By

Lew Olson,

PhD Natural Health, LMSW-ACP

 

Pain Management Options and Alternatives

 

Years ago, chronic and acute pain that our pets may have suffered was not an issue that was addressed by either the pet owner or the Veterinarians.  However, more recently the benefits of proper pain management have become important for both recovery of an injury or maintenance of a chronic disease and also to maintain appetite and comfort for our dogs with health and pain related issues.  At the same time, pet owners have become more aware of the need for pain management for their dog’s illnesses and/or injuries, however may have found they are overwhelmed by the growing list of medications that are now available to choose from. 

 

Today, there are many choices are available, and this month’s newsletter takes a look at some of the various options and alternatives.

 

The most common causes for our dogs to need pain management include:

 

Post Surgery

Arthritis pain

Cancer pain

Orthopedic problems

Injuries and wounds

 

Pain medications fall into several categories, but prescribed medications generally fall into three areas:

 

1.  Steroids

2.  Non-steroidal anti-inflammatory drugs (NSAID) and

3.  Opiates.

 

Each of these types of pain medications act to reduce pain, but use different techniques.

 

Steroids

Steroids include such drugs as prednisone and dexamethasone. These are very strong drugs that have powerful anti-inflammatory effects. They also have strong side effects and are not meant for long term use in managing pain. One of their main uses is to suppress the immune system.  While short term use, at lower doses is unlikely to cause side effects, long term use or short term use at high doses can cause the following symptoms:

 

• Increased thirst and appetite

• Panting and/or restlessness

• Diarrhea and/or vomiting

• Some dogs can develop stomach ulcers from prednisone use

• Long-term use of prednisone may result in loss of hair coat, weakening of the muscles, liver impairment and behavioral changes.

 

Steroid use should *never* be combined with non-steroidal anti-inflammatories, which includes aspirin. Steroids should be avoided in very young animals and pregnant animals.  They should also be avoided in dogs suffering from liver or kidney problems.  Additionally, do not use steroids if a dog has a fungal condition, as steroids can make these conditions worse.

 

Non Steroidal Anti-Inflammatory Drugs

 

Non-steroidal anti-inflammatory drugs (NSAID), unlike steroids, are not hormone based. Their pain control is due to blocking prostaglandin production, which is what triggers the pain. These products have become the most well known and highly used in the Veterinarian community for pain management. Like steroids, this category of drugs helps bring down inflammation.  Reducing inflammation is probably most helpful for dogs suffering from arthritis and certain orthopedic problems. These drugs can also be helpful after major surgeries. While NSAID drugs were used more frequently, the side effects from these drugs have become more apparent, so certain cautions have been taken.  It is important to have blood work done on your dog, to make sure their kidney and liver functions are in normal ranges prior to administering these drugs.  The side effects caused by NSAIDs include:

 

·         Decrease or increase in appetite

·         Vomiting

·         Change in bowel movements such as diarrhea or black, tarry, or bloody stools)

·         Change in behavior such as decreased or increased activities levels, seizure, aggression, or lack of coordination

·         Yellowing of gums, skin, or whites of the eyes (jaundice)

·         Change in drinking habits (frequency or amount consumed)

·         Change in urination habits (frequency, color, or smell)

·         Change in skin (redness, scabs, or scratching).

 

Should your dog show any of these symptoms, stop this drug immediately and contact your veterinarian right away.

The following web site lists manufacturer contact information to call and report any side effects.  Veterinarians are encouraged to give pet owners a handout with information on NSAIDs that address the benefits and side effects of the  dispensed drugs.  http://www.fda.gov/fdac/features/2006/506_nsaid.html

Most common NSAIDS used today are Rimadyl, Deramaxx, Metacam and Zubrin. A more complete list is on the web site listed above. When considering long term use, please have your veterinarian administer periodic blood panels, to make sure your dog does not develop any kidney or liver problems. Always give these medications with food, as these drugs can cause gastric problems. Used correctly, NSAIDS can give good quality pain free life for a dog suffering from arthritis problems.

 

Some of these drugs, such as Piroxocam and Metacam are also felt to help in suppressing cancer cell growth.  http://www.vetmed.wsu.edu/rdvm/cancerInfo/new.asp

 

Opiates

 

While these drugs certainly aren’t new, a fresh prospective has been given to using them for dogs as pain blockers. While they don’t have the anti-inflammatory strength of steroids and NSAIDS, they have the ability to block pain without side effects that may cause organ problems, gastric upset and the more serious side effects of long term steroid use. An additional benefit of opiates is that they can be combined with either steroids or NSAIDS if needed. *NOTE:  Never combine NSAIDS with Steroids.  (This includes aspirin, which is a NSAID).

 

Tramadol is a very good alternative for dogs that suffer from kidney or liver issues, are prone to gastric upsets, or just can’t tolerate the NSAIDS family.  It can be given two to three times daily as needed, and has few side effects. It is not entirely without side effects, but less than the NSAIDS and steroids. It can also be combined with NSAIDS and steroids if needed. For more information, here are some information sites:

http://www.marvistavet.com/html/body_tramadol.html

http://b-naturals.com/May2005.php

http://www.caberfeidh.com/Pain3.htm  - This link is part 3 of Christie Keith’s very detailed and wonderful article on dogs and pain medications.  I do recommend reading all three parts, so I’ve also included the links for Part 1 and part 2.

http://www.caberfeidh.com/Pain1.htm

http://www.caberfeidh.com/Pain2.htm

 

For surgeries, the Fentanyl patch can be used. This is morphine, delivered via the skin with an adhesive patch. I used this in one of my dogs that had his rear leg amputated, due to bone cancer. It is important to have a veterinarian that has experience with this drug to ensure you are getting the proper milligram dose for the size of the dog. This type of pain medication would be used in the more extreme pain cases. For more information on the Fentanyl patch and its use with dogs can be found here:  http://www.marvistavet.com/html/body_fentanyl.html

 

Over the Counter Pain Relievers

 

It is very important to understand that many of the OTC (over the counter) pain remedies that we use for our everyday aches and pains may not be effective for our dogs and some may be lethal. 

 

These OTC medications/remedies include:

 

Tylenol/Acetaminophen:  This drug can cause severe liver problems in dogs and must be avoided.  There are other medications that contain this drug as well, including certain prescription codeine drugs. This drug is even more lethal to cats. Signs of distress include salivation, vomiting, weakness, and abdominal pain.

 

Aspirin:  Aspirin is in the class of NSAIDS. It can have the same side effects as other NSAID drugs including intestinal bleeding and gastric problems. Always check with your vet to make sure aspirin is an appropriate choice for your pet and what the proper dosage should be. A safer form of aspirin for dogs is the Herbspirin, which is an herbal tincture of the natural form of aspirin (willow bark), given in the gum line, with meals. Never give aspirin or other NSAIDS on an empty stomach.

Keep all human over-the-counter drugs out of your dog’s reach.  Human OTC pain relievers are also known as NSAIDs.  In addition to aspirin, this group includes acetaminophen products (Tylenol^TM), Ibuprofen products (Advil^TM and Nuprin^TM) and drugs such as Celebrix, Naprosyn (Naproxen) and Phenylbutazone.  The following is a good website with more information on OTC drugs and dogs:  http://www.canismajor.com/dog/nsaids.html.

Supplements for Pain Relief and Arthritis

 

There are some other forms of medications that can be helpful for inflammation and pain in dogs. Some of these can be found in health foods stores, on the Internet or from your Veterinarian. All of these can be combined with most prescription pain relievers.

 

Glucosamine, Chondroitin Sulfate and Manganese (Flexile Plus)

 

These substances are found naturally in the body, but are felt to be in inadequate amounts in the body when arthritis or inflammation is present in the joints. Glucosamine can help with keeping synovial fluid in the affected joints. Chondroitin Sulfate is found in cartilage, and is thought to help keep cartilage healthy and to help repair damaged areas. Manganese is a mineral in the body and helps with keeping muscles relaxed (which often stiffen when affected area has inflammation) and to help Glucosamine and Chondroitin Sulfate get to affected areas. These do not work as fast as the drugs listed above, but for long term use are found quite effective. 

 

Animal Based Omega 3 Fatty Acids

 

These Essential Fatty Acids are oils from deep water fish, either EPA fish oils or Salmon Oil. Omega 3 fatty acids help to control inflammation and also help to protect the immune system. Plant based oils are generally high in omega 6 fatty acids, which can promote inflammation, so they need to be avoided. General dosage would be 1,000 mg (180 EPA, 120 DHA) per 20 lbs of body weight. But for dogs affected by inflammation, give a therapeutic dose of 1,000 mg per ten lbs of body weight.

 

Bromelain

 

Bromelain is an enzyme from pineapples.  It can help reduce inflammation when given away from meals. Suggested dosage is 250 mg per 25 lbs of body weight, twice daily. It’s action can also be enhanced for certain conditions such as panosteitis and rheumatoid arthritis, if given with Borage Oil. Borage oil dosage would be 500 mg per 50 lbs of body weight twice daily, in between meals with the Bromelain (ProBrom).

 

Antioxidants

 

Certain antioxidants, especially Vitamin E and Vitamin C can help promote healing and help with joint pain. Again, the effects are not immediate, but can be seen after a few weeks use. Dosage amount is 100 IU of vitamin E per ten lbs of body weight, and 500 mg of Vitamin C with bioflavanoids per 25 lbs of body weight daily.

 

Yucca Intensive

 

Yucca is most effective for dogs in the liquid form, as the anti-inflammatory properties are found in the sap of this plant. This supplement needs to be given with food, and dose is one drop per ten lbs of body weight, given once or twice daily, depending on the extent of the discomfort.

 

Adequan Injections

 

This can be found at your Veterinarian’s office. It is comprised of injectable “polysulfated glycosaminoglycan” (mostly chondroitin sulfate) and is generally given twice weekly over a period of a few weeks.

http://www.marvistavet.com/html/body_adequan.html

 

Hyaluronic Acid

 

This is a newer form of using a substance found in the body. This is currently in many supplement oral forms for dogs, although research is still showing better response with injection into the affected joint. My own local orthopedic veterinarian surgeon told me it may be more effective when used in a newer injury, and has found less effectiveness in injuries more than six months old. But more research is being done and hopefully more information will be soon become available.

 

Traditional Chinese Medicine and Acupuncture

 

This is such an extensive subject, that I couldn’t begin to cover it all here. But finding a Veterinarian that practices acupuncture and TCM is often a great way to help with pain and inflammation. Traditional Chinese Medicine also offers alternatives in treating many conditions, including arthritis and recovering from illness and surgeries.  For more information on these treatment practices, here is the American Academy of Veterinary Acupuncture: http://www.aava.org/

 

For a brief overview of acupuncture and Traditional Chinese Medicine:

http://www.canismajor.com/dog/accupunc.html

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