Needles and pins

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Like many of the treatment options available to veterinarians, CAVM has crossed over into animal medicine from the human medical field.
Like many of the treatment options available to veterinarians, CAVM has crossed over into animal medicine from the human medical field.

While alternative therapies remain controversial within the profession, more and more practitioners and pet owners are exploring what’s involved. By Dr Deepa Gopinath

It is hard to imagine that the family labrador would sit still while pins are inserted into his skin until he resembles a large and fluffy echidna. Yet, according to Dr Mark Hocking, the traditional Chinese practice of acupuncture is very well-tolerated by canine and feline patients. Acupuncture is among a group of therapies known collectively as complementary and alternative veterinary medicine (CAVM). CAVM encompasses a range of non-conventional therapies including acupuncture, trigger point (TP) therapy, massage, homeopathy, physiotherapy, Chinese herbal medicine and reiki, as examples. Like many of the treatment options available to veterinarians, CAVM has crossed over into animal medicine from the human medical field.

The Australian Bureau of Statistics found that the number of people who consulted a complementary health therapist increased by almost 50 per cent in the 10 years between 1995 and 2005. Likewise, CAVM seems to be a growing field, somewhat controversially, with more pet owners seeking non-conventional therapies for their pets. The majority of CAVM practitioners are qualified veterinarians who also practise conventional veterinary medicine and surgery.

“I feel there is still an unfortunate level of scepticism and fear of change within the profession with regards to CAVM.” Dr Saranyu Pearson, president, IVA

Dr Hocking is one of two veterinarians at Gladesville Veterinary Hospital in Sydney who use a combination of conventional veterinary medicine and the complementary therapies of acupuncture and TP therapy to treat animal disease. According to the theory of traditional Chinese medicine, acupuncture stimulates points on the skin to correct imbalances in flow of energy (Qi) along energy meridians. Dr Hocking explains: “Trigger points are localised, tender areas of contracture that can develop in any skeletal muscle. These areas are hypoxic, acidic and contain an above-normal concentration of inflammatory mediators which in turn cause sensitisation of peripheral nerve endings.” He uses a TENS (Transcutaneous Electrical Nerve Stimulator) to elicit local muscle twitching, followed by stretching, to relieve TPs.

While many acupuncturists subscribe to the traditional Chinese theories, Dr Hocking seeks a more scientific basis for the effects of acupuncture, and suspects that there is a significant overlap between acupuncture points and trigger points. He frequently uses TP therapy for adjunctive treatment of musculoskeletal pain, lameness and reduced function. Over the years, Dr Hocking has also seen some bizarre effects of TP therapy, such as reduced urinary incontinence and resolution of vomiting. When it comes to acupuncture, many acupuncturists employ the practice to treat disease of almost any of the body systems, but Dr Hocking uses it most for painful musculoskeletal conditions.

“There is an increased awareness among pet owners that veterinary options for safe and effective natural health practices exist,” says Dr Saranyu Pearson, president of Integrative Veterinarians Australia (IVA), a special interest group of the Australian Veterinary Association (AVA). The Geelong-based classical homeopath has seen a steady rise in numbers of clients who are seeking natural therapies for their pets over the past few years. She speculates that, “The very people who are increasingly employing complementary and alternative health solutions for themselves are seeking similar options for their pets.”

In some cases, pet owners seek non-conventional treatments because they feel that conventional treatments have not adequately treated certain conditions in their pets. Dr Pearson’s interest in the field was born of a similar frustration at the refractory nature of some chronic pet diseases to conventional treatment.

“There was some conflict initially between what I had been taught at university and my interest in homeopathy, but this is the only way I choose to practise now,” Dr Pearson says. “I feel there is still an unfortunate level of scepticism and fear of change within the profession with regards to CAVM.”

Undoubtedly, some members of the veterinary profession are more hesitant regarding the use of CAVM. In a 2012 statement titled ‘Ineffective Therapies’ published on the AVA’s website, the association’s then-president Dr Ben Gardiner cautioned that many animal treatments are extrapolated from those used in the human field. Given the recognised placebo effect in humans, this is a concern when it comes to CAVM.

Furthermore, a resolution passed by the Board says that, “The Board agreed that the veterinary therapies of homeopathy and homeotoxicology are considered ineffective therapies… Thus, these ineffective therapies cannot be the subject of AVA continuing professional development activities, nor will they be promoted in AVA publications.” The AVA goes on to warn that nutritional supplements and botanicals are often not subject to the rigorous pre-marketing evaluation that conventional medicines are. However, the organisation does support a Veterinary Acupuncture special interest group in addition to the IVA, and is clear that it does not reject any modality of therapy.

Dr Tanya Stephens, a Sydney-based small animal practitioner and veterinary ethicist, has long been an advocate of encouraging veterinarians to adhere to what is considered ‘evidence-based medicine’ (EBM). With respect to the more widely used CAVM modalities of acupuncture and homeopathy, she maintains that the lack of scientific support decidedly removes them from the EBM category.

“As we are veterinary scientists, there is an expectation by society that what we do is based on scientific evidence,” Dr Stephens says. “The use of CAVM, with its lack of scientific evidence, is an animal welfare and ethics issue.” She has most recently discussed this in her article titled ‘Needless Treatment of Pets’ in Australasian Science magazine.

However, Dr Pearson argues that the concept of EBM was developed in the laboratory setting in the ’80s, and as such rarely translates well to clinical practice. Hardly any of the conventionally used therapies or techniques in vet medicine fit the original definition of EBM and thus the argument against CAVM is flawed.

There are certainly difficulties associated with running clinical trials in veterinary medicine. Low patient numbers, difficulty in interpreting patient responses and poor compliance are among these challenges.

The challenges are probably even more relevant to CAVM related studies than to those involving conventional treatments. So it may be only a matter of time before certain treatments are proven useful. After all, there are several plant-derived medications that may have originally been considered herbal medicine, the pesticide pyrethrin and the cardiac drug digoxin as examples.

As for Dr Hocking, while he administers acupuncture and TP therapy, and regularly teaches workshops in TP therapy, his roots lie firmly in what the industry currently considers to be EBM. He employs acupuncture and TP therapy as a supplemental component of a treatment regime that prioritises conventional medicine. “My hope is that we can develop a base of robust scientific evidence to support certain forms of CAVM in the future,” says Dr Hocking. “But I will always be a conventional vet first.”

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