CHAMPAIGN, Ill. — Sending ailing dogs home with oral opioids may not be an effective way to manage their pain, experts report in a free, online continuing education program recently developed for veterinarians. In light of growing evidence that such drugs don’t work well in dogs – added to the fact that humans sometimes abuse opioids prescribed for pets – the common practice of prescribing oral opioids for dogs in pain should be reexamined, the experts say.
“We have lots of good evidence that dogs respond favorably to injectable opioids,” said University of Illinois veterinary anesthesiologist Dr. Stephanie Keating, a pain management expert in veterinary clinical medicine and a co-creator of the program. “But the same is not true for the opioid tramadol when given orally.”
The way dogs absorb and metabolize oral tramadol may hinder the drug’s pain-reducing effects, Keating said. And yet, many veterinarians routinely prescribe this drug in pill form for dogs when they leave the hospital after surgery or other traumatic events.
“For years, we assumed that since tramadol worked in people, it would also work in dogs,” Keating said. “It’s inexpensive, it’s easy to prescribe, and so it became commonplace.”
But research suggests that dogs don’t benefit from the oral versions of the drugs the way people do, she said.
“Now that we’re getting more evidence, we’re thinking, ‘Wow, it doesn’t seem to be very effective and there’s an opioid crisis. Maybe we should reconsider this.’”
Anticipating the need among opioid prescribers for additional training to meet regulatory mandates, Keating and colleagues Dr. Ashley Mitek, Dr. Maureen McMichael, Dr. Gary Stamp and Dr. Brad Weir created the continuing educational program with the i-Learning Center at the U. of I. College of Veterinary Medicine. The videos include cautions about unwarranted prescription of oral opioids and advice on effective pain management for veterinary patients. Keating, McMichael and Mitek are professors of veterinary clinical medicine at Illinois. McMichael and Weir are also professors in the Carle Illinois College of Medicine at the U. of I. Stamp was the founding director of the Veterinary Emergency Critical Care Society.
“To combat the human opioid epidemic, the U.S. Food and Drug Administration is in the process of mandating training programs for opioid prescribers to help reduce unnecessary prescriptions,” said McMichael, a specialist in small animal emergency and critical care. “This course is designed to address these issues on the veterinary side of the equation.”
When a dog is hospitalized and in acute pain, intravenous opioid administration is one of the best pain management options available, Keating said. But IV drugs are not an option for an animal at home.
“What veterinarians prescribe for dogs at home depends on the cause and duration of pain that dogs are experiencing,” she said. “If a dog has a chronic inflammatory condition like arthritis, a multimodal approach that includes veterinary-specific anti-inflammatories may be the best option.”
Keating’s dog, Triscuit, has chronic neck pain from multiple compressed cervical disks. Keating said she gives Triscuit nonopioid drugs that reduce inflammation and interrupt the neurological pathways that contribute to the dog’s pain.
Photo by L. Brian Stauffer
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The online program describes which drugs are best used to manage specific types of pain. For example, gabapentin suppresses the release of neurotransmitters involved in seizure and pain. Amantadine blocks a specific type of receptor involved in pain escalation. Local anesthetics and anti-anxiety medications can help, too, along with nondrug options such as massage, environmental enrichment, padded bedding and exercise.
According to veterinarian and pain management expert Mitek, the oversight of veterinary prescription practices varies from state to state and, in general, regulations are less strict in veterinary medicine than in human medicine.
“Oral opioids are still commonly prescribed to canine patients, despite research illustrating their lack of effectiveness,” Mitek said. “While our scientific understanding of how dogs respond to oral opioids has evolved over the years, anecdotal evidence suggests that this updated information has not been effectively disseminated to practitioners. We hope this online course will empower and educate veterinarians to treat pain effectively in dogs.”
Five video lectures developed for the course, totaling 20 minutes, are publicly available. Veterinary professionals visiting the website can sign up for one hour of free veterinary continuing education, which combines the lectures with case studies and assessments, through the College of Veterinary Medicine’s i-Learning Center.
McMichael also is a professor at Auburn University College of Veterinary Medicine in Alabama.