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Pain Management

Perforated peptic ulcer and short-term mortality among tramadol users.

Summary:

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Use of nonsteroidal anti-inflammatory drugs (NSAIDs) is a strong risk and prognostic factor for peptic ulcer perforation, and alternative analgesics are needed for high-risk patients. * Pain management guidelines propose tramadol as a treatment option for mild-to-moderate pain in patients at high risk of gastrointestinal side-effects, including pepticulcer disease. * Tramadol may mask symptoms of peptic ulcer complications, yet tramadol’s effect on peptic ulcer prognosis is unknown.

WHAT THIS STUDY ADDS:  In this population-based study of 1271 patients hospitalized with peptic ulcer perforation, tramadol appeared to increase mortality at least as much as NSAIDs. * Among users of tramadol, alone or in combination with NSAIDs, adjusted 30-day mortality rate ratios were 2.02 [9

Conclusion:

Among patients hospitalized for perforated peptic ulcer, tramadol appears to increase mortality at a level comparable to NSAIDs.

Author & Journal:Torring ML, et al, Br J Clin Pharmacol 2007;65:565-572
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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
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Nonsteroidal antiinflammatory drugs: a review.

Summary:

The increasing use of nonsteroidal antiinflammatory drugs (NSAIDs) in small animals has resulted in the development of new and innovative additions to this class of drugs. Examples of NSAIDs now available for use in small animals include aspirin, etodolac, carprofen, ketoprofen, meloxicam, deracoxib, and tepoxalin.

Conclusion:

The purposes of this article are to review the pathophysiology of prostaglandin synthesis and inhibition, the mechanisms of action, pharmacokinetics, pharmacological effects, and potential adverse reactions of aspirin and the newly released NSAIDs.

Author & Journal:Curry SL, et al, J Am Anim Hosp Assoc 2005; 41:298-309
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Effect of intraarticular hyaluronan injection on synovial fluid hyaluronan in the early stage of canine post-traumatic osteoarthritis.

Summary:

To determine how the quantity and molecular weight of synovial fluid hyaluronan (HA) within the synovial fluid (SF) of osteoarthritis (OA) joints is affected by intraarticular injection of HA.

Conclusion:

Intraarticular injection of HA did not alter the volume of SF or molecular weight of HA in SF of OA canine knees, nor did it restore the HA concentration to that of normal canine SF.

Author & Journal:Smith GN, et al, J Rheumatol 2001;28:1341-1346
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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
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A randomized controlled trial of the efficacy of autologous platelet therapy for the treatment of osteoarthritis in dogs.

Summary:

To determine efficacy of a single intra-articular injection of an autologous platelet concentrate for treatment of osteoarthritis in dogs.

Conclusion:

Results suggested that a single intra-articular injection of autologous platelets resulted in significant improvements at 12 weeks in dogs with osteoarthritis involving a single joint.

Author & Journal:Fahie MA, et al, J Am Vet Med Assoc 2013;243:1291-1297
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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
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Systematic review of nonsteroidal anti-inflammatory drug-induced adverse effects in dogs.

Summary:

The aim of this systematic review was to identify, assess, and critically evaluate the quality of evidence of nonsteroidal anti-inflammatorydrug (NSAID)-induced adverse effects in dogs.

Conclusion:

A high strength of evidence existed for carprofen, firocoxib, and meloxicam; moderate for deracoxib, ketoprofen, and robenacoxib; and low for etodolac. Quality and consistency rating were as follows: carprofen (***/***), deracoxib (**/***), etodolac (*/unable to rate), firocoxib (***/**), ketoprofen (**/***), meloxicam (***/***), and robenacoxib (**/**), respectively. Adverse effects were detected in 35 studies (55%) and commonly included vomiting, diarrhea, and anorexia. Three studies (5%) reported a power analysis related to adverse effects of ≥80%. In randomized, placebo-controlled, blinded studies (n = 25, 39%), the incidence of adverse effects was not statistically different between treated and control dogs. Finally, most studies were not appropriately designed to determine the safety of NSAIDs, and involved a healthy nongeriatric population of research dogs.

Author & Journal:Monteiro-Steagall BP, et al, J Vet Intern Med 2013;27:1011-1019
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