Managing Neuropathic Pain in Dogs.

Sarah A Moore

doi:10.3389/fvets.2016.00012

Abstract

Disorders of the somatosensory system such as neuropathic pain are common in people with chronic neurologic and musculoskeletal diseases, yet these conditions remain an underappreciated morbidity in veterinary patients. This is likely because assessment of neuropathic pain in people relies heavily on self-reporting, something our veterinary patients are not able to do. The development of neuropathic pain is a complex phenomenon, and concepts related to it are frequently not addressed in the standard veterinary medical curriculum such that veterinarians may not recognize this as a potential problem in patients. The goals of this review are to discuss basic concepts in the pathophysiology of neuropathic pain, provide definitions for common clinical terms used in association with the condition, and discuss pharmacological treatment options for dogs with neuropathic pain. The development of neuropathic pain involves key mechanisms such as ectopic afferent nerve activity, peripheral sensitization, central sensitization, impaired inhibitory modulation, and pathologic activation of microglia. Treatments aimed at reducing neuropathic pain are targeted at one or more of these mechanisms. Several drugs are commonly used in the veterinary clinical setting to treat neuropathic pain. These include gabapentin, pregabalin, amantadine, and amitriptyline. Proposed mechanisms of action for each drug, and known pharmacokinetic profiles in dogs are discussed. Strong evidence exists in the human literature for the utility of most of these treatments, but clinical veterinary-specific literature is currently limited. Future studies should focus on objective methods to document neuropathic pain and monitor response to therapy in veterinary patients.

Highlights

Disorders of the somatosensory system such as neuropathic pain affect up to 8% of the general population and up to 90% of people living with chronic spinal cord injury (SCI), yet these conditions remain an underappreciated morbidity in veterinary patients [1, 2]
The goal of this review is to summarize basic concepts in the literature related to somatosensory disturbance and neuropathic pain and to review recent publications related to the diagnosis and management of neuropathic pain in dogs
The presence of neuropathic pain can be assessed using objective laboratory techniques such as quantitative sensory testing (QST), which are discussed in greater detail below

Summary

Introduction

Disorders of the somatosensory system such as neuropathic pain affect up to 8% of the general population and up to 90% of people living with chronic spinal cord injury (SCI), yet these conditions remain an underappreciated morbidity in veterinary patients [1, 2]. Veterinarians have historically received limited background in the concepts of neuropathic pain during training, making it more difficult to recognize this potential problem in patients. The goal of this review is to summarize basic concepts in the literature related to somatosensory disturbance and neuropathic pain and to review recent publications related to the diagnosis and management of neuropathic pain in dogs. Terminology related to neuropathic pain is vast, and often misused in both the human and veterinary clinical literature. Definitions of important terms relevant to the discussion of neuropathic pain, as recommended by the International Association for the Study of Pain (IASP), are summarized in Table 1 [3].

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Results

Conclusion