reflections from his book Monkey Business.

Listeners are invited to challenge assumptions about pain, embrace observation over assumption, and reflect on how empathy and environment shape the way we interpret suffering in both humans and animals.

Guest Bio:

Vincent Hoogstad began his career as a human physiotherapist in Rotterdam before shifting his focus to animal rehabilitation and behavioral ecology. He has trained extensively in physical rehab (University of Tennessee), primatology, wildlife conservation, and the One Health perspective. Based in Crete, he runs a small rehabilitation business while lecturing internationally.

Vincent is also the author of Monkey Business, a book exploring empathy, sociality, and the interconnectedness of humans and animals. He is passionate about bridging science, philosophy, and practice to better understand pain and behavior across species.

Key Takeaways

1. Pain is always real, but pain behavior is heavily influenced by environment and context.

2. Animals often hide pain, especially prey species, which makes observation skills critical.

3. Human cultural expectations strongly influence how caregivers interpret and respond to their pet’s pain.

4. Observation is often more reliable than owner reports when assessing discomfort.

5. Education, empathy, and environmental modification are as powerful as medication in managing chronic pain.

Relevant Links:

Monkey Business (Vincent Hoogstad’s book): https://www.amazon.co.uk/Monkey-Business-Empathy-Animals-People/dp/1916238549/

Join the CAM Member Zone

Access tools, guides, and exclusive education to help you better understand and manage arthritis in dogs. From lifestyle modification resources to validated pain questionnaires, the Member Zone equips you with everything you need to improve your dog’s quality of life.

Join here: 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 speaks with João Alves MRCVS, a veterinary surgeon with a special interest in chronic pain and osteoarthritis. Together they discuss why spotting pain early is vital, how misinterpreting behaviour can delay care, and why arthritis should be considered long before obvious lameness develops.

João shares practical advice for general practitioners on integrating chronic pain assessment into everyday consults, from history-taking to subtle movement observation. He and Hannah also explore the importance of teamwork with owners, how simple validated tools can improve accuracy, and why communication and empathy are often as powerful as prescriptions in managing canine OA.

Guest Bio:

João Alves MRCVS is a veterinary surgeon based in the UK with a strong focus on chronic pain management and welfare. He has built his clinical practice around improving outcomes for dogs living with osteoarthritis and other long-term pain conditions, ensuring that both vets and owners have the knowledge and tools to intervene earlier. João is passionate about bridging the gap between research and everyday practice, making pain management more accessible and effective for all.

Key Takeaways:

1. Chronic pain is often under-recognised. Behavioural changes such as reluctance to jump, subtle stiffness, or reduced play may be early red flags.

2. Owners are key partners. Teaching them to recognise and record changes helps provide better evidence for diagnosis and management.

3. Validated assessment tools reduce subjectivity and help track progress more reliably than owner memory alone.

4. Pain management should begin early—waiting for overt lameness means lost time and welfare compromise.

5. Empathy, continuity, and communication are central. Building trust leads to more accurate reporting and better adherence to management plans.

Relevant Links:

Join the CAM Member Zone

Access webinars, guides, case studies, and a supportive community of professionals and pet owners working to improve canine arthritis care.

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

Use the Suspicion of Chronic Pain Form

Help identify dogs that may be living with hidden pain. This validated form supports early recognition and structured conversations with owners.

Download here: https://caninearthritis.co.uk/suspicion-of-chronic-pain/

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.

This episode of Canine Arthritis Matters takes a practical look at how telehealth can strengthen osteoarthritis care in the UK (and beyond). Host Hannah Capon is joined by registered veterinary nurse Evie Tumon and senior anaesthetist/pain specialist Dr. James Hunt to unpack what remote guidance adds: time to listen, continuity, calmer conversations outside the “white coat” setting, and a clearer framework for weight, lifestyle, and analgesia decisions that owners can take back to their primary vet. The team discuss variability in current OA care, why “no recipes” means we must monitor and adapt, and how validated tools (like the Canine Brief Pain Inventory) help align owner perception with a dog’s day-to-day function. They also share how the CAM teleguidance service supports overloaded practices by offering owners structured coaching, while reinforcing that in-person exams and prescribing stay with the primary vet.

Guest Bios:

Evie Tummon, RVN

Evie is a registered veterinary nurse working in clinical practice and on CAM’s tele-platform, where she hosts discovery calls and leads nurse calls. Her focus is demystifying choices for overwhelmed caregivers and breaking change into doable steps that fit each home and dog.

Dr. James Hunt

James is a senior anaesthetist at a multidisciplinary referral hospital, runs Pet Pain Relief (a clinic dedicated to pain management), and is a specialist in ethics and welfare with a PhD focused on chronic pain/OA. In CAM’s tele service he helps owners and vets build robust, basics-first plans—weight, lifestyle, analgesia—and use validated tracking so everyone can see what’s working.

Key Takeaways:

1. Telehealth complements, it doesn’t replace. Remote sessions remove time pressure, reduce the “frozen in the consult room” effect, and let clinicians tailor plans to the caregiver’s reality—then loop back to the primary vet for exams and prescribing.

2. Framework over “fix.” OA management isn’t a one-step recipe; start with weight, daily life changes, and clear priorities, then add/adjust analgesia and adjuncts based on response.

3. Measure what matters. Pair an owner’s unique pain indicators with a validated tool like the Canine Brief Pain Inventory to track severity, interference with activities, and quality of life over time. Expect scores to spark useful conversations, not just produce a “number.”

4. Lower the stress to raise the care. For reactive or anxious dogs, remote guidance can be a lifeline; it builds caregiver confidence and plans for low-stress vet visits (timing, ramps, car setups) before the next in-person appointment.

5. Plan for flares and continuity. Set expectations that flare-ups happen, agree an analgesic “flare plan” in advance, and keep the same clinician(s) involved so owners feel heard and supported across visits.

Relevant Links:

Get Support Through Teleguidance

Whether you’re feeling overwhelmed with options or just want a clear, step-by-step plan for your dog’s osteoarthritis care, our teleguidance team is here to help. You’ll receive personalised advice you can take straight back to your own vet—without leaving home.

Find out more: https://caninearthritisteleguidance.co.uk

Chronic Pain Symposium On-Demand

Missed the live event? Watch all lectures anytime through the Education Centre and level up your OA toolkit.

Access now: https://www.cameducation.co.uk/

Join the CAM Member Zone

Get ongoing support, templates, webinars, and Q&As to manage canine OA more confidently.

Join here: 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.