Pain Relief for
Pets
Here’s Steve Dale’s story on why pain relief
for pets is important, not to mention humane
By
Steve Dale
“As
our pets age, pain is inevitable, but suffering isn’t,” says Dr.
Peter Hanson, senior director companion animal pharmaceuticals
at Merial in Duluth, GA.
Statistically
most dogs and cats are over six years old, and as a result of
regular vet check ups, enhanced health care and better nutrition
– overall, pets are living longer than ever. Dogs and cats are
impacted by the same diseases associated with longevity as in
people, including various kinds of cancers and osteoarthritis.
“We
can’t prevent all the illnesses associated with old age, but we
can prevent chronic pain,” says Dr. Daniel Aja, president of the
American Animal Hospital Association. Earlier this year, the AAHA
published new Guidelines For Senior Care, which includes strong
wording concerning pain relief. The bottom line, according to
Aja is there’s absolutely no excuse for a dog or cat to be in
prolonged pain.
Historically,
this stance wasn’t always the case in veterinary medicine. “After
15 years in an emergency practice, I know that pain relief was
once considered, at best, an after thought,” says Michael McFarland,
director of sedation and pain management at Pfizer Animal Health.
He says, “It was thought veterinarians actually shouldn’t relieve
the pain – even if they could - because you wouldn’t want the
animal to do further damage.” For example, say after leg surgery,
you wouldn’t a dog to slow healing or risk a re-injury by being
active; a dog who is in pain won’t be active.
In
fact, science now shows not relieving pain is unwise. McFarland
explains, “Pain is a significant stressor and has a profound affect
on the ability to mount an immune response to heal.
“Relieve
pain and you’ll promote healing,” says Aja, who has a practice
in Traverse City, MI.
McFarland,
who is in Dallas, TX adds, “There was a second camp who simply
felt animals weren’t capable of feeling pain. Today, we know better,
and we understand that dogs and cats do feel pain very much the
same as we do.” So do hamsters and gerbils – birds, and even reptiles.
“We’re only now beginning to learn more about how to treat pain
in reptiles,” says Dr. Steve Barten, a veterinarian from Vernon
Hills, IL with a special interest in cold-blooded pets. “I believe
veterinarians have a responsibility to relieve their discomfort
just as (we do for) any other pet.”
The
ethical line in the sand has shifted. Aja says, “It’s simply wrong
to realize an animal is in pain and do nothing about it.”
The
first step may come down to realizing when an animal is in pain
in the first place. Small animals – like those hamsters and gerbils,
as well as birds and reptiles are masters at masking pain. In
the wild, if a bird or reptile looks like he or she is suffering,
that animal will quickly become dinner for a predator seeking
an easy meal. Even cats often times trick their owners into thinking
everything is fine, when in reality they’re hurting.
“If
a pet owner thinks a pet is in pain, that pet is probably suffering
no matter how it presents at the vet office,” says Aja. “No veterinarian
should discount an owner’s concerns, or minimize the importance
of managing pain.”
Even
in the recent past, the question was how to relieve pain. When
Dr. Daryl Millis, professor at the University of Tennessee College
of Veterinary Medicine – Knoxville, began practicing, his pain
relief tools were pretty much limited to aspirin and steroids.
Today,
aspirin is joined by a long list of additional non-steroidal anti-inflammatory
drugs (NSAID’s), as well as alternative therapies ranging from
acupuncture to physical therapy. Special drug preparations, known
as compounding, allows animals to take drugs they previously couldn’t.
Analgesics help pets post surgically. Even diet may play a surprising
role in pain management.
For
the first time, pain relief is now a discipline being researched.
Drugs are specifically being designed to help pets, rather than
hoping human drugs can do also ease anguish in animals. In fact,
as a result of this new focus on pain relief for pets, people
may also benefit.
For
example, at the University of Illinois college of Veterinary Medicine,
Urbana, veterinary oncologist Dr. Timothy Fan is now combining
a drug-class called bisphosphonates with chemotherapy and radiation
to treat bone cancer in dogs. “If we’re successful, not only will
we increase the lifespan of animals with bone cancer, but we’ll
alleviate excruciating pain associated with the disease,” he says.
So
far, about half the dogs have responded short term to the drug
cocktail, and about a quarter of them have improved longer term.
Fan adds, “This is significant because people also get this kind
of cancer, and our hope is to ultimately help people as well as
animals. As veterinarians and oncologists – we pay a lot of attention
to quality of life.”
Most
estimates indicate over half of all senior dogs and cats have
some degree osteoarthritis. As any person with arthritis can concur,
the pain can be overwhelming, absolutely impacting quality of
life. There’s no doubt that before Pfizer Animal Health marketed
a NSAID called Rimadyl in 1997, many more arthritic pets were
euthanized than today just because their owners couldn’t stand
to see them suffer.
Still,
until now, the assortment of recent NSAID’s for pets have been
based on human NSAID drugs; however the latest NSAID to hit the
market, called Previcox, was specifically researched and developed
by Merial to help dogs with osteoarthritis.
Hanson
of Merial maintains that the action of Previcox is specific to
dogs. ”We believe the safety and efficacy (of the drug) reflects
this.”
What
might be surprising is that even the drug company vets, Hanson
and McFarland of Pfizer are the first to agree that popping a
pill is not a long term solution to dealing with most chronic
pain.
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- - - - -
Animal
health experts concur pain relief is more than a matter of pushing
pills. In a nation of aging animals conservative estimates are
that chronic pain from osteoarthritis occurs in at least a third
of all dogs and cats. It turns out some relief might come from
chowing down dinner.
Nutrigenomics
is a new science that explores the inter-play between genetic
make-up and nutrition. For example, among some women it’s been
discovered green tea may lower the likelihood of breast cancer.
Dr. Craig Prior says the same inter-play occurs in all animals.
The Hills pet food company (Science Diet) has utilized this new
science to develop the best possible ratio of Omega 3 and Omega
6 fatty acids in their new prescription JD formula diet.
“What
happens is that the gene that causes the enzyme that erodes cartilage
is turned off,” says Prior, who has a private practice in Nashville,
TN. He’s saying the diet ultimately decreases inflammation, and
as a result the dogs simply don’t hurt as much.
Pet
food companies are realizing that their products can help manage
pain, which is why, for example, many brands include the nutritional
supplements Glucosamine and chondroitin sulfate in senior diets.
In conjunction with one another the balance of these two supplements
work to support the existing cartilage, and prevent further erosion.
Some
stalwart veterinarians maintain these nutritional supplements
aren’t effective, however most of their colleagues don’t see it
that way, and even rely on this tandem of nutritional supplements
as much as they do non steroidal anti-inflammatory drugs (NSAID’s).
“In many dogs – especially those who are most susceptible to arthritis,
we put them on Cosequin (a veterinary product with glucosamine
and chondroitin) even before there’s discernable pain,” says Dr.
Daniel Aja, president of the American Animal Hospital Association,
and a contributor to the Association’s Guidelines on Senior Care
which was crafted for veterinarians earlier this year.
Aja,
who has a practice in Traverse City, MI says he specifically recommends
Cosequin. Since nutritional supplements aren’t regulated by the
government, there’s no way to verify manufacturer’s claims or
the quality of the product. He says the manufacturer of Cosequin
(Nutrimax Laboratory in Edgewood, MD) backs their product with
considerable research, and answers to both vets and consumers.
According
to Aja about 75 per cent of his canine clients improve on Cosequin
(there’s also a Cosequin for cats). Still, many animals also require
a NSAID.
“Today,
we know chronic pain takes a toll on the immune system, and might
even affect lifespan,” says Aja. “Most certainly though, it’s
about quality of life. No pet should be in pain when we have so
many ways to combat pain.“
Is it like those TV commercials where an older dog is having a
difficult time climbing stairs in the first scene, and then after
popping a NSAID pill, the dog bounds up and down like a puppy?
“Well,
there’s no fountain of youth – but NSAID’s can make a significant
difference,” says Dr. Daryl Millis, a professor of orthopedic
surgery at the University of Tennessee College of Veterinary Medicine
– Knoxville.
Jean
Townsend of John’s Island, SC learned the hard way that bad may
come with the good. Like all drugs, NSAID’s do have potential
side-effects, and some may be life threatening. In 1997 her beloved
George succumbed after taking Rimadyl (the first NSAID to be marketed
to pets). “Of course, I didn’t want my dog to suffer with arthritis,
but I sure didn’t want to kill him,” she says.
Townsend
was a plaintiff in the Class Action lawsuit against Pfizer Animal
Health, the manufacturer of Rimadyl, and today she rallies on
the Internet to anyone who will listen against using NSAID’s in
pets.
Townsend
continues, “Look at drugs like Celebrex and Vioxx and the problems
they’ve caused in people.”
However,
those same cardiac related side-effects that can happen in people
don’t occur in pets, according to Dr. Colin Burrows, specialist
in internal medicine and chair at the small animal clinic at the
University of Florida College of Veterinary Medicine - Gainesville.
So,
what would Townsend do if her dogs began to suffer chronic pain?
Her first choice: buffered aspirin.
However,
aspirin might not be the best option. The truth is that aspirin
is a NSAID too, and therefore related to Rimadyl and the other
NSAID’s for pets. The difference is a certain formulation the
pet drugs have that is intended to lessen the odds of stomach
upset.
Dr.
Michael McFarland, director of the sedation and pain management
team at Pfizer points out, “Aspirin actually has an increased
risk (compared to NSAID’s specifically marketed for pets) of G/I
lesions. When a dose (of aspirin) isn’t effective clients tend
to increase it on their own, escalating the risk for a serious
reaction.” Having said that, there are vets who maintain old-fashioned
aspirin is still the best choice.
Even
McFarland, who works for a drug company, says, “Certainly, NSAID’s
do work, but they should be used appropriately. The most efficient
way to alleviate pain is to make informed choices with your veterinarian,
and certainly there’s nothing wrong with utilizing additional
modalities simultaneously.”
“A
program of exercise and physical therapy can make all the difference
in the world,” adds Millis. “Swimming and walking are the best
kept secrets. A NSAID may make it possible for a dog or cat in
pain to begin (an exercise or therapy program). In many cases,
the goal is to eventually wean them off medications. Sometimes
we can achieve that.”
Therapeutic
ultrasound, acupuncture, homeopathy and chiropractic are increasingly
gaining credibility in veterinary medicine. “I’m not a magician,”
says Dr. Julie Mayer in Chicago, IL, who practices these approaches.
“This is all based on science. There’s no placebo affect here.
The pets don’t know you’re trying something your friends and neighbors
think is a joke. But still, they get better.”
While
Mayer says she doesn’t want to her clients on a NSAID, even she
concedes sometimes it’s just a good idea. “I realize NSAID’s do
save lives,” she says. Millis adds that he recognizes that some
of the so-called alternative approaches might, in fact, be very
effective to help many pets, including the nutritional supplements
SAM-e (or S-adenosylmethionine) and avocado soy bean unsaponfiable
(or ASU) to alleviate pain.
Millis
says about half the pets with chronic osteoarthritis could lessen
their pain substantially without a single drug, without expensive
visits to facilities with underwater treadmills and all without
a single side effect. “If I could only convince them to lose a
few pounds,” says Mills. “For many pets going on a diet would
be the best bang for the buck. Getting people to give their pet
a pill, that’s easy. Convincing people their dog or cat will feel
better by losing a few pounds, it’s not nearly as easy.”
“The
good news is that are choices, and by implementing a program no
pet has to suffer,” says says Dr. Peter Hanson, senior director
companion animal pharmaceuticals at Merial in Duluth, GA. “The
worst thing you can do is to ignore that your pet is in pain,
and allow suffering to occur when it just doesn’t have to.”
