Bedinvetmab, alone or in combination with photobiomodulation and pulsed electromagnetic field therapy, on pain and quality of life in dogs with hip osteoarthritis

Osteoarthritis (OA) represents one of the leading causes of chronic pain in dogs, particularly in elderly animals (Neagu et al. 2023). It is a progressive and degenerative condition characterized by articular cartilage degradation, inflammatory responses and chronic pain, leading to biomechanical limitation and progressive loss of function (Szponder et al. 2022). OA can be classified as primary, usually idiopathic and associated with age and obesity, or as secondary, the most common form, resulting from joint injuries and dysplasias. Genetic predisposition, inadequate diet and sedentary lifestyle may act as contributing factors (Anderson et al. 2020).

In the United Kingdom, an annual prevalence of 2.5% has been reported, equating to around 200.000 cases per year. Moreover, the condition affects approximately 11.4% of the lifespan of affected dogs, with direct repercussions on their quality of life (Anderson et al. 2018). It is noteworthy that recent prevalence estimates may be underestimated due to limitations in reporting methods. These include dogs that did not receive veterinary care, absence of a formal OA diagnosis, and incomplete data recording by veterinarians (Anderson et al. 2020). In a cohort of 500 dogs screened using an owner‑reported osteoarthritis checklist, 38% were clinically confirmed to have OA, indicating that a substantial number of cases might otherwise remain undetected and unreported in routine practice (Wright et al. 2022). Chronic pain invariably interferes with mobility, posture, quality of life, sleep, and social interactions (Lascelles et al. 2019). Nonetheless, it is often underestimated and regarded as a natural consequence of aging (Monteiro et al. 2023). Early signs of OA in dogs are generally subtle and progressive, reinforcing the importance of regular pain assessment by veterinarians and the involvement of caregivers in detecting behavioral changes at home (Belshaw et al. 2020).

From the owner’s perspective, treatment is considered effective when it is readily available, easy to administer, fits into daily routines, and requires less frequent dosing. When these criteria are not met, caregivers may avoid or discontinue treatment, underscoring the importance of effective and practical pain management strategies (Gildea et al. 2024). In contrast, inadequate management may lead to systemic complications, caregiver emotional burden, and, consequently, euthanasia (Spitznagel et al. 2022), which is common in cases of chronic pain and degenerative diseases (Mota Rojas et al. 2023). Collaborative follow-up between veterinarians and caregivers facilitates the adaptation of therapeutic strategies, slowing disease progression and improving quality of life (Belshaw et al. 2020).

Over the last decade, several advances have expanded the pharmacological treatment options available for dogs with OA, including non-steroidal anti-inflammatory drugs (NSAIDs), piprants, monoclonal antibodies, adjunctive analgesics, structure-modifying OA drugs, and regenerative therapies (Pye et al. 2022). NSAIDs remain widely used as a standard treatment for pain management in dogs with OA. However, despite their well-established efficacy, long-term administration is associated with clinically relevant adverse effects, and analgesic response is often insufficient when these drugs are used as monotherapy (Lascelles et al. 2005; Enomoto et al. 2019; Corral et al. 2021).

Among available therapeutic options, the caninized monoclonal antibody (mAb) bedinvetmab has emerged as an important approach for the management of osteoarthritis-related pain in dogs (Enomoto et al. 2019; Lascelles et al. 2019; Reid et al. 2024; della Rocca et al. 2025) Bedinvetmab acts by inhibiting nerve growth factor (NGF), thereby interrupting NGF/TrkA signaling involved in the development and maintenance of chronic pain (Enomoto et al. 2019; Lascelles et al. 2019). Clinical studies have demonstrated significant analgesic efficacy and functional improvement in dogs with OA treated with bedinvetmab (Corral et al. 2021; Michels et al. 2023), with a favorable safety profile when compared with traditional NSAIDs (Enomoto et al. 2019).

Given the complexity of chronic pain pathophysiology, OA management should be based on a multimodal approach that integrates pharmacological and non-pharmacological strategies, aiming at pain reduction, preservation of joint function, and improvement of quality of life. Current guidelines and reviews consistently emphasize that effective OA management requires combining analgesia with weight control, nutritional strategies, and structured physical rehabilitation (Gruen et al. 2022; Mosley et al. 2022; Cachon et al. 2023). Core components of multimodal care include body weight management, supplementation with fatty acids such as omega-3, adapted physical exercise, and physiotherapeutic modalities. These modalities encompass therapeutic exercise, hydrotherapy, photobiomodulation therapy, and electromagnetic field therapy, which are increasingly incorporated into comprehensive OA treatment plans (Mille et al. 2023; Monteiro et al. 2023; Pye et al. 2024).

Among physiotherapeutic modalities, photobiomodulation therapy (PBM), when applied to arthritic joints, has been reported to reduce pro-inflammatory mediators, improve tissue oxygenation, and stimulate mitochondrial activity, which may contribute to tissue repair and analgesia (Hamblin, 2019). PBM may also decrease inflammatory cells in synovial fluid and modulate bradykinin receptors, attenuating nociceptive sensitivity (Bortone et al. 2008). In canine OA, PBM has been investigated as an adjunctive modality, with clinical studies reporting reductions in pain and improvements in mobility and functional outcomes (Looney et al. 2018; Alves et al. 2022; Barale et al. 2022). In addition, evidence from in vitro and in vivo studies suggests that PBM may modulate inflammatory pathways and cellular processes involved in OA, reinforcing its biological plausibility in musculoskeletal disorders, although clinical effects remain protocol-dependent and require further investigation (Kunimatsu et al. 2025).

Pulsed electromagnetic field therapy (PEMF) has been explored as a non-pharmacological modality capable of influencing bioelectrical and cellular processes. Experimental and translational studies indicate that PEMF may modulate inflammatory signaling pathways and cartilage metabolism, although the underlying mechanisms remain incompletely understood (Yang et al. 2020). At the cellular level, experimental models suggest that PEMF may influence chondrocyte activity and extracellular matrix metabolism, contributing to its proposed disease-modifying potential (Yang et al. 2020). Analgesic effects associated with PEMF have been reported in experimental and clinical contexts and are hypothesized to involve modulation of nociceptive signaling, potentially through effects on ion channel activity and neuronal excitability (Rajalekshmi and Agrawal 2024). In veterinary medicine, PEMF has been investigated as a standalone intervention in dogs with hip OA, with preliminary clinical studies describing pain-related improvements following treatment (Kühl et al. 2025; Šutalo et al. 2025). However, available evidence remains limited, and direct mechanistic data in canine OA are scarce. Systematic reviews and clinical studies in human OA have also reported reductions in pain and functional improvement following PEMF therapy, supporting its potential relevance as an adjunctive modality, although protocols and outcomes remain heterogeneous (Cianni et al. 2024).

To the authors knowledge, there are no studies associating PBM and PEMF therapies in dogs with hip OA. Thus, while PBM exerts direct photobiological effects on metabolic and inflammatory processes, PEMF induces electromagnetic alterations capable of modulating the inflammatory and structural response of cartilage. Considering that bedinvetmab blocks NGF/TrkA signaling and interrupts pain transmission (Enomoto et al. 2019), the combination of these modalities provides distinct and complementary mechanisms: blockade of the nociceptive pathway, modulation of inflammation, and stimulation of tissue repair.

In this context, the present study aims to evaluate whether the combination of PBM and PEMF enhances the analgesic effects of bedinvetmab and improves quality of life in dogs with OA compared with the monoclonal antibody alone.