A PRIMER OF PAIN MEDS
Julie Manet et son Lévrier Laerte, Morisot, Berthe (1841-1895); 1893;
Musée Marmottan, Paris.
Image from the WebMuseum.
Suzanne Stack, DVM
major classes of pain medications for our greyhounds include
narcotics, nonsteroidal antiinflammatory drugs (NSAIDS), and
corticosteroids aka "steroids" – not the
anabolic bodybuilding ones.
Narcotics are for heavy-duty pain relief that a dog might need
post-op or with a very painful disease such as bone cancer. Fentanyl
patches offer the strongest pain relief, but are seldom-used long
term. Morphine tablets are available, but the most commonly
dispensed narcotic for dogs with skeletal pain is a combination of
codeine and Tylenol. Torbutrol is preferred for internal pain. As an
alternative to narcotics, which may "whack out" the patient, some
veterinarians use the narcotic-like tramadol (Ultram) in these
painful situations. Since narcotics don't ulcerate the GI tract,
they may be used in combination with both NSAIDs and steroids for
more complete pain relief.
number of dog-approved NSAIDs is growing every day. Rimadyl and
Etogesic have been around for a few years. Now we have Deramaxx,
Zubrin, and Metacam, touted to be more effective and less stomach
upsetting, which is the bane of all NSAIDs. Just as some people
can't stomach aspirin but are fine with ibuprofen, so it can be with
dogs. And just as you do for yourself, you may need to "shop around"
until you find an NSAID that helps your dog. So more choices are
better. All NSAIDS have label precautions for kidneys and liver,
especially if these organs are already compromised. It's always a
good idea to monitor blood test periodically while on long term
Steroids, most notably prednisone and dexamethasone, often control pain that NSAIDs won't get at, such as spinal pain. NSAIDs are generally preferred for long term use when efficacious as they have fewer side effects than steroids. Every prednisone prescription I send home forewarns the owner of increased thirst, urination and panting. With long term steroid use, dogs may develop Cushingoid signs such as thinned haircoat, poochy belly, and muscle loss. Because steroids can also ulcerate the GI tract, NSAIDs and steroids are rarely used together. Sometimes it is possible to inject a steroid directly into a painful area to relieve pain without causing all the side effects, i.e. DepoMedrol injections for lumbosacral stenosis.
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