Pain Management

Opioids Out, Cannabis In Negotiating the Unknowns in Patient Care for Chronic Pain

Summary:

“Unless the nation develops an increased tolerance to chronic pain, reduction in opioid prescribing leaves a vacuum that will be filled with other therapies.” Consideration for the pharmacological, social and legal role of cannabis as an alternative for prescribing opioids.

Conclusion:

The prescribing of opioid therapy for chronic noncancer pain advanced unchecked until opioid-related adverse events and other consequences reached epic proportions. To ensure the medical community does not repeat this mistake with cannabis, physicians should balance the need to keep pace with the swiftly evolving cultural, social, and legal climate surrounding cannabis use for pain with the imperative to guide practice with sound science.

Author & Journal:Choo, Esther K. et al, JAMA, 2016

Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis.

Summary:

To investigate the effectiveness of tramadol for treatment of osteoarthritis in dogs.

Conclusion:

10 days of treatment with tramadol as administered (5 mg/kg, PO, q 8 h) provided no clinical benefit for dogs with osteoarthritis of the elbow or stifle joint.

Author & Journal:Budsberg SC, et al, J Am Vet Med Assoc 2018;252:427-432

Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: a randomized, double-blinded, multicenter, controlled trial.

Summary:

Autologous stem cell therapy in the field of regenerative veterinary medicine involves harvesting tissue, such as fat, from the patient, isolating the stem and regenerative cells, and administering the cells back to the patient. Autologous adipose-derived stem cell therapy has been commercially available since 2003, and the current study evaluated such therapy in dogs with chronic osteoarthritis of the hip.

Conclusion:

Dogs treated with adipose-derived stem cell therapy had significantly improved scores for lameness and the compiled scores for lameness, pain, and range of motion compared with control dogs. This is the first randomized, blinded, placebo-controlled clinical trial reporting on the effectiveness of stem cell therapy in dogs.

Author & Journal:Black LL, et al, Vet Therapeutics 2007

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

Summary:

The included pain management “guidelines continue the trend in all branches of medicine toward evidence-based consensus statements that address key issues in clinical practice. Although not a review article, this compilation is a force multiplier for the busy practitioner, consolidating in a single place current recommendations and insights from experts in pain management.”

Conclusion:

“Behavioral changes are the principal indicator of pain and its resolution, for which there are now several validated, clinical scoring instruments. Pain is not an isolated event but instead exists either as a continuum of causation, progression, and resolution or as a chronic condition. Thus treatment of pain should consist of a continuum of care in the form of anticipatory analgesia through the anticipated pain period followed by longer-term or even chronic treatment that relies on periodic reassessment of the patient’s response.”

Author & Journal:Epstein, Mark et al, Journal of the American Animal Hospital Association, 2016

Pharmacokinetics and pharmacodynamics of oral acetaminophen in combination with codeine in healthy Greyhound dogs.

Summary:

The purpose of this study was to determine the pharmacokinetic and antinociceptive effects of an acetaminophen/codeine combinationadministered orally to six healthy greyhounds.

Conclusion:

Further studies using different models (including clinical trials), different dog breeds, multiple dose regimens, and a range of dosages are needed prior to recommended use or concluding lack of efficacy for oral acetaminophen/codeine in dogs.

Author & Journal:KuKanich B., J Vet Pharmacol Ther 2016;39:514-517

Effect of intraarticular injection of autologous adipose-derived mesenchymal stem and regenerative cells on clinical signs of chronic osteoarthritis of the elbow joint in dogs.

Summary:

Autologous adipose-derived mesenchymal stem cell (AD-MSC) therapy involves harvesting fat from the patient, isolating the stem and regenerative cells, and administering the cells back to the patient. Autologous AD-MSC therapy in veterinary regenerative medicine has been commercially available since 2003. Previously reported results from a blinded, controlled trial in dogs with chronic osteoarthritis of the coxofemoral (hip) joint demonstrated efficacy of a single intraarticular injection of autologous AD-MSC therapy. The primary objective of the current study was to evaluate the effectiveness of this therapy in dogs with chronic osteoarthritis of the humeroradial (elbow) joints and to determine the duration of effect. Fourteen dogs were recruited. Veterinarians assessed each dog for lameness, pain on manipulation, range of motion, and functional disability using a numeric rating scale at baseline and specified intervals up to 180 days after treatment. Statistically significant improvement in outcome measures was demonstrated.

Author & Journal:Black LL, et al, Vet Therapeutics 2008

Outpatient Oral Analgesics in Dogs and Cats Beyond Nonsteroidal Anti-inflammatory Drugs

Summary:

This article evaluates the current literature on oral analgesics and analgesic adjuncts in dogs and cats. An overview of how dosing recommendations are made covering controlled clinical trials, experimental study design, and pharmacokinetic studies is included.

Conclusion:

The weight of evidence for each drug [Polysulfated glycosaminoglycans, Amantadine, Tramadol, Gabapentin, Pregabalin, Codeine, Hydrocodone, Amitriptyline, Venlafaxine, Duloxetine, Glucosamine and chondroitin, Morphine, Oxycodone, Methadone] is reviewed and compared with the gold standard, controlled clinical trials. Other evidence such as experimental studies, extrapolation of pharmacokinetic studies, and case reports/series is also considered.

Author & Journal:KuKanich, Butch, Veterinary Clinics of North America: Small Animal Practice, 2013

Pharmacokinetics of intravenous and oral amitriptyline and its active metabolite nortriptyline in Greyhound dogs.

Summary:

To evaluate the pharmacokinetics of amitriptyline and its active metabolite nortriptyline after intravenous (IV) and oralamitriptyline administration in healthy dogs.

Conclusion:

Amitriptyline at 4 mg kg(-1) administered orally produced low amitriptyline and nortriptylineplasma concentrations. This brings into question whether the currently recommended oral dose of amitriptyline (1-4 mg kg(-1)) is appropriate in dogs.

Author & Journal:Norkus C, et al, Vet Anaesth Analeg 2015;42:580-589

A prospective, randomized masked, and placebo-controlled efficacy study of intraarticular allogeneic adipose stem cells for the treatment of osteoarthritis in dogs

Summary:

This report describes a prospective, randomized, blinded, and placebo-controlled clinical efficacy study of intraarticular allogeneic adipose stem cells for the treatment of dogs with OA.

Conclusion:

The study’s primary objective was achieved and the data confirm that the target dose of allogeneic adipose-derived MSCs delivered intraarticularly to one or two joints was statistically significantly more effective than a placebo in reducing clinical signs of OA in dogs. Both veterinarians and dog owners evaluated stem cell-treated dogs as more often experiencing treatment success than placebo-treated dogs.

Author & Journal:Harman R, et al, Frontiers Vet Sci 2016

Assessing Chronic Pain In Dogs

Summary:

“Finding precise, reliable, and accurate measures of chronic pain in animals is a difficult effort. However, much research has gone into developing measurement methods to evaluate chronic pain in dogs (and, more recently, cats); this article reviews the pain scales currently available.”

Conclusion:

Details in linked article reviews the following pain scales: Helsinki Chronic Pain Index, Canine Brief Pain Index, Cincinnati Orthopedic Disability Index, Liverpool Osteoarthritis in Dogs.

Author & Journal:Epstein, Mark E., Today’s Veterinary Practice, 2013