what are folks using for cat pain relief?

My Gwyn has a range of problems that can cause her varying degrees of pain, so I've had her on intermittent, low doses of oral buprenex for at least 3 years. I probably average about 1cc per month. (That's an average, ranging from 1cc for an entire summer to 3cc in a week with an acute pancreatitis attack.) Unfortunately, despite hoarding what I have since I moved to New Jersey, I'm almost out.

We're on our third local vet here. I left one vet because of dog issues. During the initial consult, the second seemed perfectly fine in agreeing to continue to prescribe Gwyn's current meds as long as I had periodic bloodwork done, but then basicly accused me of wanting phenobarbitol for my own use: I had asked them to renew Gwyn's prescription when I had ten doses left instead of waiting until I was completely out.

The third vet also seemed perfectly fine in agreeing to continue Gwyn's current meds during the initial consult, but then refused to arrange DSS enema syringes either by their buying them for us or by calling in a prescription somewhere. They also refused to contact my old vet to verify that we *had* been doing DSS enemas previously and that I actually *am* capable of doing enemas at home -- the office staff essentially hyperventilated at the mere idea of home enemas. (My old vet happily mailed me some DSS syringes from Maryland.)

Also, Gwyn's on 19 meds, so when I run out of something, I usually try to refill with a 2-3 month supply just so I'm not constantly refilling meds all over the place (even so, I'm usually buying *some*thing at least twice a week). With my old vet, 2-3 month refills weren't a problem, but I honestly don't have a read on the current vet or her staff or what will set them off -- the enema syringes took me by complete surprise -- so I don't know how easy it'll be to get a refill for 2-3cc of buprenex -- or even 1cc. And, yeah, I did ask this vet about the availability of buprenex before even making the initial appointment and they said at the time that it wouldn't be a problem -- but the enema syringes weren't supposed to be a problem, either, and yet they were.

Anyway: at the moment, I know that I'm not up to finding a new vet and then baselining Gwyn with them, so I *am* trying to work with this vet. I need to call them up and ask for some buprenex. In case it turns out that buprenex *does* turn out to be a problem, what are folks using for their cat's pain relief? Metacam is out due to kidney issues. Buprenex is my ideal but, if I can't get it, I'd like to be able to say, "Well, could I at least get some xxx instead?" Any thoughts are appreciated. And thanks!!

-- Jean and her Gwyn

 

Hi JJ

You can try tramadol. You did have your vet fax your old records, right? It should show her long-term use of buprenex.

Some cats get too zonky on tramadol. I tried it with both Earl and Dillon, and they both tolerated it well (though they did walk around with dilated pupils for several hours!). It is a synthetic opioid and is not a controlled substance.

 

Tramadol is OK but some cats zone out on it. Also, it is hard to control the dose since the standard pill is 50 mg and the nominal cat dose is 1/4 of a tab. Some tabs are oblong and hard to split. Further, it tastes terrible and many cats foam at the mouth when it is administered. I recommend that you put it in a #3 or #4 gel cap to avoid the foaming.

 

> You did have your vet fax your old records, right?
> It should show her long-term use of buprenex.

I can't remember. I did with the first two, but perhaps not with this one; I'll have to check. I *did* bring in my personal stash of Gwyn-records, which they did xerox and review. But most of that stack are reports from the various consults Gwyn's had done in the past three years or so, along with a medical-history summary for context, not the records from my regular vet.

If I *didn't* have the regular records faxed up, then, since the stack-of-consult-reports alone is about 3/4-inch thick, the new vet may not have initially realised the normal records weren't included. Though I *did* include all of my old vet's contact info, so the records should've been pretty easy to get, and also included a note that my vet is wonderfully willing consult with the new vet as needed. (New vet has refused to contact old vet to date. :grrr: )

But thank you for the reminder; I'll definitely check into this and rectify it if needed.


If I can't get buprenex, I'll see if I can get tramadol and see how Gwyn tolerates it. The gelcaps, while a wonderful idea, aren't possible: Gwyn lost the ability to handle solids after her last stroke :'( .

Thank you, Jess and Larry, for your input; it's much appreciated!

 

This is what I push hard for.

I have no personal experience with tramadol but from the consensus of opinion from the Feline Medicine board on VIN regarding the reactions of many cats on this drug, you can bet that I would be pushing very hard for buprinex.

The thought of old Gwen being forced to change from something that works for her....does not sit well with me.

 

I had great luck giving it to Dillon by chopping it up and putting slivers into wee pill pocket blobs. It doesn't seem to smell funny, only prolonged contact with saliva makes them flip out (I've used it with my dog too).

Dr. Lisa, I've read some of the anti-tramadol comments by the feline vets on VIN ... I just haven't had that experience so far with my own cats or the hospitalized cats.

 

[quote="Jess & Earl
Dr. Lisa, I've read some of the anti-tramadol comments by the feline vets on VIN ... I just haven't had that experience so far with my own cats or the hospitalized cats.[/quote]

Yep...this is one of those situations like metacam. If it works in your cat, great. But if your cat ends up in ARF.....

Lousy analogy because at least with tramadol you can take away the med and all will be well but you know what a wimp I am about putting drugs into any body. And.....I have a soft spot in my heart for any cat that has made it to 19.

Tramadol is worth a try but my frustration with this situation is that it should not be necessary to take a chance with a patient's well-being....just because of paperwork issues......even though they are frustating, pain-in-the-butt paperwork issues.

I feel for you guys having to go through these complications. I am not saying that the new vet is right or wrong....just sympathizing with what lay people have to go through.

 

I have a "no metacam" note in my cats' files, so I made a list of alternatives to ask the vet about (should the need arise). Buprenorphine and Fentanyl are on my list, but I did find 4 pain meds that are not opiates and are not in the NSAID group. The Veterinary Anesthesia & Analgesia Support Group (VASG.org) site has an overview on meds for chronic (longterm) pain in cats. Its not very specific about different kinds of pain, but does have some info on side effects and cautions.
http://www.vasg.org/newer_options_for_chronic_pain_management_2.htm
http://www.vasg.org/chronic_pain_management.htm

It didn't say anything about effects on the pancreas, but if you eliminate the ones that have cautions for the liver, it leaves you with Amantadine and Gabapentin.

[EDIT.... ummm.. oops... I just saw Dr Lisa's comments about tramadol... don't know how I missed them :?: What kind of problems have they found in cats?]

> Tramadol - generic, inexpensive;
Side effects - GI upset, constipation, sedation; not well studied in cats;
Dual action; not technically opioid but some effect on opioid receptors; mild anti-anxiety effect;
synthetic mu-receptor opiate agonist that inhibits reuptake of serotonin and norepinephrine;
Dose starts at 1 to 2 mg/kg BID to TID; up to 2-4 mg/kg (generally ¼ of a 50 mg tablet) BID;
Metabolized principally by liver, small amount excreted unchanged by kidneys;
Cautions - dose reduction for impaired hepatic or renal function.

> Amantadine - generic, inexpensive; adjunct use (or alone?);
Side effects rare - agitation, diarrhea; long-term daily use considered safe; often effective 2 weeks on, 1-2 weeks off;
"Is the best-suited oral NMDA antagonist available for .. cat pain mgmt today";
Dosed at 3 to 5 mg/kg every 24 hours PO;
Elimination almost exclusively via kidneys; excreted, unchanged, in the urine;
Cautions - dose reduction for impaired renal function.

> Amitriptyline - inexpensive; use alone or adjunct;
Possible side effects - sedation;
Antidepressant, used for pain; has some effect on opioid receptors;
Dosed at 2.5 to 12.5 mg total dose SID per cat;
Metabolized by liver;
Cautions - dose reduction for impaired hepatic function; monitor cardiac status.

> Gabapentin - moderately expensive; use alone or adjunct;
Possible side effects - weight gain, transient sedation;
Particularly effective in neuropathic pain and cancer related pain;
Dosed at 2 to 5 mg/kg BID PO;
Metabolized by liver; primarily excreted unchanged by kidneys;
Short half life; fast clearance, requires frequent dosing;
Cautions - dose reduction for impaired renal function (no cautions for liver).
-- currently being studied on a Winn Feline Foundation grant by Bruno Pypendop at UC/Davis (also studied Tramadol) to determine accurate dosages and adverse effects.

Its a shame the vet has such a "gatekeeper" perspective.... if he won't give you Buprenex, then Fentanyl is probably out of the question, but its worth a try. It comes in a patch so you don't get the fluctuations you'd get from the drops.

> Fentanyl - opiate, 75-100x stronger than morphine, moderately expensive, use alone;
Possible side effects - respiratory depression, other opiate effects
Uses - after surgery, injury, for chronic pain, cancer
Dose - comes in a patch that lasts about 4 days; provides a more continuous dose than drops or pills
Cautions - don't combine w/sedatives;
http://www.marvistavet.com/html/body_fentanyl.html
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=534

I hope the vet rethinks this and gives your sweet little Gwen the buprenex. With all the other meds she's taking, you really wouldn't want to rock the boat.
Keeping fingers crossed for her -
Deb, angel Evie, and the boys