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Pain Management

Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture.

Summary:

To evaluate pain intensity and kinetic variables in dogs with hip dysplasia (HD) treated with acupuncture, carprofen, or a placebo.

Conclusion:

Neither acupuncture nor carprofen was significantly different from placebo. Acupuncture and carprofen reduced the degree of subjectively evaluated lameness, and acupuncture was associated with a decrease in validated chronic pain scores.

Author & Journal:Teixeira LR, et al, J Am Vet Med Assoc 249(9):1031-1039, 2016
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Effects of treatment with polysulfated glycosaminoglycan on serum cartilage oligomeric matrix protein and C-reactive protein concentrations, serum matrix metalloproteinase-2 and -9 activities, and lameness in dogs with osteoarthritis.

Summary:

To investigate the effects of polysulfated glycosaminoglycan (PSGAG) treatment on serum cartilage oligomeric matrix protein (COMP) concentration, matrix metal-loproteinase-2 (MMP-2) and -9 (MMP-9) activities, C-reactive protein (CRP) concentration, and lameness scores in dogs with osteoarthritis.

Conclusion:

IM administration of PSGAG inhibited COMP degradation in dogs with osteoarthritis. Results indicate that decreases in serum COMP concentrations might be related to improvement in lameness after PSGAG treatment.

Author & Journal:Fujiki M, et al, Am J Vet Res 2007;68:827–833
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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
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Long-term treatment with carprofen of 805 dogs with osteoarthritis.

Summary:

The pain-relieving effect of carprofen and tolerance to the drug were investigated in 805 dogs that were lame as a result of osteoarthritis. The dogs were of different breeds, ages and bodyweights and of both sexes, and were selected from 51 veterinary clinics. Each dog was treated orally by its owner with 4 mg/kg carprofen for 84 consecutive days.

Conclusion:

Twenty-four dogs were removed from the study because of side effects, and 55 left the study for reasons unrelated to the treatment. The condition of the dogs and the benefit of the treatmentwere evaluated by the veterinary surgeons and the owners after 14 days, and at the end of the period of treatment, when 194 of the dogs (26.7 per cent) were no longer lame, and 357 (49.2 per cent) had improved. The period for which the dogs had been lame before entering the study significantly (P<0.01) affected the results and the rate of improvement. Too much exercise during the 84 days of treatment caused some dogs to relapse.

Author & Journal:Mansa S, et al, Vet Rec 2007;160:427-430
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Examination of synovial fluid and serum following intravenous injections of hyaluronan for the treatment of osteoarthritis in dogs.

Summary:

A randomized, blinded, prospective clinical trial was performed to determine the effects of intravenous (i.v.) administration of hyaluronan sodium (HA) on serum glycosaminoglycans (GAG) concentrations, synovial fluid (SF) hyaluronan concentrations and viscosity in dogs treated for unilateral rupture of the cranial cruciate ligament.

Conclusion:

Data were analyzed using a Wilcoxon sign rank test (p < 0.05). Mean +/- SD viscosity (cP) was significantly higher (p = 0.011) in SF obtained from the intact stifle (450 +/- 604.1) than injured (54.8 +/- 60.8) prior to surgery. Mean +/- SD HA concentrations (ug/ml) were significantly higher (p = 0.02) in synovial fluid obtained from the injured stifles (281.4 +/- 145.9) than intact stifles (141.6 +/- 132.5). No significant difference was noted within or between treatment groups in SF viscosity, HA concentrations, or serum GAG concentrations at any time following surgery. Stifles with cranial cruciate ligament insufficiency had significant alterations in SF viscosity and HA concentrations.

Author & Journal:Canapp SO, et al, Vet Comp Orthop Traumatol 2005;18:19-174
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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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