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Peer reviewed FOCUS ON PHARMACOLOGY Feline Friendly Article Management of Chronic Pain in Cats Dinah G. Jordan, BSPh, RPh, Pharm D, FSVHP, Diplomate ICVP, and Joel D. Ray, DVM, MS C hronic pain in cats is commonly associated with malignancy, chronic inflammation, orthopedic disorders, chronic soft tissue injury, and nervous tissue injury.1 It is often difficult to recognize because the signs may be subtle, such as:2 ���Hiding/withdrawing from humans or other animals in the home ���Reluctance to move or engage in normal activities ���Lackofappetite ���Eliminationoutsidethelitterbox ���Aggressiveness. Management presents several challenges for the veterinarian, including: ���Lackofapprovedproducts ���Potentialforadversedrugreactions ���Difficultiesinlong-termdrugadministration ���Difficultydeterminingdrugefficacyin���stoic��� cats. The most effective pain control often requires multimodal drug therapy: Opioids and nonsteroidalanti-inflammatorydrugs(NSAIDs)arethe2 most commonly used drug classes; they may be supplemented with nutraceuticals and adjuvant analgesics. OPIOIDS Buprenorphine Buprenorphine is a partial mu-agonist used to manage chronic pain in cats and is classified by the Drug Enforcement Administration (DEA) as a Schedule III controlled substance. Buprenorphine is not approved by the Food & Drug Administration (FDA) for use in cats.3 Administration. The common dose range is 0.01 to 0.03 mg/kg Q 6 to 8 H, which equates to 0.033 to 0.1 mL/kg of the injectable form (buprenorphine, 0.3 mg/mL).3 The drug may be administered SC, IM, IV, or buccally; buccal administration is the preferred route for chronic pain management.3 Buccal(transmucosal)administrationofthe injectable form is well tolerated (does not cause salivation),hasawidemarginofsafety,andproduces predictable analgesia, especially for mild tomoderatepain.Italsomakesthemedication easier for owners to administer, since the volume required is small and can easily be squirted into the side of the cat���s mouth.4 Cautions. Vomiting is rarely reported in cats; inappetance may occur after several days of therapy. Other side effects typical of opiates includebehavioralchanges(euphoria)andmydriasis. Generally, side effects can be diminished by a small reduction in dose.3,4 November/December 2012 Today���s Veterinary Practice 77