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4 | Chronic and osteoarthritic pain
VetBooks.ir Paracetamol especially for acute episodes of are up. See
Chapters and for more information about
Paracetamol’s mode of action is still to be
completely described but it has peripheral and acute pain and pharmacology, respectively.
central actions, and is widely prescribed in Tramadol
humans for chronic pain, although evidence for
e cacy is weak unter and erreira, 16 . ramadol is an atypical synthetic opioid that
Currently, there is no strong evidence to interacts with adrenergic, serotonin and
support the use of paracetamol in OA in dogs, opioid receptors ukanich and Papich, 4 .
but it may be suitable for use as a bridging he opioid mechanisms of action can be
medication between switching NSAI s or in attributed to both the interaction of the parent
some cases in conjunction with NSAIDs. compound and its metabolite mono-O-
Paracetamol is available as a licensed desmethyltramadol 1 at the mu opioid
formulation in combination with codeine limited receptor, although the production of active
to a day course. he licence states it should 1 is variable between dogs and this may
not be co administered with NSAI s; however, explain the variability in analgesia e cacy.
it may, as in humans, be safe to use in dogs in Currently the evidence is weak to support its
use in dogs or cats with A. ollowing
con unction with NSAI s. he recommended administration there is a large variability in
dosage is mg kg in two or three divided uptake, particularly with the human sustained-
doses. It is also available as an injectable release formulation. In one study tramadol
solution 1 mg kg over mins . Paracetamol has been shown to have a positive e ect in
should be avoided in cats.
dogs with OA (Malek et al., 1 and may be
Steroids useful in some cases of chronic pain. ramadol
can be used in cats, but administration is
Steroids can be of use if the chronic pain has an hampered by the seemingly unpleasant taste
in ammatory component, but are not a of the tablet and side e ects such as dysphoria
commonly used rst line treatment because of and agitation. he recommended dosage for
the side e ects associated with long term use. dogs is 4 mg kg two to four times a day and
Paradoxically, it has also been shown that for cats 4 mg kg twice a day. ramadol
steroids can exacerbate neuropathic pain in alone is unlikely to be e cacious for treating
some human conditions cEwen and alia, chronic pain, but may be a useful drug for
1 . A prednisolone and cinchophen animals with chronic pain that experience a
prednoluecotropin combination is available for are up. ramadol should not be used in
dogs with A and can be e cacious in some animals that have received a monoamine
patients where other modalities have failed to oxidase inhibitor.
bring about an improvement. Prednisolone can
also be e ective in cats; the lowest possible Adjunctive treatments
e ective dose should be used. Gabapentin
Opioids Gabapentin is an anticonvulsant drug with
antinociceptive e ects. It has been
Long-term administration of opioids in cases of successfully used as a rst line treatment in
chronic pain is uncommon because of the side animals with neuropathic pain rubb, 1 .
e ects caused by these drugs constipation, he recommended initial dose is . 1 mg
anorexia, sedation, pupil dilation, euphoria . kg two to three times a day, and gradual
Liposome-encapsulated and sustained-release increases in dose are less likely to result in the
formulations, which allow for a slower release side e ect of sedation. It can be useful in
and fewer side e ects, may be suitable for managing chronic pain especially in cats
some patients and conditions. Opioids may be unable to tolerate long-term administration of
of use in conjunction with other modalities, NSAI s Robertson, 8 , and appears to be
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