Spondylosis and pain management: UPDATE acupuncture started

Does anyone have any experiencing of caring for a rabbit with this? Or just any general pain management tips?

Had some bad news from the vets this morning: Muppet has spondylosis in his neck vertebrae (and just possibly in his lumbar vertebrae too). [There are no spaces in the vertebrae so they cause pain.] This explains why he’s been reluctant to eat or drink for the past 10 days or so, although clearly interested in food; we think it hurts for him to swallow. The vet says it’s inoperable – in as much that it’s a pretty rare operation in other animals and unheard of in rabbits and would cost several thousand pounds even if it was available. So, Muppet’s only hope is that painkillers manage his condition. If not, we have to see what quality of life he has and putting him to sleep could be the best option. That’s hard to contemplate…

If anyone has any positive experience of spondylosis, I’d be interested to know the ins and outs.

Similarly any advice about managing pain successfully would be great. We are trying a steroidal painkiller (not sure which one) as he was having metacam (non steroidal) twice a day and that didnt help enough.

Any what about alternative treatments – acupuncture? Massage?

[He's been fine since the vets appointment this morning. I really really hope this lasts.]

Spondylosis is a common finding in older bunnies - more so in lumbar vertebrae than cervical though. It is a fusion of the bony processes under the vertebrae so reduced flexibility of the spine results where it occurs. It shouldn't be markedly painful unless associated with trauma, infectious disease or inflammatory processes - most elderly buns we Xray have some degree of spondylosis and typically don't have any syptoms associated with it. Perhaps your vet could see further changes suggesting inflammation in that area.
Non-steroidal anti-inflammatories are the first line approach, as you've already tried (in fact the active ingredient in metacam is used in humans for bony pain and considered one of the best) and I would be concerned that there is no improvement at all. Steroids are more potent short-term anti-inflammatories but are not recommended for long-term use due to side effects in rabbits. There are other more specific medications for neurological pain that would be worth trying if no improvement is seen.
I would suggest ruling out all other possible problems as well, especially dental disease, before considering putting him to sleep.
Marie

Thanks Marie.

It shouldn't be markedly painful unless associated with trauma, infectious disease or inflammatory processes - most elderly buns we Xray have some degree of spondylosis and typically don't have any syptoms associated with it. Perhaps your vet could see further changes suggesting inflammation in that area.

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Muppet isnt old - only 3.5 years. The metacam helped, in that he mostly seemed OK - quieter than usual - but was occcasionally in obvious discomfort. (Me syringe feeding him probably didnt help with his neck pain ) But the metacam didnt help enough that he wanted to eat unaided - at best I've been able to get him to eat by prodding him with veg every hour or so. I think the problem is that the pain may not be great, but it's enough for him to not want to eat.

I would suggest ruling out all other possible problems as well, especially dental disease

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His teeth were the first thing that the vet looked at when we first saw him on Monday - Muppet had some tiny spurs which the vet dealt with under general anaesthetic. On Tuesday Muppet seemed almost completely back to normal (only difference was that he took the whole evening to eat 5g of pellets), so we hoped that was the answer. Then on Wednesday he was worse[\b] than he was when I realised he wasnt well in the first place. I asked about root problems today, since the vet did full xrays. The vet said they were OK (not brilliant but shouldnt be causing any problems). What other sorts of dental disease should we look for?

Vet took his temperature on Weds (or Thurs) and it was normal, so he ruled out any other infection. Should I be requesting blood tests?

Steroids are more potent short-term anti-inflammatories but are not recommended for long-term use due to side effects in rabbits. There are other more specific medications for neurological pain that would be worth trying if no improvement is seen.

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Yes, the vet said that about the steroids which is part of my concern. If you have any suggestions I could raise with him, that'd be great. He seems knowledgeable and helpful.

My bunny Hazel was diagnosed with spondylosis when she was around 2 yrs old (guestimate as she was a rescue). The vet said it was probably becasue she had been kept in too small a cage when she was a little bun.
She was being investigated for a mucky bum which was a problem over the years. We got it under control with metacam (she was able to clean her own bum) but over the years had to give her increasing amounts of metacam til she was on her maximum dose which was 2x0.5 a day - she was about 2kg something. She was on metacam for about 5 years til she died of cancer of the caecum.

It sounds bad that your bunny doesn't want to eat by himself. Maybe the pain killers take a while to take effect and reduce inflammation. I know vets do have stronger pain killers they can give rabbits but they may need to inject them into veins or they are opiates which they are not allowed to give out freely obviously!

Thanks I feel a bit less desperate today, it's good to know we dont have to give up yet and that it's possible to give him a good life. And he's obviously feeling MUCH better (binkying in the snow, bless) although he's still not eating as much/well as I would like. I'm still concerned - can this last? can we find a suitable drug for long term use?

Muppet weighs 1.7kg and was having 0.5ml of metacam twice a day which wasnt enough. Though maybe as you say it needs to 'build up'. The painkiller the vet gave him yesterday was by injection and is supposed to last him til at least tomorrow morning (so far so good...) but if it's not suitable for long term use then we're not out of the woods yet.

Definitely carry on trying to get him eating as much as possible, lots of treats and fuss! The last thing you need is for him to develop stasis so he needs as much food going through as you can get him to take. Hopefully you can avoid syringe feeding him if he's taking food willingly.
Also make sure he has water there all the time as the steroids can make them drink and wee more.
I'm glad your vet has done a complete dental investigation, that helps rule out a lot of other potential causes. Sometimes with dental disease, even if it is all corrected with dental work, they can remain sore afterwards. I'm sure if I had to chew differently or contort my face a bit to avoid spikes I'd use muscles I wasn't meant to and it would take a little while for them to fully recover. With mildly overgrown roots, unless there is infection there, the first step of treatment is exactly what you're doing - pain relief and keeping a close eye on his appetite.
A raised temperature is not always seen in infections - bunnies will often become metabolically challenged when unwell and can become hypothermic quickly, countering the fever effects of an infection. Chronic infections also don't give classic fevers. If he isn't improving then blood tests would be sensible as these will show how many of each type of immune cell are present and give a lot more information on possible infections, and also help check how all his systems are functioning.
The spondylosis will have taken a while to develop - bones change slowly, so this is not a sudden appearance. It is likely that any spondylitic pain is due to an acute change in it - whether he's tried to do too much and hurt himself, had a knock or arthritic changes have developed. Considering this then the outlook isn't so bad - the new development is likely to settle down with pain relief, limited activity and time and he will always have the spondylosis but it shouldn't give more symptoms than it has prior to this episode unless something happens to make it flare up again. I hope that makes sense, I'm a little sleep deprived this week and may not be able to transfer what's in my head to the screen!
See what response he has to the steroids - they are potentially more aggresive than the metacam so may give a better response, but longer term treatment would be low-dose non-steroidals (if metacam isn't giving great effects then there are others within this class of medications), and oral opiates are available for pain relief but don't reduce inflammation. There are also other less common medications for neurological pain if this is considered a factor but this doesn't sound like the case for him.
Keep him warm and try everything you can to keep him eating. See how he responds to gentle massage of the area or heat application as this can help relieve muscular spasms/localised pain.
Marie

Thanks Marie - makes perfect sense and I appreciate your help

Just a quick update - Muppet's more or less OK on his dexamethosone but I've booked him in to try acupuncture on Thursday morning. I think it'll be really interesting (and hopefully bl**dy effective) so I'm looking forward to it.

Hiya

I didn't see your original post, but thought I would add a little now. My bunny Nibbler was presenting with back leg weakness and loss of litter tray habits at the beginning of December.

We started him on Metacam straight away but he wasn't improving. We had XRays taken which showed a calcification in between the vertebra - they were also shown to an orthopeadic specialist who noticed some inflammation at the edges of the vertebra. So, we treated for infection causing the inflammation also.

I'm very happy to report that Nibbler is back his old self again! He has a small amount of "lag" in one leg, but we think thats always going to be there now.

Hope your bunny enjoys his acupuncture! Does he still show signs of pain??

All stories welcome - especially ones with happy endings! What treatment did Nibbler have for the inflammation? I think this is something which we should be considering.

Muppet still shows some signs of pain - mainly that he wont eat his pellets in the mornings. I give him veg instead and some mornings he's slower to eat this than others (very slow on Friday, OK over the weekend, pretty good today). He does noticeably improve during the day interestingly but I'm not sure why. By mid afternoon he'll nibble on pellets (I put them out as a test to see...) and generally will eat his teatime pellets at 6pm. He's happily chomping on hay as I type.

On the whole he's quite cheerful in himself, a bit more languid than usual. Even on slow-eating-mornings, he's keen to get out into the garden for a roam/chase the birds.

We used "just" Baytril, but a 3-4 week course. Apparantly its notoriously difficult to treat, so needed a long course, and possibly different abx. but seemed to work for Nibbler.

Vets have said to keep an eye on him (of course!) as it could re-occur, but he is back to binkying - although I do try to restrict this and build his exercise up slowly. I forgot to mention he was on cage rest for 3ish weeks.....

Three weeks cage rest! Bet that made you popular :lol: I've stopped him going out after dark as it's colder (just in case the cold sets him off - that could be why he's worse in the mornings :? - and it all started during that very very cold spell). It's different with it being in his neck of course.

There are other things different about his behaviour but I'm not sure whether to ascribe them to the spondylosis or the dexamethosone (or even whether they're important). Mainly he seems well enough.

Will enquire about treating the inflammation I think - the steroids alone havent 'cured' him (although it's only been 10 days. But I'm impatient!!!)

It's good to know Nibbler's made a good recovery

Update: first acupuncture treatment

Muppet had his first acupuncture treatment this morning I was worried he wouldnt stay still long enough for the vet to make him into a pin cushion but he was actually pretty good.

She works from home so it not being a 'surgery' helped him be less nervous (he's been to other people's houses before). Also she was happy to treat him on the floor (I warned her he would take a flier from the table) and her floors are laminate/rugs so, just like home, he wanted to stay on the rug anyway She put half a dozen or so needles on him and left them there for 15-20 mins (we let him go back in his carrier during that time). Mind you, the first needle was for calming.

There might not be any immediate benefits (or indeed none at all) so he'll need a few more treatments before we can say for sure. But this first one went well and he wasnt distressed by it, so I'm happy to keep going. Next one is in 10 days time.

Hmmmm.Acupuncture worked for me!!

However,having discovered my 2 related bunnies have this condition,at the ripe old age of 1 year..Born with it I presume, I can only say this is what we look forward to.
No pain..bouncing all over the place.Eating well,and the other end seems to be in working order too.My eyes are peeled.xx
Good luck with your fella.

Thank you

Marie said earlier in this thread:

It shouldn't be markedly painful unless associated with trauma, infectious disease or inflammatory processes - most elderly buns we Xray have some degree of spondylosis and typically don't have any syptoms associated with it.

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so you may be lucky and neither of them have major problems. I have no idea what triggered Muppet's: the only theory I have is the major cold spell we had over Christmas and that's only a theory :? I suspect the syringe feeding (when he wasnt eating but before he was diagnosed) wont have helped as he struggles so much, it was bound to have hurt his neck.

Acupuncture photos

Pictures of Muppet having acupuncture, if anyone's interested

http://forums.rabbitrehome.org.uk/showthread.php?t=216120