Drugs and Their Possible Side Effects
Part 2: Pain Medications
There is no substitute for good veterinary care.
This information is for educational purposes only and
should NOT be used in place of consultation with your veterinarian.
Why is pain medication needed?
One of the most heartbreaking parts of IVDD recovery with our sweet ones is watching them suffer in pain and feeling helpless to do something about it. But today, your vet has the ability to help provide pain relief. While the anti-inflammatories get to work on the inflammation, pain medications are needed to control the pain. It can take a week, 2 weeks, or a month or more to resolve the inflammation causing the pain, so pain medications play a huge role in ensuring your dog stays pain free 24/7 from dose to dose of medications. As you probably already know from personal experience, pain is horrible; but, what you might not know is that pain deters healing. Being pain free is very important in the healing process.
Ensuring your dog’s pain gets and stays under control 24/7 from dose to dose of medicine takes constant communication with your vet. Each dog is different and pain control has to be tailored to your dog. Don’t feel bad about hounding your vet if your dog is still in pain. Constant feedback is how your vet knows if what he/she has prescribed is working. If it isn’t, you need to call the clinic immediately.
Let’s take a look at what your vet has available to get and keep your dog’s pain under control. We are all probably familiar with using non-steroidal anti-inflammatories (NSAIDs) like aspirin, Motrin, or Aleve for a headache or other aches or pains. Many vets prescribe the veterinary versions such as Rimadyl, Metacam, Previcox, and Deramaxx for minor pain for our dogs. But NSAIDs do not work on the central nervous system like analgesics do, so NSAIDs many times simply cannot handle the pain of a severe disc episode.
If your dog is taking an NSAID for inflammation, the NSAID probably will not be enough to control the pain. If your dog is taking a steroid, remember that steroids and NSAIDs should never be given at the same time meaning that you vet will need to select another type of medication for pain. This job calls for the heavy-duty power of medications like tramadol which is often combined with a muscle relaxer called methocarbamol (Robaxin V) or diazepam (Valium) which has muscle-relaxing effects to control the muscle spasms that often are a part of the pain from a disc episode. Today, Gabapentin is being prescribed often to control post-surgical and hard-to-control pain in conservative treatment.
Tramadol is probably the most common general pain reliever prescribed by veterinarians. It is a synthetic opiate but a dog’s body does not recognize it as an opiate. So, as strange as it may seem, why it is effective in dogs is still a mystery! It is not considered very strong and it does not last very long in the blood (approximately 1.7 hours) so it doesn’t provide pain relief very long. For that reason, it is usually most effective when given every 8 hours for severe pain if pain resurfaces with 12-hour dosing. Tramadol can be combined with steroids or NSAIDs as well as Gabapentin and Robaxin or Valium.
Nice to know info: Tramadol is available under the $4 generic program at many pharmacies such as Wal-Mart as well as grocery store and regular pharmacies. That means you get 30 pills for $4. All you need to do is ask your vet to write a prescription for it (some will and some won’t but it never hurts to ask!). Tell them at the pharmacy the prescription is for your dog.
Reasons Why Your Dog May Not Be Able To Take Tramadol:
If your dog has a history of seizures, your dog may not be able to take Tramadol as Tramadol may make seizures more likely. Liver and/or kidney problems, depending on the severity, may not make it advisable to use Tramadol.
Possible Side Effects Your Dog May Experience:
Medications That Should Be Avoided Or Used With Caution Along With Tramadol:
Many fall into the categories of anti-depressants, anxiety, or behavior modification drugs such as:
· Amitriptyline (Elavil® or Tryptanol
· Clomipramine (Clomicalm® or Anafranil®)
· Doxepin (Aponal®)
· Imipramine (Antideprin or Deprenil)
· Desipramine (Norpramin® or Pertofrane)
· Nortriptyline (Sensoval)
· Fluoxetine (Reconcile® or Prozac®)
· Paroxetine (Paxil®)
· Sertraline (Zoloft®)
· Fluvoxamine (Luvox®)
Used for cognitive dysfunction and Cushing’s disease:
· Selegiline (Anipryl®)
Used for some types of liver problems
Used for heart problems:
Used to treat blood clots
Other General Pain Relievers
Sometimes, pain is so severe that stronger general pain relievers are needed and among the options are morphine, buprenorphine (Buprenex®) injections, and fentanyl patches. Read more about them here:
Methocarbamol (Robaxin V)
Methocarbamol is a very effective muscle relaxer which affects the nerves of the brain and spinal cord that control the muscles rather than affecting the muscles directly. Muscle spasms are very common with a disc episode and adding in methocarbamol to the medication mix can make all the difference in the world in helping control pain.
It takes effect about 30 minutes after taking it and it reaches its max effectiveness in about 2 hours. Because it works on the nerves in the brain and spinal cord, methocarbamol can also cause sedation (which can be a good thing!). Methocarbamol can be given every 8 to 12 hours.
Reasons Why Your Dog May Not Be Able To Take Methocarbamol:
If your dog has kidney problems of any kind or is pregnant, your vet might choose not to prescribe methocarbamol. Dogs with myasthenia gravis who take the drug pyridostigmine may experience extreme weakness if these two drugs are combined.
Possible Side Effects Your Dog May Experience:
(Should your dog have any of these, please notify your vet immediately.)
· Severe lack of energy
· Not wanting to eat
Note: One additional possible side effect is that their urine may become darker but it isn’t anything to worry about.
Methocarbamol is also a human drug and the human drug is a slightly different combination and dosage than the vet product, so please do not use the human version unless authorized to do so by your veterinarian. The human brand name is Robaxin and the vet product is Robaxin V. The generic name for both is methocarbamol.
Although diazepam is known as a tranquilizer, some vets have begun to use it to relieve muscle spasms. Diazepam can be used for a wide variety of problems and muscle spasms are just one of them. But diazepam does react with quite a few drugs and can also make dogs much hungrier which are a few of the reasons some vets still prefer not to use it for muscle spasm relief. You can read more about diazepam here:
Gabapentin started out as a drug to control seizures in humans. Then it was discovered to be very effective in controlling neuropathic pain (those tingling or burning sensations) from nerve damage. It didn’t take long before gabapentin was being used in the vet arena for both seizures and neuropathic pain and has proven to be very effective in helping control the pain IVDD dogs experience from nerve damage and post-surgical pain.
Gabapentin is often the most effective when combined with other medications such as NSAIDS or pain medications like tramadol. Gabapentin and tramadol work very well together and are even more effective together than either one is alone. For hard-to-control pain, many vets today are combining gabapentin and tramadol.
Another drug similar to gabapentin is pregabalin (Lyrica) which has been used for neuropathic pain in dogs but is not prescribed as often as gabapentin.
Reasons Why Your Dog May Not Be Able To Take Gabapentin:
If your dog has kidney problems of any kind or is pregnant, your vet might choose
not to prescribe gabapentin. Gabapentin may affect blood sugar, so if your dog is diabetic, gabapentin should be used with caution.
Possible Side Effects Your Dog May Experience:
· False positive reading on urine dipstick tests for protein
Medications That May Interact With Gabapentin:
Antacids containing aluminum or magnesium (such as Phillips'® Milk of Magnesia, Maalox®, or Gaviscon®) may affect the absorption of gabapentin. Pepcid AC, Zantac, and Prilosec are acid reducers and are not considered antacids and will not affect the absorption of gabapentin. However, Tagamet (cimetidine), although an acid reducer, does slightly interact with gabapentin but is not considered important.
Morphine increases the effectiveness of gabapentin.
If your dog takes phenobarbital for seizures, please discuss with your veterinarian whether gabapentin is appropriate as a pain medication for your dog.
Human liquid gabapentin preparations which your vet may have in stock are sweetened with xylitol which can be toxic to dogs. You can have a compounding pharmacy prepare a liquid gabapentin in the proper dosage without the xylitol. Gabapentin also comes in 100mg capsules and tablets so depending on the dosage prescribed for your dog, you may be able to get a capsule or tablet that you can cut in half or quarter to get the proper dosage.
Don’t Be Patient About Pain Control
Just as each disc episode is different, pain can be very different with each episode too. Each dog is different and medication affects each dog differently; therefore, please keep communicating with your vet so that he/she can adjust or add in more medications to ensure your sweet one stays comfortable.
If a weekend or holiday is coming up and you are running low on medications, call ahead and get them refilled in plenty of time. You want to make sure you don’t run out or if you have to up the dosages, you will have enough.
Healing does take patience but DON’T be patient about pain control for your sweet one! Pain is excruciating and your vet has an arsenal of medications to help provide relief.
Here is a handy chart you can use to track your medications: