Page 168 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Cancer pain

VetBooks.ir Therapy Considerations

• Reduce bone pain and the risk of pathological fractures in humans with
Bisphosphonates
Examples pamidronate, malignant skeletal lesions an, 14
clodronate, oledronate, • echanism of action is principally through induction of osteoclast apoptosis,
aledronate attenuating pathological bone resorption Spugnini et al., 9 . hey also
promote apoptosis, inhibit angiogenesis, cancer cell division and
osteoclastogenesis
• Used for relief of osteolytic bone pain in veterinary patients from primary and
metastatic tumours and can help to control hypercalcaemia of malignancy, e.g.
with round cell tumours lymphoma, myeloma and anal sac adenocarcinoma
• Intravenous pamidronate, as a single agent or in combination with palliative
radiotherapy or and chemotherapy, has been shown to successfully alleviate
bone cancer pain and increase weight bearing in dogs an, 4 . he use of
oral bisphosphonates and in ectable oledronate has also been reported in
canine osteosarcoma aynor, ; omlin et al.,
• Both oral and intravenous formulations are available. Amino bisphosphonates
are the most potent
• here may be poor absorption of oral bisphosphonates from the
gastrointestinal tract, especially in the presence of food Spugnini et al., 9
• esophageal in ury can occur if the oral medication is not swallowed uickly
and completely, leading to prolonged contact with the mucosa
• here is a theoretical risk of renal in ury associated with use of these drugs in
dogs but this has not been clearly demonstrated; however, monitoring renal
function during use is recommended
Complementary therapies • Used for acute and chronic pain, lymphoedema and reduction of post surgical
including traditional swelling in human medicine. ay reduce treatment related nausea
acupuncture and • Side e ects are minimal
electroacupuncture • or further information see Chapter 6 and specialist texts Sliwa and arciniak,
1999
ther physical therapies • Physical supportive therapy is expanding in veterinary medicine, however the
including massage, hot and evidence base is still sparse. espite this many of these therapies have been
cold therapy, laser therapy shown to be bene cial in the human eld Looney, 1
Nutrition and supplementary • mega free fatty acids have been shown to decrease oint in ammation in
therapies osteoarthritis. hey have also been shown to be bene cial in in vitro and in vivo
Examples omega free fatty studies in humans and dogs with cancer such as lymphoma, nasal tumours,
acids, omega 6 fatty acids haemangiosarcoma and osteosarcoma
• mega 6 fatty acids may be bene cial in the management of epitheliotrophic
lymphoma in dogs by reducing painful skin in ammation
opical therapies • ay be useful to aid healing and reduce in ammation in some oral, mucosal,
Examples steroids, mucocutaneous or cutaneous lesions secondary to cancer or its treatment
antihistamines, a ueous • Seek specialist advice before applying any topical therapy to open surgical
agents, silver sulfadia ine, wounds or in the case of radiotherapy side e ects
aloe, honey, colloidal
oatmeal, capsaicin
Surgical techni ues • Usually a last resort and infre uently used due to other uality of life issues.
Examples neuroablative hese techni ues may be explored more over the next decade in both human
techni ues and veterinary medicine

continued Important considerations regarding the use of medications in a clinical setting.

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