Chronic pain is a common problem in dogs and cats, and it can significantly impact their quality of life. Fortunately, there are many therapies available to help manage pain in our furry friends, though some options have considerably more evidence supporting their use than others.
The 2022 AAHA Pain Management Guidelines for Dogs and Cats provide a comprehensive approach to pain management that includes multiple tiers of therapy options based on proven effectiveness.
Tier 1 Therapies
Tier 1 therapies are generally the first line of treatment for chronic pain. They includes nonsteroidal anti-inflammatory drugs (NSAIDs), anti-nerve growth factor antibodies, omega-3 fatty acids, optimizing body weight, encouraging moderate daily activity, and even surgery to address a specific condition.
NSAIDs, like carprofen, meloxicam, and Galliprant are commonly used to manage chronic associated with arthritis and a variety of other conditions because they are predictably effective. Although kidney, liver, and gut side effects are possible, they occur infrequently–most pets tolerate NSAIDs well, and longer term use is not associated with more side effects than short term use (though they do work better and better over time!).
Unfortunately, no NSAIDs are approved for long-term use in cats in the US. However, meloxicam and Onsior are used long-term elsewhere and have been proven to work well for controlling chronic arthritis pain. Large studies have proven Onsior to be a safe long-term option for older cats, even those with chronic kidney disease.
Anti-nerve growth factor antibodies
Anti-nerve growth factor antibody treatments are newer developments with enough evidence supporting their effectiveness that they’re considered good first-line options. Nerve growth factor (NGF) is a major driver in the pain pathway, so blocking it has shown to be an effective way to control chronic pain. At this time, Solensia is available for chronic pain relief in cats, and a canine version is on the horizon.
Omega-3 Fatty Acids
Diets enriched with high levels of omega-3 fatty acids, like Hill’s j/d or Pro Plan JM, have been shown to lead to measurable reduction in pain. Supplementing an OTC diet with fish oil may be useful as well.
The importance of weight optimization cannot be overemphasized. Fat tissue secretes inflammatory mediators that worsen arthritis inflammation, and excess weight applies more force to painful joints. Evidence is showing maintaining a lean body condition through a lifetime of calorie restriction reduces the severity and speed of arthritis progression and extends overall lifespan.
Moderate exercise has been well proven to reduce chronic pain in humans, and there is limited evidence in dogs and cats as well. Regular exercise can also help maintain a healthy weight, improve cardiovascular health, and promote a positive mental state.
Environmental modifications can be extremely helpful as well. For cats, it’s especially important to add ramps or stairs to allow continued access to elevated resting places to allow them to feel safe. Painful cats may also benefit from litter boxes with lowered entries. For dogs, make sure to provide easy access for potty breaks, and optimize floor and sleeping surfaces to provide secure footing. Painful pets often feel less safe, so consider providing resting spaces in quiet, restricted areas like behind a couch or under a bed.
Tier 2 Therapies
Tier 2 therapies are adjunctive options to consider adding on to Tier 1 treatments. These therapies have less evidence supporting their use.
Gabapentin and amantadine target pain pathways in the spinal cord. The use of gabapentin has become quite common, and anecdotally, it seems to work well, but we still have a lack of studies supporting its use.
If NSAIDs are not tolerated or unsafe for use, acetaminophen (dogs only!!!) or steroids are sometimes tried.
Adequan is an injectable polysulfated glycosaminoglycan (PSGAG) that has been shown to support cartilage health. Many pets appear more comfortable with the use of Adequan, and it’s generally well tolerated.
Steroid, platelet-rich plasma, or stem cell joint injections may be recommended for dogs in Tier 2 (they’re less practical in cats).
Disease-specific medications might be recommended for patients with certain issues like lower urinary tract disease in cats or bone cancer in dogs.
Physical therapy exercises (massage, stretching, myofascial release, etc.), accupuncture, laser therapy, hydrotherapy, and pulsed electromagnetic field therapy are other options to consider in Tier 2, though there has been little research investigating these treatments for controlling chronic pain.
Tier 3 Therapies
Tier 3 therapies have the least evidence supporting their use. These include tramadol, nutritional supplements other than fish oil, and supportive devices (braces, wheelchairs, slings).
Tramadol is an opioid that has shown to have a lack of effectiveness in dogs. Tramadol may work well for cats but it’s strong bitter taste makes it challenging to use. Unfortunately, oral opioids aren’t a great long-term option for dogs in general because of poor absorption and metabolism.
Nutritional supplements like glucosamine, chondroitin, and MSM fall into the Tier 3 category as well due to a lack of evidence showing a beneficial response.
CBD supplements have more recently been investigated for chronic pain relief. Studies have found mixed results, and the lack of regulation and quality control by the FDA is another concern at this time.
It’s important to note that the appropriate therapy for chronic pain management can vary based on the individual pet’s needs, underlying condition, and potential adverse effects. Therefore, it’s essential to work closely with a veterinarian to determine the most appropriate course of therapy.
In addition to the above therapies, there are also many non-pharmacological pain management options available. These include weight management, physical therapy, acupuncture, and laser therapy. Non-pharmacological therapies can be particularly beneficial for pets with chronic pain as they can help manage pain while minimizing potential adverse effects associated with medications.
In conclusion, chronic pain management in dogs and cats is a complex issue that requires a comprehensive approach. The 2022 AAHA Pain Management Guidelines for Dogs and Cats provide a tiered approach to pain management, with different therapies recommended based on the current evidence of effectiveness. It’s important to work closely with a veterinarian to determine the most appropriate therapy for your pet and to monitor for potential adverse effects. With the right combination of tools, most pets with chronic pain can enjoy a better quality of life.
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