I have a special interest in geriatric medicine. While roly-poly puppies always brighten up a veterinarian’s day, for me, nothing beats a gray muzzle smiling up at me. The most common condition I have to deal with in my older patients in chronic pain. When the source of that pain cannot be eliminated (think osteoarthritis in multiple joints or some types of cancer), effective pain relief can quite literally be a life-saver.
Because I treat pain so frequently, I have come up with a go-to combination of medications that I reach for unless the dog’s condition demands something different. Most chronic pain patients respond best to what is called “multi-modal” pain relief. In other words, by using several medications that have different mechanisms of action, we can achieve better pain control and reduce the incidence of side effects.
Most dogs that I treat for chronic pain receive some combination of the following:
A Non-Steroidal Anti-Inflammatory (NSAID)
- Examples include carprofen, deracoxib, etodolac, firocoxib, and meloxicam.
- NSAIDs work by blocking enzymes that promote the production of pro-inflammatory prostaglandins.
- Common side effects - decreased appetite
- Occasional side effects - vomiting, diarrhea, dark or tarry stools, behavioral changes
- Rare side effects - increased water intake, increased urination, pale or yellow gums or skin, incoordination, seizures
- Should not be given to dogs who are not eating or have stomach ulcers, major kidney or liver dysfunction, known bleeding disorders, or previously not tolerated NSAIDs well. Stomach protectants, such as famotidine, can be used as a precaution in dogs who have sensitive stomachs.
- Do not use in combination with prednisone or other NSAIDs. Ideally 4 to 7 days of “washout” time should be allowed between ending Prednisone or another NSAID and starting an NSAID.