Page 167 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir Therapy Considerations

Anti convulsants
• Especially useful for chronic and neuropathic cancer pain
Examples gabapentin, • Can be e ective in combination therapy, e.g. with concurrent NSAI s and or
pregabalin tramadol
Antihistamines • E ective for speci c tumour types, e.g. mast cell tumours where in ammation
Examples chlorphenamine, may be associated with histamine release
loratidine • ay reduce radiation induced dermatitis
• Available as in ectable and oral formulations
• ay also have anti nausea and appetite stimulatory e ects; therefore useful in
patients receiving chemotherapy
Sedatives and • ay be useful for the management of chronic and neuropathic pain
antidepressants • Alter re uptake of serotonin and noradrenaline in the central nervous system
Examples amitriptyline,
clomipramine
Local analgesic techni ues • enerally useful for the management of acute or surgical pain. Can be highly
Examples intercostal nerve e ective in the short term and are associated with minimal systemic side
blocks, intrapleural local e ects
anaesthetic, brachial plexus • Some techni ues re uire specialist knowledge and expertise
nerve block, opioid or local • Lidocaine patches may be suitable for local bruising, surgical wounds. No
anaesthetics administered by apparent systemic toxic e ects have been noted. ust be stapled in place and
epidural in ection or infusion hair clipped for contact eiland et al., 6
catheter, craniofacial
maxillary, mandibular,
mental, infraorbital nerve
blocks , wound soaker local
anaesthetic catheters
Radiotherapy • ighly e ective at palliative doses for the management of osteolytic bone
pain in human cancer patients an, 14 . echanism of action is complex but
may be by inducing apoptosis in malignant osteoblasts and activated
osteoclasts and reduced secretion of prostaglandins by tumour associated
in ammatory cells. Also has direct anti neoplastic activity ilner et al., 4
• Its use is well described for management of bone cancer pain in dogs with
osteosarcoma, where amputation is declined. ay be useful for primary
tumours that invade bone, e.g. s uamous cell carcinoma of the oral cavity in
cats, or for management of secondary bone metastases, e.g. from prostatic
carcinoma in dogs. Can be highly e ective in the treatment of round cell
tumours with bone involvement lymphoma, myeloma
• Radiotherapy may be the chosen primary treatment modality for tumours
associated with pain, e.g. brain tumours or nasal tumours
• Re uires referral for access to specialist e uipment and treatment planning
• Expensive
• ost palliative protocols involve 4 individual treatments delivered 1 week
apart. ive daily fraction protocols are also employed
• Late side e ects theoretically of greater concern although patients may not
live long enough to develop these
• ay be used in combination with other analgesic drugs, bisphosphonates and
chemotherapy agents. Radiotherapy can enhance analgesic drug
e ectiveness by reducing tumour bulk e.g. in intracranial tumours or
mediastinal tumours
continued Important considerations regarding the use of medications in a clinical setting. continues

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