Chronic pain: what are the options when NSAID treatment is inadequate?

Abstract

The focus of this article is the pharmacological management of chronic pain caused by osteoarthritis. There is no universally accepted definition of chronic pain in the veterinary literature, but a useful working definition is pain that has been ongoing for weeks or months. By definition, all pain encompasses both sensory and emotional components; however, arguably in chronic pain the emotional component predominates. This component is very poorly understood in animals, yet improving an animal's quality of life in addition to decreasing the sensory component of pain should be one of the key goals of therapy, and quality of life should be monitored alongside pain intensity. Non-steroidal anti-inflammatory drugs (NSAIDs) should form the backbone of analgesic therapy for pain caused by osteoarthritis. Tramadol, amantadine and gabapentin are the three ‘non-traditional’ analgesic adjuncts for which there is the greatest clinical data to support use in cats and dogs. It is currently impossible to make evidence-based recommendations about the order in which these drugs should be introduced into an analgesic regimen, and trial analgesic therapy, combined with close monitoring of analgesic efficacy and quality of life, is recommended.