Page 36 - BSAVA Guide to Pain Management in Small Animal Practice

4 | Chronic and osteoarthritic pain

VetBooks.ir

Diagnosis of osteoarthritis and maladaptive pain in dogs

Are NSAIDs contraindicated?
Yes No

Initial course of analgesia provided using Initial course of NSAID, weight loss
opioid, steroid or suitable adjunct, weight programme, diet supplementation/
loss programme, diet supplementation/ modi cation, controlled e ercise if possi le,
modi cation, controlled e ercise if possi le, baseline haematology, biochemistry
blood sample for baseline haematology and urinalysis
and biochemistry and urinalysis

Re-check within 2–4 weeks using
PAT and clinical evaluation

Improving No improvement

Continue with analgsia, reassess regularly Consider owner compliance, palatability of
using PAT, and monitor haematology and medication, consider switching to another
biochemistry and urinalysis every 6–12 months NSAID* or longer course of current NSAID**.
Evaluate the complementary therapies
the dog is receiving

Manage owner expectations, and prepare Re-check after changing NSAID, and ensuring dog
owner that acute are ups may occur re uiring is gaining ma imum ene t from complementary
treatment and that the disease is progressive therapies, diet, exercise, and enrichment

Improved Little improvement

Consider adding an adjunct such
as amantadine in refractory cases

ecision making algorithm for managing chronic pain in dogs. NSAI non steroidal anti in ammatory
drug; PA pain assessment tool. Bridging medication may be re uired for the washout period;
Re evaluate diagnosis.

31

Ch04 Pain Management.indd 31 19/12/2018 10:35