OA pain management moves beyond single-drug strategies

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Osteoarthritis pain management is back in the spotlight with a new Clinician’s Brief podcast featuring Dr. Robin Downing, one of veterinary medicine’s best-known pain specialists. In the sponsored episode, Downing discusses practical ways to build more complete pain-control strategies and help pet parents recognize discomfort earlier, reflecting a broader shift in small animal practice away from one-size-fits-all OA care. (cliniciansbrief.com)

That shift has been building for years. AAHA’s 2022 pain management guidelines frame chronic pain care as an essential, still-evolving part of companion animal medicine, and note that musculoskeletal pain, especially osteoarthritis, remains one of the most common chronic pain problems in practice. The guidance also emphasizes team training, regular reassessment, and a structured approach to pain evaluation rather than relying only on radiographs or a brief exam-room impression. (aaha.org)

The current conversation is also shaped by a broader set of therapeutic options. In addition to NSAIDs, consensus frameworks such as COAST and the 2025 Frontiers trial comparing bedinvetmab with meloxicam reflect how anti-NGF monoclonal antibodies have moved into the first-line discussion for canine OA pain. In that study, investigators reported that bedinvetmab and meloxicam delivered comparable pain relief over 56 days, underscoring that clinicians increasingly have multiple evidence-backed paths to consider when building a plan. (frontiersin.org)

At the same time, safety oversight has become a bigger part of those conversations. FDA says Librela was approved on May 5, 2023, for control of OA pain in dogs, and later completed an evaluation of reported adverse events that included ataxia, seizures, paresis, recumbency, urinary incontinence, polyuria, and polydipsia, with death or euthanasia reported in some cases. In response, safety-related labeling changes dated February 18, 2025, added post-approval adverse reactions, directed veterinarians to provide and discuss a client information sheet before each injection, and advised clinics to discuss a return-to-activity plan for dogs that may become more active once pain is controlled. (fda.gov)

That context makes Downing’s practical framing especially timely. Her long-standing public commentary on OA has consistently pushed a multimodal model that combines analgesics with weight control, controlled exercise, rehabilitation, nutrition, and home-environment changes, rather than expecting any single therapy to carry the whole case. Other educational materials featuring Downing make the same point directly: OA care works best when veterinarians target pain from several angles and tailor the plan to the patient’s comorbidities, function, and pet parent capacity. (vcahospitals.com)

Why it matters: For veterinary teams, the real operational challenge is no longer whether OA deserves treatment, but how to deliver treatment consistently, safely, and in a way pet parents can follow. This means building repeatable workflows for pain screening, setting expectations that OA is progressive and requires reassessment, and documenting response to therapy over time. It also means being explicit about tradeoffs. As more clinics use biologics alongside traditional NSAIDs and adjunctive therapies, informed consent, adverse-event reporting, and activity counseling are becoming core parts of OA management, not side conversations. (aaha.org)

There’s also a business and retention angle for practice leaders. Multimodal OA care often creates more touchpoints, including rechecks, rehab referrals, nutritional counseling, and long-term monitoring, but it also asks more of the care team in communication and follow-through. Practices that can clearly explain why a dog may need layered therapy, and why improvement in comfort doesn’t eliminate the need for monitoring, may be better positioned to keep pet parents engaged and avoid disappointment when a single intervention doesn’t solve a chronic disease. This is an inference based on the guideline emphasis on team-based pain care and the FDA’s newer communication requirements. (aaha.org)

What to watch: The next phase of the OA conversation will likely center on protocol refinement, not just product adoption, as clinics absorb post-market safety lessons, compare newer agents against older standards, and look for practical ways to measure response in real-world patients over months, not weeks. More label updates, post-approval data releases, and comparative studies could further shape how veterinarians sequence NSAIDs, anti-NGF therapies, rehab, and supportive care in 2026. (fda.gov)