Earlier this week we covered mobility issues in senior pets and how we can modify our environment to assist them. Today I want to focus on medications, and supplements that are commonly used to alleviate pain and discomfort in senior pets. Broad categories of treatment include non-steroidal anti-inflammatory drugs (NSAIDs), opioid drugs, injectable drugs, and supplements (sometimes called nutraceuticals).
This category of drugs is very commonly used in pets, as it is in people. We use NSAIDs in younger pets to manage post-surgical pain or acute injuries. Older pets with arthritis may take these drugs daily for a long time, sometimes years. When this is the case, your vet will schedule your pet for periodic (usually every 6 months) bloodwork to ensure the drug isn’t causing problems with the liver and kidneys. Commonly used brand names include Rimadyl, Novox, Carpaquin, Deramaxx, Previcox, Metacam, and Onsior. These drugs have made a huge difference in the quality of life for many dogs. I commonly hear, “My dog is acting like a puppy again!”
Cats are a bit trickier with this category of drugs, as they are with most drugs. They are much more likely to have serious side effects with long term use of NSAIDs. Currently in the U.S., Metacam is approved for use in cats as a one-time injection at the time of surgery, and Onsior is approved for use in cats by mouth for 3 consecutive days. In other countries, such as Canada and the UK, Metacam is approved for use by mouth to control arthritis. This means there is a large amount of data available on long-term use in cats, and it shows that kidney and liver function must be monitored closely while using it, just as in dogs.
Please, please, please do NOT give your dog or cat Alleve, Advil, ibuprofen, naproxen, Tylenol, or acetominophen from your medicine cabinet unless your vet has specifically prescribed it! The margin of safety for these drugs is very narrow in dogs and cats, and although you may mean well, your pet can experience life-threatening side effects (such as severe GI bleeding) from taking these drugs.
What about using aspirin? Aspirin is a bit safer than the drugs mentioned above, although it can still cause GI bleeding. Before using it, discuss dosage with your vet. I always recommend using a buffered aspirin to help protect the stomach.
When dogs cannot tolerate an NSAID drug, or if they are taking an NSAID drug and still experience pain, we may prescribe an opioid. This is the category of drugs including morphine and oxymorphone. The most common drug prescribed from this group for daily use is called tramadol. It is available as a tablet and can be compounded into liquid form for ease of dosing in smaller animals. It can also be used in cats, although some cats will experience side effects (such as excitement) that preclude its use. Side effects occasionally seen in dogs include agitation, salivation, lack of appetite, vomiting, and diarrhea or constipation. For the most part, pets can take tramadol long-term and it is well-tolerated. You may need to work with your vet to adjust the dosage, especially if your pet’s pain level is increasing.
Injectable and Other Drugs
A drug called Adequan (polysulfated glycosaminoglycan) is available for dogs and horses. Veterinarians have also used it successfully in cats. It is given as an injection twice a week for four consecutive weeks, then as a maintenance injection every four weeks. The drug promotes growth of healthy joint tissue (such as cartilage) and blocks harmful chemicals that are present in arthritic joints. It is generally a safe drug, with few side effects. I have personally seen it help a number of older patients, and I have also taught dog owners to administer it at home, which cuts down on the time and expense of taking your dog into the clinic.
I want to mention a few other drugs that vets are using to control pain in certain cases. Dogs or cats that are experiencing chronic pain originating from the nervous system may benefit from a drug called gabapentin. This drug’s primary use in people is to control seizures. Another drug used for chronic neuropathic pain is called amantadine. It is most often combined with another pain medicine (such as an NSAID) to boost the level of pain relief.
There is a multitude of nutritional supplements on the market targeted at joint health and relief of pain. The first thing to understand about any of these supplements is that they are not going to make quick changes in your dog or cat’s body. They are definitely more of a “slow and steady wins the race” approach. Combined with other treatments, they provide benefit to most animals.
Glucosamine/chondroitin, which is ground up cartilage from sea mollusks, provides building blocks for the body to repair its own cartilage. It’s also thought that this supplement is anti-inflammatory. Omega-3 fatty acids, derived from cold-water fish oils, are also anti-inflammatory. Note that flax seed oil, commonly used in people, is not a great choice for dogs and cats because they aren’t efficient at converting flax seed oil into omega-3’s. Work with your vet to get the right dose for your dog or cat. Methyl sulfonyl methane (or MSM) is often combined with glucosamine/chondroitin to provide a source of sulfur to the body. Sulfur is a cartilage building block and acts as an anti-oxidant.
Herbal treatments can also play a role in pain relief. Boswellia, Willow, Devil’s Claw, Ginger and other herbs have anti-inflammatory effects and are often included in supplements sold over the counter for pain relief. For most effective pain control when using herbal preparations, I suggest working with a vet who has training in this area. The Veterinary Botanical Medical Association (VBMA) maintains a list of veterinarians in the U.S. and internationally who may be able to help you.
We have more effective tools to manage our older pet’s pain than ever before. Pain is an active area of research, both in humans and animals. Most pets I have treated for painful conditions do best with a multi-modal approach, that is, we use more than one therapy to relieve their aches. I advise clients to be careful observers of their pets behaviors and attitude. If it seems the approach you are taking is becoming less effective, talk to your vet about it. You may need to add or subtract a medication or explore other therapies.
What has your experience been with managing pain in an older pet? Was it successful?