Page 45 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir CASE EXAMPLE 1 CONTINUED . Considering that there may be a

component of central sensitization to his
LONG-TERM MANAGEMENT disease, the decision was made to add
unlicensed amantadine at 4 mg kg daily
After discussing the options with Pilot’s owner (Lascelles et al., 8 to the robenacoxib
the decision was made to initiate treatment and omeprazole treatment. Pilot’s demeanour
with robenacoxib at the licensed dosage, and improved after approximately weeks of
continue omepra ole. he owner completed treatment and after 4 weeks his CPI scores
the elsinki Chronic Pain Index CPI weekly. had reduced to the 6 11 range, suggesting
After 4 weeks of treatment, Pilot s demeanour present control of his pain. In the long term,
was still concerning to his owner, and the weight loss should be advised for the dog to
scores on CPI were indicative of chronic reach a target body condition score of 4 or
pain greater than 1 ielm B rkman et al., out of 9.

e ex p e Degenerative joint disease

or e ective posturing, need to be excluded.
HISTORY AND PRESENTATION
Given the crepitus noted in multiple joints it is
Socks is a 1 year old female neutered likely that the Socks has degenerative joint
Domestic Shorthaired cat who has been fed a disease , and a trial period of analgesia
restricted phosphate diet since diagnosis of should be considered. NSAIDs have
renal insu ciency during a geriatric health demonstrated e cacy in managing
screen 1 months previously. er owner is musculoskeletal pain in cats (Lascelles et al.,
concerned as she has defecated next to 7; ruen et al., 14 but owing to their
her litter tray on three occasions over the e ects on prostaglandin formation, re uire
past fortnight. additional caution when prescribed to
animals with renal disease that may be prone
to dehydration. here is some evidence that
INVESTIGATIONS AND INITIAL TREATMENT
cats with chronic renal disease and DJD,
n examination Socks is bright, alert and treated with low doses of meloxicam median
responsive with a body condition score of 4 dose . mg kg daily do not experience
out of 9; her weight is unchanged since her increased morbidity or mortality relative
previous check up 6 months earlier. er heart to untreated renal disease in cats (Gowan
rate is 19 , respiratory rate 8 and no goitre is et al., 11; 1 , and also that renal disease
palpable. Both kidneys feel small on does not increase the risk of adverse events
abdominal palpation and her urinary bladder associated with administration of the licensed
is moderately full. Crepitus is noted on exion dose of robenacoxib over a 8 day period
of both elbows and sti es. (King et al., 1 . It is worth noting that none
hile cognitive changes in older animals of the above studies have provided data on
may be associated with loss of house training the e ects of treatment of cats with
(Landsberg et al., 1 , medical causes, proteinuric renal disease with NSAIDs in
including pain preventing access to the tray addition to angiotensin-converting

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