Chronic Pain Management

By: Mary Newell Sanders, DVM

TVMA Member
Bellville, TX

Published November 2015

Pain plays an important biological role in warning your pet of tissue damage, helping to prevent further harm. Left untreated, pain becomes detrimental, leading to stress, self-mutilation, immune compromise and eventual deterioration. Humans and animals share very similar pain pathways. Because dogs and cats cannot tell us where it hurts or why, it is important for us to recognize signs of pain in our pets and know which treatment options are available.

Osteoarthritis is the most common source of chronic pain in cats and dogs. Effective pain management requires an approach that impacts the pain pathway at multiple points and may require multiple medications and non-drug therapies.

Signs that your pet may be in pain include:

  • More time spent sleeping
  • Inappropriate urination and/or defecation
  • Poor coat from lack of self-grooming
  • Less interest in playing, jumping, climbing, etc.
  • Reduced appetite
  • Sudden sensitivity to a particular area of the body
  • Limping and/or lameness
  • Self-mutilation (e.g., licking, chewing, biting)
  • Vocalization
  • Change in attitude (e.g., hiding, aggression, excessive comfort seeking)

Osteoarthritis (OA) affects approximately 20 percent of our cat and dog population, and the incidence increases with age. In fact, 90 percent of cats over nine years of age show evidence of arthritis on X-rays.* Some breeds have a predilection for orthopedic issues and are thus more likely to develop OA. Working animals are also more likely to develop OA due to the increased wear and tear on their joints.

Weight Reduction and Joint Supplements

Weight reduction is a crucial part of pain management. All other therapies will work considerably better if your pet is not overweight. Weight loss may, in cases of minor OA, eliminate the need to use drugs to treat your pet’s pain. Pets with OA are often stiff after periods of inactivity but become more comfortable and “warm up” with exercise. Regular, controlled exercise helps maintain or build muscle mass to support joints, stimulates production of joint fluid and encourages weight loss.

Joint supplements are recommended for patients with OA. These supplements slow the progression of cartilage degradation and promote synthesis of joint fluid. Examples include glucosamine/chondroitin, hyaluronic acid and polysulfated glycosaminoglycans.

There are a number of different types of medications that your veterinarian may recommend if weight loss and joint supplements alone are not enough to control your pet’s pain. Your veterinarian will first want to do a complete physical exam and may recommend radiographs (X-rays) to diagnose the problem. They may also recommend bloodwork and urinalysis before starting any medical therapy.

Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key tool in managing pain associated with OA. There are a number of different NSAIDs on the market, and NSAIDs can be combined with a number of other pain medications. There is significant variability in individual response to NSAID therapy; the medication can have major side effects on the liver, kidney and GI tract.

It is important that you never administer any of these medications without consulting your veterinarian as they can be extremely toxic, even lethal, to dogs and cats. When administered in doses prescribed by your veterinarian, these medications can be an effective way to manage pain. It should be noted that risk for dependence and addiction of pain medications is not a problem in veterinary patients and should not be a concern.

Steroidal anti-inflammatory drugs (cortisone) can help reduce pain and inflammation temporarily but are typically not recommended long-term due to the number of adverse effects associated with chronic use. Steroids should never be given with NSAIDs due to the increased chance of stomach and intestinal ulceration.

Other medical therapies for chronic pain include:

  • Tramadol, a medication useful for moderate to severe and chronic pain
  • Amantadine, used for neuropathic pain
  • Gabapentin, also used for neuropathic pain
  • Opiods, such as morphine, oxycodone, etc.

Physical rehabilitation also plays a vital role in the management of chronic pain. Massage therapy, neuromuscular electrical stimulation, low-level laser therapy and therapeutic ultrasound are great adjunctive treatments. Water therapy provides low-impact exercise for dogs with chronic pain. The buoyancy of water reduces joint load, allowing for more comfortable exercise. Water pressure reduces swelling, and water resistance is useful for building and strengthening muscle.

It can be hard to recognize the signs of chronic pain in your pet, but once diagnosed, with the development of new medications and technologies, our pets are able to live much more comfortably with chronic conditions that would have previously caused unrelieved suffering.


References:

*Hardie, E. M., S. C. Roe, et al. (2002). “Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994-1997).” J Am Vet Med Assoc 220(5): 628-32.

OBJECTIVE: To determine prevalence of radiographic evidence of degenerative joint disease (DJD) in geriatric cats.

DESIGN: Retrospective study.

POPULATION: 100 cats > 12 years of age.

PROCEDURE: One investigator reviewed radiographs and for each articulation (or group of articulations) that was visible assigned a grade of severity (0, 1, 2, 3) for DJD. Another investigator reviewed medical records and recorded signalment, environment, previous disease, diseases evident at time of radiography, FeLV vaccination and infection status, feline immunodeficiency virus serologic status, serum creatinine concentration, serum globulin concentration, and any other important findings. Associations between DJD of grade 2 or 3 and variables recorded from the medical record were determined. RESULTS: Radiographic evidence of DJD was evident in 90% of cats. Neurologic disease was associated with lesions in the lumbosacral portion of the vertebral column. Severe lesions were found in 17% of the elbow joints, but an underlying cause was not determined.

CONCLUSIONS AND CLINICAL RELEVANCE: Degenerative joint disease was detected radiographically in most geriatric cats and may be an overlooked cause of clinical disease. Clinicians should be alert to the possibility that DJD is associated with neurologic signs.

Dr. Mary Newell Sanders practices at Marek Veterinary Clinics in Bellville and Sealy, Texas.