ELIMINATE THE HURDLES: IDENTIFYING AND TREATING CHRONIC PAIN IN CATS DR. TAMARA GRUBB, DVM, PHD, DACVAA
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6 DEVELOP TREATMENT PLANS WITH THE EXISTING OPTIONS There are no research-backed, FDA-approved, easy-to-administer, long-lasting analgesic treatments for chronic pain in cats in the US. Other than NSAIDs, options for OA pain treatment are largely unproven. Most pharmacologic treatments require oral administration, which can be difficult in cats, and most nonpharmacologic options require repeat visits to the veterinary clinic, which can be difficult for both the cat and owner. But we can’t just let cats suffer in pain with no help! Here are some options that have at least some clinical success and are worth trying: The NSAIDs meloxicam and robenacoxib are approved outside the US for treatment of chronic pain in cats and are commonly used off-label in the US. Concerns for the class include adverse GI and/or renal effects. Gabapentin may be efficacious in some pain states, including the maladaptive component of chronic OA/DJD pain. The effective dose is variable between patients, often requiring dosing alterations. Sedation is the most common adverse effect. Amantadine (oral) and ketamine (infusion) are options in some circumstances. Tramadol (oral) is more effective in cats than dogs but cats vehemently dislike the taste. Oral transmucosal (OTM) buprenorphine can be an option but
type of antigen or target molecule, like a cytokine. In human medicine, mAb use includes treatment of pain, cancer, several GI diseases, endocrine diseases, transplant rejection and many other pathologies. Early mAbs were produced from mice and the foreign murine antigen occasionally produced reactions. Newer mAbs are species-specific, or ‘specified’, thereby eliminating the murine antigen. Specified anti-NGF mAbs are in development (but not yet available) for both cats and dogs. In proof-of- concept studies, anti-NGF mAbs have shown promise for relief of OA-associated pain for approximately one month following subcutaneous injection, thereby potentially decreasing the need for oral delivery of medications and decreasing trips to the veterinary clinic. More information on the technology is available in an open access article (Enomoto et al. 2019 https://pubmed. ncbi.nlm.nih.gov/30368458/) and websites thenewscienceofOApain.com and felineOApain.com. With these tools to clear the hurdles, let’s start getting cats into the clinic for some pain relief!
limitations include variable uptake following OTM administration and the need to dispense controlled drugs. Acupuncture, laser, massage and other nonpharmacologic treatments can be effective in cats. See more information on treatment options at https://www.cliniciansbrief. com/article/feline-osteoarthritis-pain- tools-clinicians-pet-owners. 7 ANTICIPATE NEW TREATMENT OPTIONS! Keep those cats coming in – even if current treatment is frustrating – help is on the way! One very promising treatment is the not-yet-released anti- nerve growth factor (NGF) monoclonal antibody (mAb) or anti-NGF mAb. Nerve growth factor (NGF) , a cytokine that binds to tropomyosin receptor kinase A (trkA), plays a major role in the generation, propagation, and sensation of pain through direct effects on nociceptors, internalization of the NFG/ trkA complex and stimulation of other pro-inflammatory cells (e.g., mast cells). NGF is involved in both peripheral and central sensitization, creating a ‘maladaptive’ pain state marked by hyperalgesia and/or allodynia. Because of its profound pronociceptive effects, NGF is a key target for OA pain therapeutics. Monoclonal antibodies (mAbs) are produced from cloned immune cells to block the activity of a single
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