Managing Chronic Non-osteoarthritic Pain | Part 3a (Chronic, Active inflammatory pain)

Updated: Oct 18


What is chronic pain?

Chronic pain is an unpleasant sense of discomfort that persists or progresses over a long period. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.

The following are scenarios whose rate of occurrence is closer to that of osteoarthritis:-

  1. Chronic, Active inflammatory pain

  2. Maladaptive chronic pain

  3. Cancer pain.

The therapeutic rationale of these pain phenomena is from the understanding of the disease pathophysiology.


Chronic, Active Inflammatory Pain

Examples of Chronic, Active Inflammatory Pain include the following:-

  1. Chronic periodontal disease (Dental disease)

  2. Feline lymphocytic—plasmacytic stomatitis (Inflammation of the mucous membranes of the mouth)

  3. Idiopathic feline lower urinary tract disease (Kidney disease)

  4. Inflammatory bowel disease (Inflammation/infection of the Digestive Tract)

  5. Meningoencephalitides (Inflammation/infection of the brain)

  6. Otitis external (Inflammation/infection of the outer ear)

  7. Pancreatitis (Inflammation/Infection of the pancreas)

  8. Feline interstitial cystitis (Inflammation / Infection of the urinary bladder)



Treatment

The treatment order for this category of chronic pain should be in the following order:

  1. Anti-inflammatory medications: non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids

  2. Treatment of underlying disease or aggravating comorbidities

  3. Neuromodulatory analgesic drugs, such as gabapentin, tramadol, and amitriptyline

  4. Weight optimization.


Further reading

  1. Chronic pain management in cats & dogs I Part -1(Overview)

  2. Chronic pain management in cats & dogs I Part-2 (Osteoarthritis)

  3. Managing chronic non-osteoarthritic pain I Part-3b (Maladaptive chronic pain)

  4. Managing Chronic Non-osteoarthritic Pain I Part-3c (Cancer-pain)


References

[1] L. Ray, R. B. Lipton, M. E. Zimmerman, M. J. Katz and C. A. Derby, "Mechanisms of association between obesity and chronic pain in the elderly," PAIN®, vol. 152, no. 1, pp. 53-59., 2011.


[2] K. A. Mathews, "Neuropathic pain in dogs and cats: if only they could tell us if they hurt," Veterinary Clinics of North America: Small Animal Practice, vol. 38, no. 6, pp. 1365-1414, 2008.


[3] R. A. Gupta and R. N. DuBois, "Colorectal cancer prevention and treatment by inhibition of cyclooxygenase-2," Nature Reviews Cancer, vol. 1, pp. 11-21, 2001.


[4] W. G. Marshall, B. A. Bockstahler, D. A. Hulse and S. Carmichael, "A review of osteoarthritis and obesity: current understanding of the relationship and benefit of obesity treatment and prevention in the dog.," Veterinary and Comparative Orthopaedics and Traumatology, vol. 22, no. 05, pp. 339-345, 2009.


[5] L. I. Slingerland, H. A. W. Hazewinkel, B. P. P. P. Meij and G. Voorhout, "Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats.," The Veterinary Journal, vol. 187, no. 3, pp. 304-309, 2011.


[6] D. F. Lawler, R. H. Evans, B. T. Larson, E. L. Spitznagel, M. R. Ellersieck and R. D. Kealy, "Influence of lifetime food restriction on causes, time, and predictors of death in dogs.," Journal of the American Veterinary Medical Association, vol. 226, no. 2, pp. 225-231, 2005.


[7] K. A. Kirkby and D. D. Lewis, "Canine hip dysplasia: reviewing the evidence for nonsurgical management.," Veterinary Surgery, vol. 41, no. 1, 2012.


[8] R. J. Corbee, M. M. C. Barnier, C. H. A. Van De Lest and H. A. W. Hazewinkel, "The effect of dietary long‐chain omega‐3 fatty acid supplementation on owner’s perception of behaviour and locomotion in cats with naturally occurring osteoarthritis.," Journal of animal physiology and animal nutrition, vol. 97, no. 5, pp. 846-853, 2013.


[9] R. I. Krontveit, C. Trangerud, B. K. Sævik, H. K. Skogmo and A. Nødtvedt, "Risk factors for hip-related clinical signs in a prospective cohort study of four large dog breeds in Norway.," Preventive veterinary medicine, vol. 103, no. 2-3, pp. 219-227., 2012.


[10] J. G. Smith, R. L. Hannon, L. Brunnberg, V. Gebski and D. Cullis-Hill, "A randomised, double-blind, comparator-controlled study of the efficacy of sodium pentosan polysulfate injections and carprofen capsules in arthritic dogs.," Osteoarthritis and Cartilage, vol. 9, no. Supplement B, p. 21., 2001.


[11] J. M. Vandeweerd, C. Coisnon, P. Clegg, C. Cambier, A. Pierson, F. Hontoir, C. Saegerman, P. Gustin and S. Buczinski, "Systematic review of the efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis.," Journal of Veterinary Internal Medicine, vol. 26, no. 3, pp. 448-456, 2012.


[12] B. D. X. Lascelles, J. S. Gaynor, E. S. Smith, S. C. Roe, D. J. Marcellin‐Little, G. Davidson, E. Boland and J. Carr, "Amantadine in a multimodal analgesic regimen for the alleviation of refractory osteoarthritis pain in dogs.," Journal of Veterinary Internal Medicine, vol. 22, no. 1, pp. 53-59, 2008.


[13] B. KuKanich and M. G. .. Papich, "Pharmacokinetics and antinociceptive effects of oral tramadol hydrochloride administration in Greyhounds.," American Journal of veterinary research, vol. 72, no. 2, pp. 256-262, 2011.

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