Page 172 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Cancer pain

VetBooks.ir CASE EXAMPLE 2 CONTINUED ■ Analgesic ladder level for management

at home paracetamol codeine
ANALGESIC PLAN mg kg Pardale V orally 8–1 h ;
tramadol 4 mg kg orally 1 h ;
■ Analgesic ladder level initially gabapentin 1 –1 mg kg orally 8h ;
methadone .1– . mg kg i.v. 4h ; prednisolone oral tapering dose .
radiotherapy fractions of radiotherapy
to a total dose of y ; prednisolone Tips from the authors
. mg kg orally 1 h ; gabapentin In this case the invasive nature of the
1 –1 mg kg orally 8h ; fentanyl patch sarcoma was associated with severe pain and
placement changed every 7 hours ; neurological dysfunction. Euthanasia was
oledronate 4 mg over 1 minutes with o ered from the outset given the poor overall
.9 NaCl i.v. infusion . prognosis. owever, the owners wanted to
pursue treatment if her oL could be
improved and maintained.

e ex p e 3 Appendicular osteosarcoma

HISTORY AND PRESENTATION ANALGESIA PLAN
A year old male neutered Labrador Analgesic ladder level meloxicam .1 mg
Retriever was diagnosed with appendicular kg orally 4h ; tramadol –4 mg kg orally
osteosarcoma. here was local osteolytic 8–1 h ; gabapentin 1 mg kg orally 8h ;
bone disease at the time of presentation with verbal and physical comforting by the owner
no nodal or distant metastases. he right following pain episodes.
forelimb was amputated and a course of
chemotherapy with carboplatin Tips from the authors
implemented. hirty days after amputation, Phantom limb pain is under reported in
spontaneous pain episodes began and were veterinary amputees but occurs in the
subse uently documented in a pain diary ma ority of human amputees. It is part of a
kept by the owner. complex of symptoms that can also include
stump pain neuroma formation at the
TYPES OF PAIN surgical site and phantom sensations. It is
chronic in nature, neuropathic in origin
Severe, intense, short duration but multiple although local neuroma formation may be
episodes daily. Possible in ammatory concurrent with local in ammation and
somatic pain at surgical site; clinical signs appears to respond well, as in this case, to
most compatible with neuropathic pain gabapentin therapy. Chronic pain prior to
including central sensiti ation leading to amputation may contribute to wind up and
hyperalgesia . central sensiti ation. ultimodal pre and
perioperative analgesia appears to reduce
the incidence and severity of phantom pain in
human amputees.

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