Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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FEATURES NOVEMBER/DECEMBER 2018 25 Gabapentin and Amantadine for Chronic Pain: Is Your Dose Right? PAIN MANAGEMENT Tamara Grubb, DVM, PhD, DACVAA Associate Professor, Anesthesia and Analgesia Washington State University, College of Veterinary Medicine Pullman, Washington Pain is not always a bad thing, and all pain is not the same. Acute (protective) pain differs from chronic (maladaptive) pain in terms of function and treatment. This article describes the types of pain, the reasons why chronic pain can be difficult to treat, and the use of gabapentin and amantadine for treatment of chronic pain. ACUTE PAIN Acute pain in response to tissue damage is often called protective pain because it causes the patient to withdraw tissue that is being damaged to protect it from further injury (e.g., a dog withdrawing a paw after it steps on something sharp) or to become less active to protect tissue that is already damaged but healing (e.g., a cat sleeping frequently after abdominal surgery). A commonly used definition of acute pain reflects its normal role in tissue protection and healing: "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." 1 Protective pain (also called adaptive or nociceptive pain) is normal and a necessary adaptation for survival, but even protective pain causes adverse effects, and pain that exceeds the level needed for protection should be treated. Untreated or undertreated pain can cause myriad adverse effects, including but not limited to insomnia, anorexia, immunosuppression, cachexia, delayed wound healing, increased pain sensation, hypertension, and behavior changes that can lead to changes in the human–animal bond. 2 Hence, we administer analgesic drugs to patients with acute pain, not to eliminate the protective portion but to control the pain beyond that needed for protection (i.e., the pain that negatively affects normal physiologic processes and healing). This latter type of pain decreases quality of life without providing any adaptive protective mechanisms and is thus called maladaptive pain. It serves no protective purpose but can cause the pain- mediated adverse effects previously mentioned. CHRONIC PAIN Chronic pain falls largely into the maladaptive pain category. This pain is often not protective because chronic pain is generally not caused by conditions that require rest for tissue healing, even if an acute injury that might have healed actually started the pain process. A common definition of chronic pain reflects SENIOR PATIENTS DEALING WITH CHRONIC PAIN The most common cause of chronic maladaptive pain is osteoarthritis, or degenerative joint disease. CONTINUING EDUCATION

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