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Pain Medications

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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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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Amantadine in a Multimodal Analgesic Regimen for Alleviation of Refractory Osteoarthritis Pain in Dogs

Summary:

“Nonsteroidal anti-inflammatory drugs (NSAIDs) do not always provide sufficient pain relief in dogs with osteoarthritis (OA). Hypothesis: The use of amantadine in addition to NSAID therapy will provide improved pain relief when compared with the use of nonsteroidal analgesics alone in naturally occurring OA in dogs.”

Conclusion:

“In dogs with osteoarthritic pain refractory to an NSAID, physical activity is improved by the addition of amantadine. Amantadine might be a useful adjunct therapy for the clinical management of canine osteoarthritic pain.”

Author & Journal:Lascelles, B.D. et al, Journal of Veterinary Internal Medicine, 2008
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Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs

Summary:

“The objectives of this study were to determine basic oral pharmacokinetics, and assess safety and analgesic efficacy of a cannabidiol (CBD) based oil in dogs with osteoarthritis (OA).”

Conclusion:

“Pharmacokinetics revealed an elimination half-life of 4.2 h at both doses and no observable side effects. Clinically, canine brief pain inventory and Hudson activity scores showed a significant decrease in pain and increase in activity (p < 0.01) with CBD oil. Veterinary assessment showed decreased pain during CBD treatment (p < 0.02). No side effects were reported by owners, however, serum chemistry showed an increase in alkaline phosphatase during CBD treatment (p < 0.01).”

Author & Journal:Gamble, Lauri-Jo et al, Frontiers in Veterinary Science, 2018
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