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 33 include memantine, dextromethorphan, and a few others, 29 none of which have been studied for relief of neuropathic pain in veterinary patients. CONCLUSION Although research evidence is currently lacking, the scientific mechanisms of gabapentin and amantadine support their use as part of analgesic protocols for chronic pain relief in dogs and cats. Each can effectively treat chronic pain when the dose, administration frequency, and duration of treatment are correct. When to choose one drug over the other? That choice is somewhat personal preference but also based on disease progression. Either or both can be part of initial therapy for chronic osteoarthritis pain. I often use both (usually with no dosage adjustments) if pain is severe. Your first choice for known nerve damage should be gabapentin, and your first choice for pain that is suddenly worse than expected with no signs of worsening disease should be amantadine. But you really cannot go wrong; grab one of them—or both of them—and try! Gabapentin and amantadine are best used as part of a multimodal protocol, especially when pain is moderate to severe. References 1. Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 2 nd ed. Seattle: International Association for the Study of Pain Press; 1994. 2. Muir WW. Pain and stress. In: Gaynor JS and Muir WW, eds. Handbook of Veterinary Pain Management. 3 rd ed. St Louis: Mosby; 2014:42-60. 3. Adrian D, Papich M, Baynes R, Murrell J, et al. Chronic maladaptive pain in cats: a review of current and future drug treatment options. Vet J 2017;230:5 2-61. 4. Jensen TS, Baron R, Haanpää M, et al. A new definition of neuropathic pain. Pain 2011;152(10):2204-2205. 5. Mathews KA. Neuropathic pain in dogs and cats: if only they could tell us if they hurt. Vet Clin North Am Small Anim Pract 2008;38(6):1365- 1414. 6. Moore SA. Managing neuropathic pain in dogs. Front Vet Sci 2016;3(12):1-8. 7. KuKanich B. Outpatient oral analgesics in dogs and cats beyond nonsteroidal antiinflammatory drugs: an evidence-based approach. Vet Clin North Am Small Anim Pract 2013;43(5):1109-1125. 8. Budsberg SC, Torres BT, Kleine SA, et al. Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. J AVMA 2018;25 2(4):427-432. 9. KuKanich B, Papich MG. Pharmacokinetics of tramadol and the metabolite O-desmethyltramadol in dogs. Vet Pharmacol Ther 2004;27(4):239-46. 10. Monteiro BP, Klinck MP, Moreau M, et al. Analgesic efficacy of tramadol in cats with naturally occurring osteoarthritis. PLoS One 2017;12(4):e0175565. 11. Bockbrader HN, Wesche D, Miller R, et al. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet 2010;49(10):661-669. 12. Kukanich B, Cohen RL. Pharmacokinetics of oral gabapentin in greyhound dogs. Vet J 2011;187(1):133-135. 13. Siao KT, Pypendop BH, Ilkiw JE. Pharmacokinetics of gabapentin in cats. Am J Vet Res 2010;71(7):817-821. 14. Lorenz ND, Comerford EJ, Iff I. Long-term use of gabapentin for musculoskeletal disease and trauma in three cats. J Feline Med Surg 2013;15:507–512. 15. Vettorato E, Corletto F. Gabapentin as part of multi-modal analgesia in two cats suffering multiple injuries. Vet Anaesth Analg 2011;38:518–520. 16. Crociolli GC, Cassu RN, Barbero RC, et al. Gabapentin as an adjuvant for postoperative pain management in dogs undergoing mastectomy. J Vet Med Sci 2015;77:1011–1015. 17. Plessas IN, Volk HA, Rusbridge C, Vanhaesebrouck AE, Jeffery ND. Comparison of gabapentin versus topiramate on clinically affected dogs with Chiari-like malformation and syringomyelia. Vet Rec 2015;177:288. 18. Aghighi SA, Tipold A, Piechotta M, Lewczuk P, Kastner SB. Assessment of the effects of adjunctive gabapentin on postoperative pain after intervertebral disc surgery in dogs. Vet Anaesth Analg 2012;39:636– 646. 19. Pypendop BH, Siao KT, Ilkiw JE. Thermal antinociceptive effect of orally administered gabapentin in healthy cats. Am J Vet Res 2010;71:1027–1032. 20. Vollmer KO, von Hodenberg A, Kölle EU. Pharmacokinetics and metabolism of gabapentin in rat, dog and man. Arzneimittelforschung 1986;36(5):830-839. 21. Salazar V, Dewey CW, Schwark W, Badgley BL, Gleed RD, Horne W, Ludders JW. Pharmacokinetics of single-dose oral pregabalin administration in normal dogs. Vet Anaesth Analg 2009;36(6):574-580. 22. Esteban MA, Dewey CW, Schwark WS, et al. Pharmacokinetics of single-dose oral pregabalin administration in normal cats. Front Vet Sci 2018;20;5:136. 23. van Haaften KA, Forsythe LRE, Stelow EA, Bain MJ. Effects of a single preappointment dose of gabapentin on signs of stress in cats during transportation and veterinary examination. J AVMA 2017;251(10):1175- 1181. 24. Bleidner WE, Harmon JB, Hewes WE. Absorption, distribution and excretion of amantadine hydrochloride. J Pharmacol Exp Ther 1965;150:484–90. 25. Siao KT, Pypendop BH, Stanley SD. Pharmacokinetics of amantadine in cats. J Vet Pharmacol Ther 2011;34:599-604. 26. Lascelles BD, Gaynor JS, Smith ES, et al. Amantadine in a multimodal analgesic regimen for alleviation of refractory osteoarthritis pain in dogs. J Vet Intern Med 2008;22(1):53-59. 27. Siao KT, Pypendop BH, Escobar A, et al. Effect of amantadine on oxymorphone-induced thermal antinociception in cats. J Vet Pharmacol Ther 2012;35(2):169-174. 28. Niesters M, Martini C, Dahan A. Ketamine for chronic pain: risks and benefits. Br J Clin Pharmacol 2014;77(2):357-367. 29. Aiyer R, Mehta N, Gungor S, Gulati A. A systematic review of NMDA receptor antagonists for treatment of neuropathic pain in clinical practice. Clin J Pain 2018;34(5):450-467. Tamara Grubb Dr. Grubb is a board certified veterinary anesthesiologist with a strong clinical interest and research focus in pain management. She is a certified acupuncturist and a consultant in a private small animal veterinary practice. She is also a member of the board of directors of the International Veterinary Academy of Pain Management (IVAPM). Her most notable achievement was winning the Carl J. Norden Distinguished Teaching Award, which has been awarded to her from students at two universities.

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