Yeowch! Hissss! On the Hows, Whys and Stresses of Modern Feline Pain Control
Analgesia, we call it. It’s the absence of pain. The holy grail for so many conditions. But it’s not enough not to feel pain. It’s got to be safe, comfortable, appropriate, reliable and effective. A tall order, especially for cats.
Why so? As far as drugs are concerned, cats have historically been treated like small dogs. And dogs, in turn, as small humans. Is it any wonder we’ve got so few drugs that really work well for our feline companions?
Pain relief, in particular, is a surprisingly frustrating issue in feline medicine for a couple of reasons:
- Pain in cats is a tough thing to assess. Their silent stoicism, while admirable, doesn’t exactly lend itself well to ready interpretation in the event of pain. Even severe pain often goes undiagnosed in cats. How do we know? Good question. Here’s an article that addresses the behavioral characteristics we’ve now come to associate with post-operative pain in felids. We’re getting smarter on this issue.
- The presence of few reasonable alternatives to long term pain control in cats typically means NO long term pain control in cats. So while severe acute or post-op pain can be managed with heavy duty narcotics (think, strong opiates like hydromorphone), there’s little available to treat long term illnesses (think, osteoarthritis, a very common condition in cats).
Still, I’m proud to report that pain relief in cats has come a long way over the last couple of decades. Here’s an excerpt from a 2003 World Small Animal Veterinary Association meeting lecture on the subject to illustrate the [newly enlightened] motivation for feline analgesia:
Pain interferes with healing and can, in fact, make the disease process more harmful. Hypotension, gastrointestinal injury, hypothermia and immunosuppression may all occur as negative physiologic results of pain. The body, in response to the trauma, releases all sorts of leukotrienes: some of these are helpful, but many aggravate the problem.
As a result, if a patient has, or is going to have tissue trauma, analgesic therapy is required.
Makes lots of sense, right? It’s more than just the humane approach, it also happens to be the more effective approach when it comes to healing.
Above all do no harm? It’s now clear that to deny a patient a pain control drug on the basis of "safety" may not make so much sense if the patient’s pain score is significant. The impact on the patient’s long term well being is now considered in a more "holistic" manner. And that’s undoubtedly a good thing.
But the sad truth remains that few drugs are available for certain kinds of pain. While opiates (morphine-like drugs) are eminently useful, they’re only helpful for relatively short term pain control or hospice care. With some exceptions, cats are just too whacked out by these meds to live normal lives.
As I said, there are some exceptions. Transdermal fentanyl patches, tramadol and, butorphanol are all opiates that are used for acute and sub-acute pain control. (The difference? Acute: think, post-op or trauma. Sub-acute: think, a flare-up of arthritis.) For chronic pain control, these drugs are typically considered just too drowse-inducing. But not for all. Sometimes it’s worth a try.
For dogs we’ve got lots of pain meds for long term pain. Osteoarthritic dogs are living longer than ever before, now that they’ve got great drugs to control their chronic discomfort. NSAIDs (non-steroidal anti-inflammatory drugs) are our go-to meds for this purpose. And while they’ve got plenty of side-effects, the vast majority of dogs will safely enjoy their benefits for years without them. No drowsiness. No vomiting or diarrhea. No liver or kidney disease.
Not so with felines. Gastrointestinal and renal side effects (think, kidney failure) are much more common with NSAIDs when used in cats. Though we will tap these meds for their anti-inflammatory effects, we tend to do so only in well hydrated cats whose renal status is demonstrably normal ... and only for one dose.
Metacam (meloxicam) is one such drug whose one-dose injectable formulation that is approved by the FDA for use in cats. It’s great for spays and neuters and other procedures we undertake in young, healthy cats …
… not so much for those who suffer chronic pain, as in the case of arthritis, or slow-moving cancers that require some anti-inflammatory palliation. In fact, a recent FDA labeling advisory cautioned us strongly against the use of oral Metacam for long-term care. It’s just too toxic to the kidneys.
Here are other NSAIDs that are sometimes used instead:
- Ketorolac tromethamine
- Carprofen (Rimadyl)
But I approach these with caution, and I suggest you do the same. Nonetheless, I’ve used them all to great effect in cats. After all, there is no "one size fits all" in medicine. Even less so when it comes to controlling pain, and nowhere is this more true than when trying hard to control pain in cats. In the absence of approved drugs, sometimes cautious creativity is the only key.
Dr. Patty Khuly
Pic of the day: "Cat on the water" by me and my CatPaint app