Cant decide on best pain med to use...

I know there are a zillion posts on this. Im sorry to add another, but sometimes I think certain situations may call for more specific advice. I apoligize in advance if we are not one of those circumstances.

I think Latte might benefit from some pain relief for her arthritis. She is not crying, or howling (except when tummy hurts). Back in september she lost her ability to walk for a few days. she could only scoot. It was very sad, and no one has figured out what specifically caused it - neuropathy, arthritis, clot ruled out, vitamin deficiency (cant recall which one, but we tried supplementing it anyway), metabolic acidosis. Since then she has been slower and wobbly in the back legs. She can get up quickly, but laying down is obviously quite a chore for her. it takes a few minutes. Sometimes, when changing laying positions I notice she does not use her back legs much...just drags them around. She uses stairs and/or ramps to get up onto things. She can jump OFF things without much hesitation. She can also jump accross pretty well. Its the walking and laying down that is most obvious.

Her BG's have been going up a lot higher lately as well. Could be one or more of a zillion reasons. Pain could be part of it.

Now, Latte is a survivor of ARF from Metacam. She has CRF now. She cannot any other NSAIDS. Quite frankly I am terrified of any choice out there. I dont want her to spend the rest of her days drugged up and loopy from pain meds. Thats not any more fair than letting her be in a bit of pain. And, if a drug can cause problems - usually serious ones- Latte will be 'that' cat who suffers the reaction. She seems very sensitive between the metacam, pred causing diabetes, and side effects from leukeran nearly killing her.

Im trying to touch base with her specialist, and her regular vet is out. Her back up vet has recommended tramadol. But after reading one of Dr. Lisa's comments that its like metacam - it either works great for some cats or will cause BIG problems - Im now hesitant. I know bup is an option, but her specialist made it sound like it possibly wouldnt be enough for arthritis pain. I need to confirm that however. I also understand it is expensive and will likely have that side effect of making a cat drowsy or loopy.

Can anyone give other options and/or clarify the risks that might be involved with pain meds and a sensitive cat?

Thanks!

Re: Freakin' out on pain meds! Experiences, please...

Carolyn

there have been lots of threads on the topic and there are options that include adequan and others that work similarly, so if you do a search that will be a start. you can also add in cosequin, msm, omega 3s, etc

Re: Freakin' out on pain meds! Experiences, please...

Jen & Squeak said:

Carolyn

there have been lots of threads on the topic and there are options that include adequan and others that work similarly, so if you do a search that will be a start. you can also add in cosequin, msm, omega 3s, etc

Click to expand...

Thanks Jen,
I guess Im asking more for a little bit of support in deciding what to do and what to choose. Maybe I should change the title? As of right now my view towards pain meds is that when I give her first dose of whatever it may be, I best be prepared to say goodbye. Might sound kind of extreme and irrational, but the association due to our metacam experience is so strong I cant shake it. And yes, I do this with almost all new meds for her...but pain meds are even harder.

I have done a search on pain meds and I could be here until its too late for her, reading the various threads and googling. As a long time member of the board, Im sure you get tired of answering the same questions. But really, there are times when the personal responses to your unique (or not so unique) situation can make a world of difference in helping you make a good decision.

Is there a better way for me to put this question forward to the group?

If I cant decide because I dont know if any of them will help enough or be safe enough for her then do I need to consider pts? In the back of my mind I've always wondered if that is what it would come down to. I cant bear giving her something again that might kill her. I would NEVER forgive myself. I also cant let her be in so much pain that she is not enjoying life. I dont think we are there yet, but probably getting much closer.

Adequan is only for joints.....won't help for arthritis anywhere but joints. Carolyn, have you had her spine checked? I know when I ruptured a disc the pain was in the leg but actually was coming from the one disc that we crushing the sciatic nerve.

((((Carolyn)))) I have no experience, but wanted to know I can hear your concern.

Here are some other products you could use. Keep in mind that I would use these in ADDITION to anything else, as these are cat treats, but have the glucosamine, chrondroitin, MSM in them. So they will help with joints and cartilege, but alone may not be the solution.

I do know that for years, I gave Sydney Schiff brand Move free pills (the smallest dose available) and broke pills in half. Only recently, I learned about kitty treats that contain the same ingredients and no pill.

I've purchased catswell, happy hips - now this doesn't contain MSM, so I stopped using it, but ingredient wise, it's chicken jerky strips and the supplements. I found it really cheap on Amazon:
http://www.amazon.com/Catswell-Chicken- ... 701&sr=8-1

And the other product I am using that contains MSM is pet naturals of vermont, however, it may not be the most diabetic friendly product:

http://www.luckyvitamin.com/p-4070-pet- ... -chewables

These are the cheapest places, I've found both.

So, you can safely use these products while you are deciding what else to use.

Carolyn
I can relate to what your saying. My cat Harley has front leg issues that I can't figure out and I have posted for recommendations before. Right now I am trying the methyl b-12 in hopes that helps him but I am not sure I am expecting much.

You mentioned something about metacam and I would like to hear more about that because my vet actually prescribed that for my cat. I gave Harley about 4 doses of it before I heard it was dangerous. What did it do to your cat?

I already have Harley on treats that have glucosamine and chondroitan and have for several months but so far those don't seem to make a lot of difference but he does LOVE the treats.

I am considering speaking to my vet about the buprenex.

Tramadol is an opiate like Buprenex. The only bad effects that I know about tramadol is that it makes a lot of cats foam at the mouth during administration and it over sedates many cat. The advantage is that is is very cheap. It if work, I would use it.

Hi Carolyn

I don't know what post of Dr. Lisa's you're referring to, but her comment about tramadol is probably not related to its being detrimental health-wise. It can cause behavioral side effects such as yowling, restlessness, or a "drunken stupor" type episode. This would happen soon after administering it, and would wear off in six hours or so. I don't know if Dr. Lisa has used it before; I know one of the cat people on VIN doesn't like it. I've used it at my hospital and on my own cat. Dillon's pupils dilated but he did not have any ill effects. We rarely use it in the hospital since we have buprenex, but the few times we have, it was similar to Dillon where the cat looked a little "high" but did not appear to be disturbed. In another thread, Carolyn said it made her cat very loopy and she wouldn't use it, so this is definitely an ECID sort of thing. Since it is known for having behavioral effects and not known for causing physical damage, it would be worth trying if there is no alternative. Note that it has a horrible taste; I gave it to Dillon by chopping it up into slivers and wrapping the slivers in smudges of pill pocket. You want them to just swallow it without chewing on it.

Regarding the pain, I'd say start Adequan, fish oil, and Dasuquin. If she doesn't get good pain relief, you can speak to the vet about gabapentin and amantadine. As a warning, most vets aren't familiar with these drugs, so if one of the vet you use is into trying new things and researching, make an appt with that one. Because of Latte's renal compromise, you'd probably be in a situation in which you start out on a very low dose and titrate up, checking renal values along the way. BOth of these drugs work more centrally to reduce the cat's ability to sense the pain, rather than dulling the pain as traditional pain meds do. As I've mentioned in other posts, my dog is now on gabapentin and it has made a big difference for him (he can't have NSAIDS either)

The use of an opioid like Buprenex can be difficult in the long term, even in terms of getting someone to prescribe it. AFAIK, the only noted side effect in long term use can be inappetence and "tolerance" -- needing more drug to get the same amount of pain relief. That's why using an opioid with gabapentin or amantadine may be better than an opioid alone.

This site is a little technical, being more geared towards vets than laypeople, but does break pain mgmt protocols down by category: http://www.vasg.org/chronic_pain_management.htm

but her comment about tramadol is probably not related to its being detrimental health-wise.

Click to expand...

Correct. I just know that it can cause behavioral issues in some cats. But other than that, I don't know much about this drug. I have not used in any cats in my care. I am only reflecting on the VIN posts that I have read.

Since it is known for having behavioral effects and not known for causing physical damage, it would be worth trying if there is no alternative.

Click to expand...

Agreed. Life is one big trade-off.....and pain is no fun. Also, we have to always keep in mind the DOSAGE of any drug that gets a bad name for any reason. Some drugs may be a god-send - at lower dosages.

My views of metacam have been shared on this list in the past. (My cats' charts say NO METACAM on them....)

That said, this study was just posted on VIN today discussing metacam usage for old, arthritic cats:


RETROSPECTIVE ANALYSIS OF LONG-TERM USE OF MELOXICAM IN AGED CATS WITH MUSCULOSKELETAL DISORDERS AND THE EFFECT ON RENAL FUNCTION
R Gowan 1, 1. The Cat Clinic, Melbourne, Australia

Meloxicam is the only molecule licensed for treatment of chronic musculoskeletal disorders in the cat. These conditions affect the quality of life of cats and require treatment. Impaired renal function is currently listed as a contraindication on NSAID data sheets. However, chronic renal disease and chronic musculoskeletal disorders, such as osteoarthritis are common in the elderly cat and often coexist. The objective of this study was to investigate the long-term use of meloxicam in a practice setting to treat musculoskeletal disorders in aged cats and to determine the effects on renal function in aged cats without renal disease and those with IRIS stage 1-3 renal disease.

The records of a feline-only practice were searched for cats which fitted the following criteria: reduced mobility and examination findings suggestive of a chronic musculosketal disorder, greater than 7 years old, meloxicam treatment duration of greater than 6 months and creatinine, urinalysis and body weight results available from regular monitoring. The progression of renal disease in the aged non-renal and renal group treated was compared to age matched and IRIS matched untreated controls from the same clinic.

Out of 214 cats which had been treated with Metacam oral suspension, 39 cats fitted within the search criteria. 22 cats (56%) had IRIS stage 1-3 renal disease at the start of treatment (8 cats IRIS stage 1, 13 cats IRIS stage 2, 1 cat IRIS stage 3) The median age of the renal group and non-renal treated group was 15.5 years and 13.4 years respectively. The median treatment duration was 527 days in the renal group and 400 days in the non-renal group. After dose titration to the lowest effective dose, the median maintenance dose was 0.02 mg/kg daily in both groups. The median pre-treatment creatinine, urine specific gravity and weight in the renal treated group was 0.17, 1.021 and 4.97 kg and the final results (median length between samples 462 days) were 0.19, 1.018 and 4.81 kg. There were no statistically significant differences between the progression of renal parameters or weight loss in the renal group versus the non-renal group treated with meloxicam or in the renal group treated with meloxicam versus the 39 age and IRIS matched untreated control group.

These results indicate that a maintenance dose of 0.02 mg/kg meloxicam does not appear to hasten progression of renal disease in aged cats or aged cats with pre-existent IRIS stage 1-3 renal disease. Therefore meloxicam can be considered as a treatment for aged cats with painful musculoskeletal disorders and concurrent renal disease. Careful monitoring of aged cats treated with NSAID therapy is essential.

This is great info Lisa