Rethinking pain: Q&A with Richard Goldstein, DVM, DACVIM (SAIM), DECVIM-CA on preventive OA management

Richard Goldstein, DVM, DACVIM (SAIM), DECVIM-CA, is internationally recognized for his expertise in companion animal medicine. He currently serves as global chief medical officer at Zoetis. Before joining Zoetis, Goldstein was chief medical officer at the Stephen & Christine Schwarzman Animal Medical Center in New York, New York, the largest nonprofit animal hospital globally. He previously served as an associate professor of internal medicine at Cornell University College of Veterinary Medicine in Ithaca, New York, where his work focused on infectious, renal, and genetic diseases.

This interview has been edited and condensed for clarity.

dvm360: National Pet Wellness Month emphasizes prevention. How does osteoarthritis (OA) fit into the larger preventative care conversation for cats and dogs, especially considering many cases go undiagnosed until later stages?

Goldstein: That’s a really important question and important concept. Osteoarthritis is a disease that starts in young dogs, right? It starts subtly. It’s a disease that causes abnormal inflammation structure in the joint that then causes pain, and all of those things start young, right? Often, pet owners don’t pick up [on it] until dogs are older because they don’t pick [up on it] until it’s quite severe.

When you talk about prevention, which I think is wonderful, I think we can even expand that [to] wellness as well—prevention is part of an overall wellness program, so it includes seeing pets, dogs and cats, on a schedule, starting when they’re puppies and kittens, even if there’s nothing apparently wrong with them, right?

And then we prevent the things that we can from happening using vaccines and parasitizing. But we also try to do early detection. We try to pick up things early before there are clinical signs based on physical exams, based on blood work. In this case, maybe x-rays if there’s any question. And then we can start treating early. And there’s huge advantages to start treating early. So, I would say prevention is wonderful. Wellness as an overall package is even better, and that includes prevention and early detection and treatment.

dvm360: What are some of the most common barriers veterinarians face in identifying osteoarthritis early clinically and in communicating with clients about subtle signs of pain?

Goldstein: Again, I think part of it is just that mindset of wellness and prevention, right? I think pet owners—and many veterinarians—are still used to a if it’s not broken, don’t fix it kind of mentality, which means wait until it’s really late—until [the] dog and cat is showing obvious signs, and then bringing them to the vet. We need to change [to] that wellness mindset that we talked about before.

And then there’s a lot of education that has to happen, both of veterinarians and of pet owners, on how to detect osteoarthritis early. Dogs and cats are very good at hiding their clinical signs, right? They’re a lot closer to the wild than we are, so they’re not going to show [many] subtle signs, even though, if it was pain that we were feeling, we would want to take something for it, right? We wouldn’t want to be in that level of pain.

But [dogs and cats] still appear to be normal—they’ll chase a ball and catch a Frisbee despite being in pain. So, educating pet owners on what the early signs of pain are—don’t wait until they can’t go up the stairs. Look at how they get up. Look at how they’re sitting. Look at how they’re lying down. Look at how long it takes them to get up in the morning. Make videos of your dog when they’re normal, when they’re young and healthy, and then see how that progresses.

For cats, we have a checklist, a feline OA checklist that shows people things that you can look for to diagnose OA early. And those kinds of tools are really important.

Even for the veterinarian, it’s important. Many veterinarians didn’t learn this in vet school. Pain was often not a huge subject, even though part of our role as veterinarians and the oath we take is to manage pain.

So, education first and then just [having] the awareness that pain is a disease. We don’t want dogs to be in pain, even if it appears subtle, it’s probably not subtle to them.

And then the fact that we do have therapies today can alleviate that pain in an easy, convenient, kind of persistent way. I think that [conversations on] pain should be part of the discussion that clients have with a new puppy or kitten, just like nutrition and spay/neuter and vaccines.

Let’s talk about your dog’s or cat’s mobility. Look at how they can run around and wiggle today. Let’s make sure that they have that level of comfort for as long as they possibly can in their life. If there’s any change at all, let’s jump on it early and treat it.

dvm360: How common is osteoarthritis?

Goldstein: The number we have is 40%—it may be even higher for dogs because a lot of it goes undiagnosed, right? It is one of the most common and undiagnosed problems because people think their dogs are just getting older and they don’t bring them to the vet, and then maybe by the time they’re 8 or 9 or 10, there are other issues that need to be addressed as well. They might have metabolic diseases or other diseases, and then osteoarthritis kind of takes a backseat because there are more pressing issues, supposedly. So I think really, the timeframe to diagnose osteoarthritis is when [pets] are young and when it’s relatively less clinical, and then jump on it early and try to prevent that pain from getting worse down the road and before they have all these other issues that they’re going to get as they get older.

dvm360: Over the past few years, how would you say advances in pain management, including monoclonal antibodies, have changed the way veterinarians approach osteoarthritis earlier and maybe even more effectively?

Goldstein: Monoclonal antibodies [have] changed a lot of things. They’ve changed how we treat dermatologic disease, and now they’re changing how we treat pain. Traditionally, in veterinary medicine, again, [there was] this mindset of “if it’s not crazy severe, I’m not going to worry about it.” Back in the day, when I was in vet school, many veterinarians didn’t believe that pain was a thing, right? “They don’t really feel pain, we don’t have to worry about it.” Luckily, we’ve gone past that.

But today, still, many veterinarians treat pain as needed, right? There’s this concept of “if they’re having a bad day, give them a nonsteroidal anti-inflammatory (NSAID)” because people don’t want to use NSAIDs chronically, there are issues with that. It’s also inconvenient: it’s [taken] once or twice a day; it’s given as needed. And basically, what we’re saying is, “Your dog is going to have good days and bad days. When they have a bad day, give them something.” What we should be saying is, “We don’t want your dog to have good days and bad days. We want every day to be a good day.”

So, let’s make sure we have something on board that will alleviate pain chronically, even in the days where it’s not as obvious, because the things that are causing pain—the abnormalities in the joints—they’re there all the time. The pain is there all the time. So if [pets] are not showing it all the time in the same way, that doesn’t matter—they’re still feeling it all the time in the same way. So let’s make sure they’re not in pain at all.

Monoclonal antibodies, because they are canine-specific antibodies—they’re the same as the natural antibodies in the body—they’re really safe. They’re given once a month chronically, and they provide persistent, constant pain relief, not [having] the ups and downs of “I’m going to give a pill or not give a pill.” So, it’s really game-changing for how we can treat pain starting early on, and then persistently for the life of the dog or cat, or as long as they’re in pain. Again, our oath is—and I think every pet owner would agree—we don’t want them to be in pain at all.

dvm360: Beyond new therapies, what other developments in preventive medicine or technology excite you the most about the future of maintaining long-term mobility and comfort in pets?

Goldstein: It’s definitely an exciting area. It’s a great question because it’s an area I am and all of us are very passionate about. If we can help drive that transition into preventative medicine and wellness, just like your first question we started this conversation with today, that will really provide longer, healthier, happier lives with better quality of life for our patients.

Quality of life is really the key that everybody wants for their patients. And so, all these conversations that we’re having about providing tools for veterinarians to diagnose disease early and prevent disease fill that mission of longer and happier lives for pets. It’s shifting the mindset. it’s education for pet owners and veterinarians, it’s providing tools—like the ability to look at videos and make sure that they have the same mobility that they had when they were puppies and kittens.

And then education on what to do when you do find subtle signs—if you’re palpating a joint as a veterinarian and it feels a little bit uncomfortable, take an x-ray and then be able to convey the value of that diagnosis to the pet owner. You’re going to be asking for them to pay for an x-ray in a dog that they feel is relatively healthy. Why should they do that? Well, they should do that because if we do diagnose osteoarthritis and we treat it, we’re going to alleviate the pain now, and we’re going to prevent the pain from getting worse down the road. I think those tools and that mindset and that shift that we are driving in the industry is what excites me the most—making it into a wellness-first conversation versus “call me if there’s a problem.”