Page 39 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir a safe drug to use that can be dosed to e ect
Rychel, 1 . oses can be increased up
he placebo e ect should also be considered
to mg kg two to three times daily. he drug
is eliminated exclusively via the renal route, so when assessing a patient’s response to
care should be taken in patients with renal treatment. Caregiver placebo e ects, a ecting
insu ciency and doses modi ed accordingly. both the owner and veterinary surgeon, are very
Pregabalin is similar to gabapentin, both common in dogs undergoing treatment for OA
being structural analogues of gamma- Con emius and Evans, 1 .
aminobutyric acid ABA and is also thought
to modulate the presynaptic calcium channels
resulting in a reduction of presynaptic The multimodal approach
transmitter release.

Amantadine and memantine pain
Amantadine is a NMDA antagonist drug and he owner needs to appreciate that A is a
can be useful in conjunction with NSAIDs in lifelong condition that can be managed but not
dogs with chronic OA pain that is refractory to cured. he plan should include analgesia, oint
NSAIDs alone (Lascelles et al., 8 . protection and nutritional support, which can
Amantadine can also be used alone for then facilitate strengthening, conditioning, and
treating chronic pain. he side e ects include increased exercise. In addition to the
agitation, sedation and mild GI signs, and are aforementioned drugs, the non-
usually self-limiting (Macfarlane et al., 14 ; pharmacological pain therapies including
the drug is well tolerated in the geriatric physiotherapy, hydrotherapy and acupuncture
animal. he most commonly recommended play a large role in ensuring patient comfort.
dose is mg kg once a day, but 1 mg hese modalities are covered in Chapter 6B.
kg two to three times daily has also been It is vitally important that the owner is
suggested (Pozzi et al., 6 . educated about the positive impact that all the
Memantine has also been used in cases
where amantadine was unavailable, with modalities can have on their pet.
similar e cacy. he dosage for memantine is
. . mg kg once or twice daily, increasing Environmental enrichment and
to 1 mg kg twice daily Schneider et al., 9 .

Careful consideration should be given to the
Amitriptyline is a tricyclic antidepressant used animal’s everyday environment. Simple
in humans for controlling neuropathic pain. he concepts such as providing soft comfortable
mechanism of action is thought to be via bedding, appropriate siting of beds, food bowls
central opioid receptors and also as a and litter trays, and reducing slippery oors,
noradrenaline and serotonin reuptake inhibitor. steep steps and the necessity to jump will
One small study has documented its use in ensure aggravation of OA is reduced.
treating neuropathic pain in dogs. he Enrichment such as regular grooming, toys, and
recommended dose is . mg kg once a human–animal interaction will also ensure
day to twice a day. It may be prescribed in cats mental stimulation and improve the animal’s
as well, with variable e ects; 4 weeks of well being. Owners can be reassured that
treatment may be necessary before the bene t stroking and patting will not cause further pain,
is seen. ricyclic antidepressants should not but may be of bene t as a gentle form of
be used with tramadol, St John’s wort, and massage that may go some way to breaking the
other drugs that inhibit serotonin and maladaptive cycle of irritating somatosensory
noradrenaline uptake. input that causes allodynia.

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