What’s wrong with Pain Relief in Dogs and Cats?

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Definition – Analgesia = Pain relief / pain-killer / inability to feel pain
Definition – Chronic Pain = Persistent pain – lasting beyond the (acute) original injury.

Veterinary NSAID Analgesic Drugs

As you can imagine, in my role as a Home Euthanasia Vet, I see many animals who have been undergoing prolonged courses of pain-relief. Many of these animals are receiving the so-called NSAID type drugs – these are the medicines which are an animal version of our own head-ache tablets. Brand names you may recognise are Metacam (the liquid one), Previcox, Onsior and Rimadyl. Vets have been prescribing this category of drugs for ages, and their benefits can be huge. Like all drugs, they don’t always work in certain individuals, and they can have significant side effects – often causing upset stomachs, kidney problems, etc. These NSAID drugs are usually regarded as first-line pain-relief because they only provide moderate analgesia. And the analgesia can’t be safely scaled-up by increasing the dose.

Veterinary Opioid Analgesic Drugs

Recently, I have begun to see more ‘exotic’ drugs being used for dogs suffering from chronic pain. Tramadol is probably the commonest goto “second level” pain-killer at the moment. This is an opioid analgesic – in the same category as codeine, morphine, and fentanyl.

Opioid analgesics work on the brain and nerves rather than on the actual lesion causing the pain (unlike NSAIDS). There is disagreement about how good Tramadol’s real pain-relief action is. This is partly because Tramadol has marked side effects – notably dysphoria (unease, confusion, anxiety) and sedation. These side-effects make measuring the amount of analgesia present very difficult. The general consensus is that Tramadol’s analgesic effect is roughly equal to Codeine.

Gabapentin is the other analgesic I am seeing more of recently. I was first aware of Gabapentin use in animals in cats with seizures (fits). It apparently can help some patients with neurogenic (nerve) pain. There is little research evidence that it has much benefit in other acute or chronic pains. Its practical analgesic properties are still in debate. Like Tramadol, Gabapentin has sedative effects.

Tramadol and Gabapentin are the two “second level” drugs I see prescribed the most frequently when I am visiting pets to help their euthanasia (put to sleep).

Other Veterinary Analgesics

There are many other analgesics available for more pioneering vets to try out, but there is little evidence yet of their value in reliably reducing chronic pain. Other commonly applied approaches to chronic pain are acupuncture and electro-acupuncture.

Worries and Concerns

Why are Tramadol and Gabapentin being used more?

  • Vets are much better these days at recognising pain in pets and they want to help
  • Vets increasingly realise that the analgesia from NSAID use may need to be supplemented
  • Vets are frustrated at the (sometimes severe) side-effects of NSAID drugs.
  • Tramadol and Gabapentin are reasonably cheap and readily available.

More concerning for me is that I worry that more dogs and cats are being allowed to suffer pain for longer than was once acceptable. I fear that vets are now offering these drugs as a means to avoid having to  recommend euthanasia to their owners. Additionally, many pet owners will willingly try anything to extend their pet’s life – sometimes without having all the information on their pet’s experience of pain and discomfort explained to them.

Welfare issues

Part of my motivation for doing euthanasia work is that I want to help people make the correct decision for their pets in good time. This is a welfare issue. A client suggested to me the other day that my work must be very rewarding – relieving all that suffering and pain…

It is for these reasons I want to highlight the short-comings of Tramadol, Gabapentin and the other analgesics that don’t have sufficient proof of action. I think it is too easy to feel we are reducing pain by giving our pets these drugs. But there is little or no evidence that that they actually do reduce pain. I have a horrible feeling that the sedation they produce in our pets is being mis-interpreted as comfort and ease: If a dog (or cat) is ‘at rest’, and doesn’t move when you touch their painful lesion, this does not mean they are not in pain. It may just mean the sedation is preventing them from moving!

Some advice:

When your vet recommends a change from NSAIDS to something “stronger”,

  • Ask them the true analgesic value of the new option.
  • Also, be strong, and ask them what is the long term outlook for your pet.


Suffering is suffering no matter how it is “dressed up”… If there is no good reason for it from the animal’s perspective then it should not be condoned, far less encouraged. “Periscope, 2017”

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