Old treatments not to forget:

• ICE
• HA/triamcinolone joint injections
• Liposomal encapsulation:
• Bupivacaine: Nocita (Exparel) - 72 hour duration labelled for stifle surgery in dogs
• Look for future drugs using CO₂ lasers to move liposomally encapsulated hydrophilic drugs transcutanously. Transcutaneous drug delivery by liposomes using fractional laser technology. Fujimoto T1,2, Wang J2, Baba K2, et al. Lasers Surg Med. 2016 Dec 19.
• Prostaglandni EP4 receptor antagonist: Grapiprant (Galliprant)
• lmmunotherapies: Monoclonal antibodies (mAb) are a growing field. Zoetis recently acquired Nexvet.
  • Ranevetmab, a mAb targeting nerve-growth factor (NGF) for treatment of chronic pain associated with osteoarthritis in dogs . Administered monthly by inject ion for chronic pain.
  • Frunevetmab, a monoclonal antibody targeting NGF to treat chronic pain associated with osteoarthritis in cats.
  • Cytopoint™ was licensed in the U.S. in December 2016 to control the clinical signs such as itching associated with atopic dermatitis in dogs.
• Resinferatoxin: Selective c-fiber destruction
  • lntrathecal, intra-vesicular, intra-articular (probably not topical)
  • Resiniferatoxin: The Evolution of the “molecular  scalpel” for chronic pain relief.
• Brown DC. Pharmaceuticals (Basel). 2016 Aug 11;9(3).
• Cannabinoids: Okay - not new; however, a lot of research and understanding is new.
  • CBD-THC interactions
  • A runner’s high depends on cannabinoid receptors in mice. Fuss J, Steinle J, Bindila L, et al. Proc Natl Acad Sci U S A. 2015 Oct 20;112(42).
• Non-drugs: Segue to exercise
  • Physical medicine - analgesic and neuro-restorative
  • American College of Physicians: Treatment recommendations include massage, acupuncture, spinal manipulation, tai chi, and yoga. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Qaseem A, Wilt TJ, McLean RM, Forciea MA. For the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2017;166:514–530. doi:10.7326/M16-2367.
• Regenerative medicine:
• Things in inject:
  • ACP, platelet rich plasma, IRAP
  • Stem cells, Adipose stromal vascular fraction (SVF) or bone-marrow derived
  • Allogenic vs. autologous
• Tools thought to induce stem cells:
• Extra-corporeal shock wave therapy
• Hyperbaric oxygen chambers