Pain Part 2: Getting rid of pain

Pain and pain relief are massive topics which can – and do – fill several textbooks. It’s way beyond the scope of a blog to go into all of the detail surrounding the use of painkillers, and so all I really want to do is to outline some of the different types of pain control that we can use, both in the surgery and as day-to-day treatments.

Pain relief is one of the great success stories in medicine, and it’s no coincidence that some of my favourite drugs of all time are painkillers. Our advances mean that pain in our patients shouldn’t be accepted, and although sometimes we fail to control it, we should never stop trying.

We use a number of different types of painkiller:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Steroids
  • Opioids and opioid-like drugs
  • Others

NSAIDs

These are the most widely-used type of painkiller and include (for humans) aspirin, ibuprofen and paracetamol. They act by stopping inflammation.

They’re commonly prescribed for post-op pain and for joint problems and may be given for long periods of time. When you’re given painkillers to take home from the vets, they’re usually NSAIDs.

Three things to really take on board with these drugs:

  1. Human drugs are not always safe for pets, so never give anything to your pet without talking to your vet first: half a paracetamol can kill a cat, a big dose of ibuprofen can do the same to dogs and even a solitary aspirin can be a lethal overdose for a toy breed, designed as it is for a much bigger animal (us). This is why we have veterinary-licensed drugs for our patients.
  2. Increasing doses won’t give more pain relief, and may cause side effects. If they’re not working for your pet, talk to your vet about alternatives.
  3. NSAIDs are most effective when given before the inflammation starts. It might seem odd to suggest giving painkillers before the pain even begins, but this is important in treating chronic, repeated and predictable pain like arthritis.

Two of the most common drugs we use are meloxicam and carprofen. Meloxicam usually comes as a syrup, which can be dosed very accurately, and carprofen is generally in tablet form. Both drugs may be used long term as a daily dose and both have been responsible for giving patients their lives back, sometimes for years. We’re also rediscovering paracetamol as an excellent addition to treatments in dogs.

Recently, newer NSAIDs have been introduced which are labelled either as cox-2 inhibitors (e.g. firocoxib), or else dual inhibitors (tepoxalin). Essentially, these are just descriptions of which bit of the inflammatory cascade they act upon, and they’re designed to reduce some risks of side effects that we see with other NSAIDs. It’s arguable, though, as to whether they’re better at relieving pain than some of the older drugs.

More recent still is Trocoxil, an NSAID for dogs which is only given once a month. The theory is that because it acts as a persistent block to inflammation, there’s no point where the vicious cycle of pain can really take a hold. The exact ins and outs of the drug are a bit too much to go into here, but as always, speak to your vet about this medication if you’re interested in finding out more. Do understand, though, that it’s not for every patient and your vet may have good reasons not to use it on your dog.

Steroids

Steroids are very powerful anti-inflammatories, which gives them painkilling properties. However, they also affect the immune system – many patients take them for allergies and auto-immune problems – and can have major side-effects when used long-term at high doses; they also can’t be given with NSAIDs and so for practical reasons their use as painkillers is limited. You may have experience of PLT (Predno-LeucoTropin), a medicine with a steroid component which can be great for chronic pain when other drugs seem to be failing. It’s been around for a long time, and many an experienced vet will recognise its usefulness.

Opioids

Opioids are a group of drugs which act to block the passage and brain detection of pain signals. The classic drug in this group is morphine, which still forms the basis for relief of severe pain in humans. These are very powerful painkillers indeed, although the degree of pain relief depends on whether they’re what we call a full-agonist or a partial-agonist.

Drugs like morphine, pethidine and fentanyl are full-agonists, and tend to be used only within the surgery. They are subject to close control and are never dispensed. Generally they’re given by injection, although fentanyl is available as a long-acting skin patch, which has been very successful for use in trauma patients like RTA cats.

Buprenorphine and butorphanol are partial-agonists and are often used as part of a pre-med before surgery. Buprenorphine is a great painkiller which is usually injected within the practice, but may occasionally be dispensed for oral, very short-term use. It is certainly useful in breaking pain cycles and allowing us to get onto more stable pain relief regimes. For in-patients where NSAIDs either don’t quite cut it, or else a combination therapy is needed, buprenorphine is an excellent drug.

A drug that we’ll often use long-term in out-patients is tramadol. This is a human drug which acts in a similar manner to opioids, and has a number of significant advantages:

  1. It’s usually pretty safe, although it can temporarily knock some patients a little flat. Your vet should tell you about this when prescribing.
  2. It’s a GOOD painkiller
  3. As it has a different way of working to NSAIDs or steroids, it can be used in conjunction with many other drugs to create a better painkilling effect

Others

Other drugs that we use act in novel ways, or else are designed for other purposes but just happen to help with pain control. These are important drugs, and whilst they’re described last they’re definitely not least in importance. In brief:

  • Local anaesthetics may be used in and around surgery, to numb the pain nerves. These tend to be injectable, although some creams are available which can be useful to pre-treat patients with needle phobias and the like.
  • Ketamine – yes, the horse tranquiliser – has been used for years in emergency medicine as a painkiller; it’s often included in battle packs for soldiers. Its use in our patients is quite specialised and confined to hospital environments.
  • Gabapentin. This is a very interesting drug indeed. It’s normally used as an anti-epileptic, but seems to have a great effect on pain of nervous origin (aka neuropathic pain), so can be useful for spinal and neurological conditions.
  • Cartrophen is an anti-arthritic drug (also sometimes used in bladder problems in cats) which has a number of effects on joints. It’s usually given as four weekly injections, followed by a variable period of remission. It can be very beneficial for some arthritis patients, but may need a little forward planning in its use, as its administration isn’t recommended at the same time as NSAIDs. It’s certainly a drug worthy of close inspection in long term arthritis cases.

Integrated methods of pain control

Whilst it’s obvious that we have some great drugs for relieving pain, reliance on drugs alone in any condition is generally a limiting approach, as adding in other treatment types – or modalities – may offer greatly increased success rates.

For example, in heart disease drugs may help to keep the cardiovascular system going, but are much less effective when used by themselves than in an overall strategy including lifestyle change, weight loss, exercise programmes, regular monitoring and support networks.

Similarly, drugs may form the heart of a pain relief strategy, but shouldn’t be used as an excuse to avoid other measures that can help – and there are even times when non-drug pain control is good enough that painkillers are not needed. Whatever the non-drug modality used, the decision on when not to use painkillers is a simple one:

  1. The pain is being completely controlled by non-drug methods.
  2. That’s it.

Remember that phrase – pain is not acceptable in our patients. If nothing else, these blogs should have explained both why pain is a bad thing in the long run, and the sheer number of drugs that fight pain. Treating pain completely without drugs is a brilliant solution, but simply taking the edge off the pain is not enough. Equally, though, finding a number of ways to help with the pain will almost certainly mean that your pet gets more relief and is happier.

Treatment modalities which can help in chronically painful conditions include:

  • Acupuncture – there’s a reasonable body of evidence for the physical effects of acupuncture and theories of how it may ‘close the gate’ on pain. It’s now widely available around the country, but must be performed by or under the direction of a vet.
  • Supplements – for joint problems, there are a number of supplements containing combinations of glucosamine, chondroitin and green-lipped mussel extract, which protect the cartilage and may even get rid of the need for painkillers in early arthritis. Additionally, essential fatty acid supplements and vitamin E are both mooted as aids to tissue repair and free-radical scavenging.
  • Herbal remedies containing Devil’s Claw are widely available, but be warned that the supplement can cause side effects and that clinical trials have produced highly variable results.
  • Weight loss – whilst it’s obvious that in arthritis, every excess ounce is another ounce of pain, recent work has suggested that body fat has a chemical pro-inflammatory effect which may exacerbate pain generally. Reducing body fat may reduce the body’s pain responses, particularly in chronic conditions.
  • Surgery – for many painful conditions, surgery is the obvious treatment to permanently remove the pain at source.
  • Physiotherapy – hydrotherapy, mobilisation, massage and PROM are all very useful in promoting recovery and dealing with chronically painful conditions. Access to these services is usually by referral from your vet, and animal physios are highly qualified professionals.
  • Mood enhancement – pain is depressing, so elevating mood helps patients to cope, and also makes new pain easier to deal with. A number of products are available, from pills (including zylkene, a natural extract, and amitryptilline) to pheromone sprays and diffusers (feliway, DAP), but equally, promotion of routine and enjoyable activities can be very successful.
  • Prevention –as the best pain relief is prevention, a word should be said about how we avoid seeing dogs with arthritis or cats with pancreas issues in the first place. Also perhaps timely, as the Animal Health Trust, in conjunction with Edinburgh Vet School, have just announced a project into genetic testing for hip and elbow dysplasias in Labradors. Being able to breed the conditions out of our patients will have a major impact on the wellbeing of future generations (so, if your Lab is KC registered and hip scored, the AHT might just want to hear from you).
  • Magnet therapy – to this day, I still don’t know if this really works, but plenty of my clients are convinced – including a large proportion of horse owners, who are about the most hard-bitten, unpersuadable people out there.

There are, of course, countless other integrated therapies, like Reiki or Homeopathy, and each will have their champions and detractors. The important factors with any of these are choice and inclusivity – it’s fine to explore all of the possibilities, but not to the detriment of the patient. As a general rule, the vet who prescribes you meloxicam won’t demand that you stay off the Reiki during treatment, and this should work both ways.

The mainstay of pain relief will always be drug therapy, but its effectiveness can be massively enhanced by looking at integrated treatments. Pain is such a debilitating problem that anything which can help to remove it has got to be worth exploring. If you feel that your pet may be in pain, especially if you’re already giving treatment, then speak to your vet about what you can do – there are so many ways to target pain that there’s bound to be something to help.

And do remember that phrase: pain is not acceptable in our patients.

If you are worried about your pet’s health, talk to your vet or use our Interactive Symptom Guide to help assess how urgent the problem may be.

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53 thoughts on “Pain Part 2: Getting rid of pain

    1. Hello Reg,

      Paracetamol can be given to dogs, but we strongly advise speaking to your own vet first as they know your pets medical history and can advise the dose according to weight. Paracetamol should never be given to cats as it is toxic for them.

    1. Hello Reg,

      Paracetamol can be given to dogs, but we strongly advise speaking to your own vet first as they know your pets medical history and can advise the dose according to weight. Paracetamol should never be given to cats as it is toxic for them.

  1. Thanks Dave, my 14 year old Lab is on 6 monthly cartrophen injections over a 4 week period and a daily 100mg dose of cartrophen in tablet form.
    It was late at night the other night and my dog seemed in a bit of pain and discomfort so I gave him one half of a 500mg paracetamol tablet and he really did respond well.
    I am mindful of giving dogs human medication and was surprised how well he responded. Not needed to give him anymore but I thought it may be OK should this occur again when I cant get to my vet due to the hour of the day?
    I do appreciate your help.
    Reg

    1. Hello Reg, I’m happy to help – but please get in touch with your own vet as well, especially due to your dog’s age and his current dose of Cartrophen as well. Like almost all medications for animals the dosage is calculated on weight , so your own vet will be able to advise on the best treatment. Best wishes, Dave.

  2. Thanks Dave, my 14 year old Lab is on 6 monthly cartrophen injections over a 4 week period and a daily 100mg dose of cartrophen in tablet form.
    It was late at night the other night and my dog seemed in a bit of pain and discomfort so I gave him one half of a 500mg paracetamol tablet and he really did respond well.
    I am mindful of giving dogs human medication and was surprised how well he responded. Not needed to give him anymore but I thought it may be OK should this occur again when I cant get to my vet due to the hour of the day?
    I do appreciate your help.
    Reg

    1. Hello Reg, I’m happy to help – but please get in touch with your own vet as well, especially due to your dog’s age and his current dose of Cartrophen as well. Like almost all medications for animals the dosage is calculated on weight , so your own vet will be able to advise on the best treatment. Best wishes, Dave.

  3. My 4 year old Rotty had a ruptured cruciate repaired yesterday. She is on loxicom once a day and antibiotics twice daily. The loxicom seems to be working but by tea time my dog seems to be in pain (maybe the pain relief wearing off) is there nothing else my vet can give her as she was very unsettled last night and is the same tonight

    1. Hi Lisa, There are other pain relief medications available, it’s best to have a chat to your vet, explaining how unsettled she was and see if there is another medication to make her more comfortable.

  4. My 4 year old Rotty had a ruptured cruciate repaired yesterday. She is on loxicom once a day and antibiotics twice daily. The loxicom seems to be working but by tea time my dog seems to be in pain (maybe the pain relief wearing off) is there nothing else my vet can give her as she was very unsettled last night and is the same tonight

    1. Hi Lisa, There are other pain relief medications available, it’s best to have a chat to your vet, explaining how unsettled she was and see if there is another medication to make her more comfortable.

  5. Im having trouble finding good pain relief for my 13 year old gsd
    She is on Carprodyl , we have tried Pardale and Tramodol
    Tramadol left her tired confused and thirsty.
    We are now going to try Memanture ? Cant find any details on this drug and am wondering if its a good choice for elderly dogs. At the moment its trial and error. Any other Ideas for my old girl

  6. Im having trouble finding good pain relief for my 13 year old gsd
    She is on Carprodyl , we have tried Pardale and Tramodol
    Tramadol left her tired confused and thirsty.
    We are now going to try Memanture ? Cant find any details on this drug and am wondering if its a good choice for elderly dogs. At the moment its trial and error. Any other Ideas for my old girl

  7. In what circumstances might paracetamol (in conjunction with methocarbamol and gabapentin) be selected for pain management for a 12 yr old dachshund mix suffering from IVDD? I understand that acetaminophen can be administered in safe doses, but why would it be preferred among other options?

  8. In what circumstances might paracetamol (in conjunction with methocarbamol and gabapentin) be selected for pain management for a 12 yr old dachshund mix suffering from IVDD? I understand that acetaminophen can be administered in safe doses, but why would it be preferred among other options?

  9. Hi. my dog is i think 6yrs, old and she was badly hurt in the ear because my other dog is biting it and it was totally bleeding and it seems that my dog was really in pain could you please help me. my dog is in pain and i feel really sorry for her, 🙁

  10. Hi. my dog is i think 6yrs, old and she was badly hurt in the ear because my other dog is biting it and it was totally bleeding and it seems that my dog was really in pain could you please help me. my dog is in pain and i feel really sorry for her, 🙁

  11. Hi my dog suffers from chronic artaritis I have tried everythin my vet has givin me with no avail I have red online that mobic is really really good and have been advised to try it but Icant find a vet in england that supply it . Any help I would be greatfull.
    Thanks david

    1. Hi David, the drug you mention – Mobic – is also called Meloxicam, which is better known as Metacam and widely available from UK vets. It can be very good for arthritis, please speak to your vet again!

  12. Hi my dog suffers from chronic artaritis I have tried everythin my vet has givin me with no avail I have red online that mobic is really really good and have been advised to try it but Icant find a vet in england that supply it . Any help I would be greatfull.
    Thanks david

    1. Hi David, the drug you mention – Mobic – is also called Meloxicam, which is better known as Metacam and widely available from UK vets. It can be very good for arthritis, please speak to your vet again!

    1. Only use the dose recommended by your vet – they know your dog’s medical history and can advise accordingly.

    1. Only use the dose recommended by your vet – they know your dog’s medical history and can advise accordingly.

  13. My dog is 2 years old and weighs 33.2kg. Can I give her 1 500mg tablet of paracetamol as she is in a bit of pain but can’t get into the vets until tomorrow

  14. My dog is 2 years old and weighs 33.2kg. Can I give her 1 500mg tablet of paracetamol as she is in a bit of pain but can’t get into the vets until tomorrow

  15. Hi , I have a 3 year old king staf and he has hurt his knee and is limping . I wondered if I could give him some pain relief as I’m far from home and can’t get to a vet .??

    Thanks Amanda

  16. Hi , I have a 3 year old king staf and he has hurt his knee and is limping . I wondered if I could give him some pain relief as I’m far from home and can’t get to a vet .??

    Thanks Amanda

    1. Please do not put any human medication on your pet, without first speaking to your own vet. Some human drugs can make pets extremely ill and some are even fatal. Contact your own surgery first.

    1. Please do not put any human medication on your pet, without first speaking to your own vet. Some human drugs can make pets extremely ill and some are even fatal. Contact your own surgery first.

  17. My dog is two years old with an auto immune disorder that causes pain in her joints. The thing we finally got that makes her comfortable active and happy is 5 mg of prednisone a day and 2 to 3 tramadol’s a day. This took months and months to figure out and now the vet wants to change it. Am I allowed to disagree

  18. My dog is two years old with an auto immune disorder that causes pain in her joints. The thing we finally got that makes her comfortable active and happy is 5 mg of prednisone a day and 2 to 3 tramadol’s a day. This took months and months to figure out and now the vet wants to change it. Am I allowed to disagree

  19. This was after trying for her other medications and types of pain relief and her being very very ill from these other medications. I just don’t understand why when we finally have something that works and she’s happy and healthy and

  20. This was after trying for her other medications and types of pain relief and her being very very ill from these other medications. I just don’t understand why when we finally have something that works and she’s happy and healthy and

  21. I am alarmed at how many people seem to not understand that when giving human meds to pets, such as paracetamol you must speak with your vet first to find out if it is safe due to other meds your dog is on and what dose should be given as the weight of your dog will determine this. Your vet will provide this information. My dog hurt his leg so I rang my vet straight away after hours and made sure paracetamol would be safe as he is on meds for his heart. I was told to give him a quarter of a tablet after the vet looked on his file to see what weight he was. It is also very important to make sure your pet receives a check up at the vet also. We can’t just rely on paracetamol as pain relief when our pets may need other meds that only a vet can provide.

  22. I am alarmed at how many people seem to not understand that when giving human meds to pets, such as paracetamol you must speak with your vet first to find out if it is safe due to other meds your dog is on and what dose should be given as the weight of your dog will determine this. Your vet will provide this information. My dog hurt his leg so I rang my vet straight away after hours and made sure paracetamol would be safe as he is on meds for his heart. I was told to give him a quarter of a tablet after the vet looked on his file to see what weight he was. It is also very important to make sure your pet receives a check up at the vet also. We can’t just rely on paracetamol as pain relief when our pets may need other meds that only a vet can provide.

  23. I’ve just been given some Loxicom for my Guinea pig for some inflammation on her foot, & was told to give her 5kg dose once daily. Is this correct? As it says on the box that it’s for dogs & it seems a large amount?

    1. Hi Lesley, there are very few medications licensed for small furries such as guinea pigs and rabbits so it’s no surprise that you’ve been prescribed something licensed for dogs. The volume required can be rather surprising too however since your vet knows your guinea pig’s weight and ailment, it’s best for you to give them a ring to check. Mistakes can happen every now and then so they will appreciate a vigilant pet owner, we’re sure. Many thanks

  24. I’ve just been given some Loxicom for my Guinea pig for some inflammation on her foot, & was told to give her 5kg dose once daily. Is this correct? As it says on the box that it’s for dogs & it seems a large amount?

    1. Hi Lesley, there are very few medications licensed for small furries such as guinea pigs and rabbits so it’s no surprise that you’ve been prescribed something licensed for dogs. The volume required can be rather surprising too however since your vet knows your guinea pig’s weight and ailment, it’s best for you to give them a ring to check. Mistakes can happen every now and then so they will appreciate a vigilant pet owner, we’re sure. Many thanks

  25. Hi my dog had just had a total hip replacement. She is on loxicom once a day in the morning. I have just accidentally given her the dose again at tea time. Please is that an issue???

    1. Hi Sarah, yes an overdose of meloxicam (the active ingredient within ‘Loxicom’) has the potential to cause problems for both the stomach and the kidneys. We’d advise you to get in touch with your vet ASAP and discuss the best plan of action, if you haven’t already done so. Best wishes.

  26. Hi my dog had just had a total hip replacement. She is on loxicom once a day in the morning. I have just accidentally given her the dose again at tea time. Please is that an issue???

    1. Hi Sarah, yes an overdose of meloxicam (the active ingredient within ‘Loxicom’) has the potential to cause problems for both the stomach and the kidneys. We’d advise you to get in touch with your vet ASAP and discuss the best plan of action, if you haven’t already done so. Best wishes.

  27. Out Ridgeback has been on PLT for about 3 years to cope with osteoporosis and the have worked well, he’s now nearly 11 and we have just found out that PLT tablets are being withdrawn and will no longer be manufactured, confirmed by our vet this week. We’ve been given Pardale as a replacement, also he has deteriorated quit a bit in the last month is Pardale a last option for pain relief.

    1. Hi John,

      Although PLT doesn’t work for every dog (and a lot of them can’t tolerate it), when it does work the results can be excellent. That said, there are other options above and beyond Pardale-V; my suggestion would be to have a frank discussion with your vet about using multi-modal analgesia – in other words, a number of different overlapping painkillers and anti-inflammatories. For example, a combination of a NSAID (such as meloxiam or carprofen) or a steroid (like prednisolone), with an opiate (many vets use human medications off license in this situation) can be effective. The key thing to remember is not to get hung up on one particular drug, but to try and find the combination of medications that will work – bear in mind that PLT is actually two different drugs rolled into one big fat tablet!
      It is possible that the product will come back into stock in the long term, but it is such an old fashioned and (to most dogs) dangerous product, that I suspect it will be a very long time, or at a very high price, before it becomes available again. That said, there are other options, and there are other, safer more modern drugs that (alone or in combination) may give your dog as much relief as the PLTS did.
      The key thing is going to be to talk to your vet and try and find a combination that is effective.

      1. Many thanks the vet has prescient pardale but it doesn’t seem very effective so the vet has also prescient metacam oral liquid. He’s only been on the combination for 2 days so it’s fingers crossed but so far our dog does not seem to even want to go out for his usual short trot round the block.

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