A veterinary practice that is committed to providing compassionate care to its patients must place a large amount of emphasis on pain management geared specifically toward veterinary patients. In some cases, pain management can be the core focus of a veterinary practice. The relief of animal pain is a key contributor to successful patient outcomes and enhancement of the veterinary-client-patient relationship. Treatment and management of pain in feline patients requires a comprehensive, team-oriented approach that consists of:

• Anticipation
• Assessment
• Intervention
• Evaluation

The cat owner is considered an important part of the team, particularly for managing chronic pain in their pet. The guidelines recommend pharmacologic and non-pharmacologic modalities to manage pain. Pain comes in many forms, durations, and intensities. For practical reasons, we’ll simplify the classification into two major categories: acute or post-surgical pain and chronic pain dominated by degenerative joint disease (DJD).

Acute pain resulting from surgery is anticipated and dealt with prospectively. The treatment time is short.

Chronic pain due to DJD, associated with chronic inflammation and neuropathic components, as the most common cause, needs a long-term treatment plan utilizing both modalities — pharmacologic and non-pharmacologic options. Some other causes of chronic pain include malignancy, orthopedic disorders, chronic soft tissue injury, and nervous tissue injury. The more appropriate terminology in these cases is managing rather than treating the pain.

Personalizing Feline Pain Management

The focus of our discussion will be on pharmacologic management of chronic pain in cats. In doing this, there are challenges for the veterinarian every step of the way:

• Because cats are very good at hiding their symptoms, proper evaluation for an accurate diagnosis is the initial task for the veterinarian.
• The next and major challenge in the pharmacologic management of chronic pain in feline patients is the lack of approved drugs.
• The list of issues continues with the difficulty in medication administration as cats are fearful and finicky patients.

The solution to these and other obstacles is personalized care through compounding. To be successful in managing chronic pain in feline patients, veterinarians must use compounded medications. Many are already doing so, with or without knowing it. From the FDA’s perspective, any off-label use of an approved drug for humans or animal species is considered compounding. For feline patients, more than 80% of prescribed medications are already being used off-label. Further customizing with the preferred flavor, precise strength, changing the route of administration only proves how compounding is both a necessity and an added value to veterinary practices in providing personalized care. Compounded feline pain medications are a substantial part of this individualized therapeutic approach.

Opioids for Feline Pain Management

Opioids are the most effective drug class for managing acute pain and can play a role in managing chronic pain in cats. The individual effect of any opioid, including duration, may vary widely from patient to patient, thus needing an individualized dose.

Buprenorphine is an opioid medication used to manage chronic pain in cats and is classified as a Schedule III controlled substance. Buprenorphine is not available in an FDA approved commercially available dosage form for use in cats, so when it is prescribed, it must be compounded. For many veterinarians, buccal administration is the preferred route for chronic pain management.

Tramadol is another opioid medication approved for use in humans and used off-label more frequently in veterinary medicine.  Compounded tramadol in a flavored oral suspension improves its palatability, thereby increasing compliance and providing more accurate dosing.

NSAIDs and Chronic Pain

NSAIDs are usually used for their antipyretic, analgesic, and anti-inflammatory properties. When using NSAID’s in cats, two critical factors must be considered:

• Due to their physiological deviations in metabolizing drugs, cats receiving NSAID’s may have increased risk for adverse drug reactions and toxicity compared to dogs and humans receiving the same class of drug.
• Rates of metabolism vary among different cats and are inconsistent in cats when compared to other species.

Meloxicam is one of the few NSAID’s that can be used in cats with acute or chronic pain. Any use of it for chronic pain is off-label, and many cautionary measures must be taken due to its potential for hepatic and renal toxicity, even in very low therapeutic doses. If it is prescribed, compounding is the only option for achieving an appropriate concentration of the drug.

Robenacoxib is currently approved in the U.S. for use of up to three days’ duration for postoperative pain in cats and dogs. It is reported to have a good safety profile in cats, but there are currently no studies looking at safe usage in cats with DJD, until now. If the veterinarian decides to prescribe it for chronic pain management, a compounded version would most likely be needed.

Adjunct Medications

In some cats, chronic pain may not be controlled well enough with monotherapy. Adjunct medications combined into one prescription or given separately may be needed. Selecting the most appropriate added medication depends on the type of pain and any other medications the cat patient may be taking.

Gabapentin, an anticonvulsant drug, can be used in cats in combination with opioids or NSAID’s as an adjunct for chronic pain management. It is particularly effective for neuropathic pain. Any of the forms prescribed must be compounded to meet the patient’s specific needs.

Amitriptyline is a tricyclic antidepressant (TCA). It may be used in combination either with opioids or NSAID’s in the management of chronic neuropathic pain in cats and the dosages required are only available in compounded forms.

Amantadine is an antiviral drug with NMDA antagonist properties, thus playing a role in managing chronic neuropathic pain, as part of multimodal therapy. It is usually combined with NSAID’s. To facilitate accurate dosing or allow combination, it must be compounded.

Despite the challenges for veterinarians and pet owners, chronic pain management in feline patients can be more easily accomplished through the multimodal therapeutic approach. With safety concerns in mind, personalized care with compounded medication is at the core of this approach.

If you want to learn more about the virtually endless possibilities pharmaceutical compounding can offer in treating your feline patients, you must work closely with a reliable compounding pharmacy.

If you need help with practical advice and creative solutions for your difficult to treat feline patients, an experienced compounding pharmacist is the professional to call.

Let HALDEY Pharmaceutical Compounding be that pharmacy and any of its expert pharmacists be that professional to help you.

HALDEY Makes the Pain of Pain Management Disappear

Call us today for a free assessment of your feline compounding needs.