By Michael C Petty, DVM. President, International Veterinary Academy of Pain Management and Certified Veterinary Pain Practitioner; Certified Veterinary Medical Acupuncturist; Certified Canine Rehabilitation Therapist; Diplomate, American Academy of Pain Management. Owner, Animal Pain Center in Canton, Michigan.
Jessica and I were discussing pain and animals and the frustration that many owners feel when they want to administer pain medications to their pets but can’t due to lack of availability of over the counter medications. I want to state right up front that I understand the frustration.
People can go to almost any store and buy a wide variety of pain medications for themselves, including but not limited to non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and pain drugs like aspirin and acetaminophen. Other pain drugs are available only with a prescription, including opioids, selective serotonin reuptake inhibitors and certain NSAIDs such as Celebrex/celecoxib.
In order for a drug to become over-the-counter (OTC) it has to be safe enough to be taken without supervision by a physician, or in the case of animals, without supervision by a veterinarian. Humans are lucky enough to have several OTC options. Even so, about 6000 people die each and every year in the United States as a result of complications from NSAID use. This happens despite the fact that as sentient thinking beings, we should be able to self-monitor adverse side-effects and self-report any problems.
Consider the poor dog and cat. They hide their pain and continue to soldier on despite what might be fairly severe discomfort. Not until our pets start missing meals might we finally realize that something is amiss. When we have a headache, or an arthritic knee (like myself), our chronic pain is like an unwanted friend come to visit, a friend we are familiar with. We understand the cause and can make a decision for ourselves to medicate or not, depending on what side effects and risks we are willing to accept. But our animals rely on us not only to recognize the headache or the arthritic knee, but also to decide for them whether or how their pain will be addressed. We need to help them with their pain and we need to be mindful in how we do it.
While aspirin and ibuprofen might seem like innocuous drugs to us—ones we happily pop into out mouths if we have a headache—the active substances in human OTC medicines can be quite harmful to pets. Take aspirin for example. Although some dogs can safely take aspirin, others cannot. One study demonstrated the formation of lesions in the stomach lining of some dogs after even one dose of aspirin. Cats are so sensitive to the effects of aspirin that just one or two doses can cause a stomach perforation and death. This is why even seemingly mild pain medicines like aspirin and acetaminophen are not available OTC for animals.
Acetaminophen can be taken safely by many dogs, but only if they do not have certain pre-existing liver problems. A single acetaminophen dose given to a cat can cause death. There are no OTC NSAIDs for dogs and cats, as none of them are considered safe enough to be given without monitoring by blood tests. There is no collusion between veterinarians and pharmaceutical companies; we aren’t trying to keep you from treating your own pets because we want you to pay us for veterinary visits. It is a matter of keeping animals from harm.
When I see an animal in my veterinary practice, I can localize the animal’s pain, but the question for me then arises: Is this simply arthritis? Or maybe is it a fracture or a cancer? Maybe it is neuropathic pain or back pain or shooting bolts of pain called a radiculopathy, which radiate down the leg and can sometimes be the most painful part of a ruptured disc. The plain answer is that without a diagnosis, we could be treating something that really needs more than that pain pill. Even if we had an NSAID that was available OTC for our pets, how many pets might die or suffer needlessly because the pet owner is not aware of or counseled on a serious underlying health problem? How many dogs and cats might suffer from an adverse drug event because they were given too high a dose, too many doses over time, or because a drug interacted with another medicine the animal was taking? (When was the last time you carefully read the insert on the ibuprofen you give yourself?)
What can you do for your pets to help them out? The biggest challenge for both pet owner and veterinarian is to understand that a pet is painful and to figure out the nature of the animal’s pain. There are many pain questionnaires and quality of life assessments that can walk you through the questions necessary for determining if your pet is in pain. One example is the Canine Brief Pain Inventory developed at the University of Pennsylvania. In order to be valid, any questionnaire should be administered by someone who is familiar with it and has been instructed in its use. These pain or quality of life assessments are best approached as a collaborative effort between a veterinarian (who is skilled at looking for signs of pain) and a pet owner (who knows the animal best).
It is important to understand that some veterinarians, just like some physicians, are more qualified to evaluate and treat pain. In human medicine, a person has to visit an average of 7 physicians before they find someone that can understand and treat their pain. If you want better odds for your pet, visit the website of the International Veterinary Academy of Pain Management www.ivapm.org and click the tab that says, “Search for a certified pain management professional.”
If your pet has been diagnosed with osteoarthritis, which affects the majority of dogs and cats over six years of age, the first step it to either keep them lean or have them lose weight if they are overweight. It has been shown that even a ten percent loss of body weight in an obese animal can be as effective as giving an NSAID!