Lameness Pain Management

The primary medications used to control lameness-related pain include:

• NSAIDs: These are a staple of pain management and include COX-2 inhibitors and aspirin. The source provides specific dosage tables for dogs and cats, noting that some drugs (like carprofen or deracoxib) are not recommended for cats. NSAIDs are contraindicated in animals with hepatic or renal insufficiency, gastroenteritis, coagulopathy, or those currently taking corticosteroids.

• Opioids: These drugs provide relief by binding to CNS receptors. Common options include morphine, hydromorphone, and buprenorphine, with the latter offering a longer duration of action and a sustained-release formulation. Opioids are often combined with sedatives like acepromazine to improve efficacy.

• Other Specialized Drugs: Gabapentin is recommended for chronic or neuropathic pain. Additionally, newer alpha-2-receptor blocking agents, such as dexmedetomidine, are used to facilitate examinations and diagnostic evaluations.

Analgesics are delivered through various methods, including oral, parenteral (IV, IM, SC), transdermal (fentanyl patches), and epidural routes.

• Local Injections: Preoperative intra-articular injections of morphine or lidocaine can be used to preemptively block pain receptors in the joints.

• Epidurals: Administering morphine in the lumbosacral space is highlighted as an effective adjunct for managing postoperative pain in the hind limbs.

• Corticosteroids: These are considered weak analgesic adjuncts that function primarily as local anti-inflammatory agents at the site of injury.

Joint Modifiers and Emerging Therapies

The source discusses several options for managing degenerative joint disease, though it notes varying levels of scientific support:

• Joint Fluid Modifiers: Compounds such as glucosamine, chondroitin sulfate, and omega-3 fatty acids are popular, but the document states that robust evidence for their effectiveness is currently limited and often anecdotal.

• Regenerative Medicine: Newer modalities like stem cell and platelet-rich plasma (PRP) therapies are being explored, though their scientific validity is still pending.

To complement medication, the document suggests several holistic and physical strategies, including acupuncture, massage, physical rehabilitation, and dietary management

I. Pharmacologic Strategies (Analgesics)

• • NSAIDs (Non-Steroidal Anti-inflammatory Drugs)

    • Mechanisms: Includes COX-2 inhibitors and Aspirin.

    • Common Drugs (Dogs): Carprofen, Deracoxib, Etodolac, Firocoxib, Grapiprant, Meloxicam, Robenacoxib.

    • Common Drugs (Cats): Aspirin, Ketoprofen, Meloxicam, Robenacoxib (Note: Many dog NSAIDs are not recommended for cats).

    • Contraindications: Hepatic/renal insufficiency, gastroenteritis, coagulopathy, and concurrent corticosteroid treatment.

  • Opioids

    • Mechanism: Bind to mu, kappa, and delta receptors in the CNS.

    • Potency: Oxymorphone, hydromorphone, and butorphanol are more potent than morphine.

    • Administration Routes:

      • Parenteral (IV, IM, SC): Morphine, oxymorphone, hydromorphone, buprenorphine.

      • Oral: Tramadol, codeine, butorphanol.

      • Transdermal: Fentanyl patches.

      • Transmucosal: Buprenorphine (cats).

    • Long-Duration: Buprenorphine (available in sustained-release formulations).

  • Specialized Adjuncts

    • Gabapentin: Calcium channel blocker used for chronic or neuropathic pain.

    • Corticosteroids (Prednisone/Dexamethasone): Weak analgesic adjuncts that work via local anti-inflammatory action; contraindicated with NSAIDs.

    • Alpha-2-receptor agonists (Dexmedetomidine/Medetomidine): Used to facilitate examinations and diagnostic evaluations.

II. Routes of Administration & Local Techniques

• • Systemic: Oral, parenteral (including constant-rate infusions), transdermal.

  • Regional & Local:

    • Epidural Morphine: Administered in the lumbosacral space for hind limb pain relief and to reduce anesthetic requirements.

    • Intra-articular Injections: Preoperative block of joint pain receptors using morphine, bupivacaine, or lidocaine.

    • Local Infiltration: Intraoperative use of bupivacaine liposome suspension to reduce postoperative pain.

III. Joint Health & Emerging Therapies

• • Joint Fluid Modifiers: Glucosamine, chondroitin sulfate, hyaluronan, pentosan polysulfate, and omega-3 fatty acids.

    • Note: Scientific evidence is currently limited/anecdotal.

  • Regenerative Medicine: Stem cell and platelet-rich plasma (PRP) therapies.

    • Note: Scientific validity for these is currently pending.

IV. Non-Pharmacologic Management

• • Physical Therapies: Massage and physical rehabilitation.

  • Holistic Approaches: Acupuncture.

  • Lifestyle: Dietary management.