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Pain Management in Small Animals with Lameness

By

Joseph Harari

, MS, DVM, DACVS, Veterinary Surgical Specialists, Spokane, WA

Last full review/revision Jun 2021 | Content last modified Jun 2021
Topic Resources

Control of pain in small animals with lameness, including those in the postoperative period, involves a broad range of analgesics including NSAIDs and opioids. Analgesic agents may be administered via oral, parenteral (including constant-rate infusions), epidural, local, or transdermal routes. Nonpharmacologic pain management strategies include acupuncture, massage, physical rehabilitation, and diet.

Commonly administered NSAIDs include COX-2 inhibitors, aspirin, and several other drugs (see Table: NSAIDs Used for Pain Management in Dogs and Cats). The use of NSAIDs is contraindicated in animals with hepatic or renal insufficiency, gastroenteritis, or coagulopathy, and in patients receiving concurrent corticosteroid treatment.

Table
icon

NSAIDs Used for Pain Management in Dogs and Cats

Drug

Dosagea

Aspirin

Dogs: 22 mg/kg, PO, twice a day

Cats: 10 mg/kg, PO, every 48 hours

Carprofen

Dogs: 2.2 mg/kg, PO, twice a day

Deracoxib

Dogs: 4 mg/kg/day, PO

Etodolac

Dogs: 12.5 mg/kg/day, PO

Firocoxib

Dogs: 5 mg/kg/day, PO

Grapiprant

Dogs: 2 mg/kg, PO, once a day

Ketoprofen

Dogs: 1 mg/kg/day, PO, IV, SC, IM

Cats: 1 mg/kg/day, PO, IV, SC, IM

Meloxicam

Dogs: 0.1 mg/kg/day, IV, SC, PO

Cats: 0.1 mg/kg/day, IV, SC, PO, for 1–3 days

Robenacoxib

3 days maximum use

Dogs: 2 mg/kg, PO or SC, once a day

Cats: 1 mg/kg, PO, once a day or 2 mg/kg, SC

Tepoxalin

Dogs: 10 mg/kg/day, PO

aIf no dosage is listed for cats, the drug is not recommended for use in that species.

Opioid analgesics bind to mu, kappa, and delta receptors in the CNS to provide pain relief. Commonly administered opioids include morphine (0.1 mg/kg, IV, IM, SC, every 3–4 hours), oxymorphone (0.05 mg/kg, IV, IM, SC, every 3–4 hours), hydromorphone (0.1 mg/kg, IV, IM, SC, every 2–4 hours), butorphanol (0.1 mg/kg, IV, IM, SC, every 2–4 hours in dogs and cats), and buprenorphine (0.01 mg/kg, IV, IM, SC, every 8 hours in dogs and cats, also transmucosal in cats).

Opioid analgesics can be administered with sedatives such as acepromazine (0.5 mg/kg, IV, IM, SC, every 4–6 hours) for enhanced efficacy of analgesia and sedation. Oxymorphone, hydromorphone, and butorphanol are more potent than morphine. Buprenorphine has the longest duration of action and is now available in a sustained-release formulation (dogs: 0.03–0.06 mg/kg, SC, single injection; cats: 0.12 mg/kg, SC, single injection). Another opioid, fentanyl, is most frequently administered via a transdermal patch applied at 3 day intervals on shaved skin. Oral opioids administered for pain relief include tramadol (5 mg/kg, 3 times a day), butorphanol (1 mg/kg, 3 times a day), hydromorphone (0.5 mg/kg, every 8 hours), codeine (1 mg/kg, every 8 hours), and oxycodone (0.3 mg/kg, every 8 hours).

Local administration of analgesics involves intraarticular injections of morphine (1 mg diluted in 5 mL of saline), bupivicaine (1 mL/20 kg body wt), or lidocaine (1 mL/20 kg body wt) preoperatively, as a preemptive block of intracapsular pain receptors. Recently, a bupivicaine liposome suspension was developed for intraoperative local infiltration in dogs (0.4 mL/kg) aimed at reducing postoperative pain. Administration of epidural morphine (0.1 mg/kg) in the lumbosacral space is also a useful adjunct for postoperative pain relief in the hind limbs and to reduce overall anesthetic requirements. Corticosteroids are considered weak analgesic adjuncts, because they indirectly reduce pain via their primary mode of action as local anti-inflammatory agents at the injury site. Drugs administered include prednisone or prednisolone (1–2 mg/kg/day, PO) or dexamethasone (1–2 mg/kg/day, IV). Their use is contraindicated during concurrent NSAID treatment.

Gabapentin (10 mg/kg, PO, every 12 hours) is a calcium channel blocker used to inhibit neurons stimulated by pain; it is useful for treatment of animals with chronic or neuropathic pain. Dexmedetomidine (5 mcg/kg/day, IM) and medetomidine (10 mcg/kg/day, IM) are newer analgesic-sedative, alpha-2-receptor blocking agents useful to facilitate examinations or diagnostic evaluations.

Joint fluid modifiers (glucosamine, chondroiton sulfate, hyaluronan, pentosan polysulfate, omega-3 fatty acids) have received extensive attention for the possible effectiveness in treating degenerative joint disease and alleviating associated discomfort. Although contraindications and adverse effects are few, robust evidence in support of these compounds is limited, and most reports are regarded as anecdotal. Stem cell and platelet-rich plasma therapies to alleviate pain and discomfort due to diseased joints are also newer modalities for which scientific validity is pending.

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  • Also see pet health content regarding lameness in dogsand cats.

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Musculoskeletal Disorders in Large Animals
A seven-year-old Quarter horse gelding presents with a 1-week history of mild lameness. During the examination, the horse raises his head as he places weight on his left forelimb and drops it when placing weight on the right forelimb. Which limb is most likely affected in this horse?
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