Page 166 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Cancer pain

VetBooks.ir Therapy Considerations
• PL is a compound preparation containing cinchophen and prednisolone and
Combination products
level 1 analgesia
including bone pain; it is generally well tolerated
Examples predno may be a cheap and e ective analgesic combination in cancer associated pain
leucotropin PL , • Pardale V is cheap and widely available and is a licensed product in dogs.
prednisolone cinchophen , It should never be given to cats
Pardale V paracetamol • Long term side e ects are poorly documented
codeine • Recommended dose of Pardale V contains a relatively high dose of
paracetamol and therefore monitor for side e ects including gastrointestinal.
Licensed for days of therapy
• Codeine is an opiate with weak mu receptor agonist activity
Corticosteroids • Provide excellent anti in ammatory e ects and have additional antineoplastic
Examples prednisolone, action in certain neoplasms e.g. lymphoma, mast cell tumours, leukaemias,
dexamethasone, and multiple myeloma
methylprednisolone • eak analgesics but reduction of in ammation can have signi cant bene cial
e ects
• Adverse e ects are common and include iatrogenic hyperadrenocorticism,
muscle wasting and gastrointestinal adverse events
• E ective in managing hypoglycaemia medically, a paraneoplastic e ect
associated with certain tumours, including insulinoma
pioids • Best used to e ect
full and partial mu opioid • Considered a stalwart of cancer pain relief. eliver dose dependent, reliable
receptor agonists; level and predictable analgesic e ects when using full mu agonists
analgesia • Particularly useful for acute pain management in hospitali ed patients.
Examples buprenorphine, E ective use in chronic pain and long term pain management is thwarted by
codeine, methadone, lack of availability of suitable medications and formulations for use at home
fentanyl, tramadol • ral transmucosal buprenorphine can be useful for management of feline pain
at home; this route of administration is not thought to be as e ective in dogs
Robertson et al.,
• Codeine is a weak analgesic with a risk of gastrointestinal upset therefore it is
not recommended for use alone
• entanyl patches are useful to provide full opioid analgesia without the
need for in ectable drugs; however, transcutaneous absorption of the drug
is very unreliable
• ramadol is not licensed in veterinary species and its e ects may be
unpredictable based on individual patient metabolism. It is metaboli ed to its
active form and works through serotonin and noradrenalin reuptake inhibition
and is a weak mu opioid receptor agonist. It is often used in combination with
NSAI s or corticosteroids and is useful in the management of chronic
cancer associated pain.
• In cats, high concentrations of active metabolites mean lower doses and a
longer dosing interval are recommended
Alpha adrenergic agonists • Re uire parenteral administration
Examples medetomidine, • ay be administered as an infusion
dexmedetomidine • hen administered at low doses can provide e ective analgesia with
arousable sedation
• hese drugs may have signi cant cardiovascular e ects
N methyl aspartate • Provides reasonable analgesia. Plays a role in reducing central sensiti ation
N A antagonists and wind up . Particularly useful for pre emptive cancer analgesia and can be
Examples ketamine, e ective at low doses as a constant rate infusion during and after surgery to
amantadine reduce postoperative pain and opioid re uirements, e.g. following limb
amputation agner et al.,
• Amantadine has the added advantage of being available as an oral medication.
It can reduce chronic post surgical pain in amputees Pud et al., 1998
• Can be used in combination with NSAI s for e ective management
particularly of chronic pain
continued Important considerations regarding the use of medications in a clinical setting. continues

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