Gabapentin is a drug that veterinarians are increasingly prescribing, sometimes alone but more often in combination with other drugs, to relieve pain in dogs. It is also increasingly being prescribed in combination with other canine anxiety medications. Why did it become so popular? I’ll come back to this, but first we need to talk about pain.
Treating pain is a medical priority
Pain therapy has become an integral part of health care in both human and veterinary medicine. If you’ve ever been admitted to the hospital or have had an operation, you are familiar with the common question, “How is your pain? Rate it on a zero to 10 scale. ”While in the hospital, keep trying to pick a number.
It turns out that there is a very compelling reason for this. Pain is not our friend. It hurts. But the meaning goes much deeper. Uncontrolled pain causes not only physical, but also emotional and psychological damage. It delays healing and has a negative effect on the immune system. In humans and non-human animals, this often leads to harmful, undesirable behaviors such as self-trauma, aggression, or withdrawal from the joys of life.
You have heard medical professionals say it is important to stay one step ahead of pain. There’s a strong reason for that too. Untreated pain makes your pain receptors more and more sensitive, which leads to the pain getting worse and worse. This is known as “wind-up pain” and becomes more difficult to control.
We vets work hard to prevent pain. When this is not possible, we work even harder to alleviate it. This has become easier over the years with the advancement of science, medical knowledge, and extrapolation from discoveries in human medicine. Veterinarians now have a variety of drugs and other therapeutics available to manage pain.
Chronic pain, something that is Not likely to leave is a particular challenge for us. It often needs to be managed for the rest of the dog’s life. For this type of pain, “polypharmacy” (multiple drugs) and a multimodal approach (more than one treatment modality) are usually most effective.
To relieve chronic pain, we typically use prescription drugs and safe and potentially effective “nutraceuticals” – dietary supplements that have beneficial effects on disease. There are more and more veterinarians using Chinese and herbal medicines as complementary therapies to treat pain. Modalities such as acupuncture, laser therapy, therapeutic ultrasound, physical therapy, and rehabilitation are available to dog owners in most areas. More and more dog owners are using various forms of cannabidiol (CBD) to manage their dog’s pain.
Pain is a very personal experience. How one patient perceives pain can be completely different from that of another. Some have higher tolerances than others. A drug or therapy can work wonders for one patient and nothing for another. Therefore, it is critical for owners to be vigilant, closely monitor their dogs for response to therapy, report accurately to their vets, and be open to any recommended changes to the prescribed pain protocol.
AN UNEXPECTED BENEFIT
Gabapentin has skyrocketed in popularity due to its potential contribution to pain management in veterinary medicine (hey! This is what we aim for: jumping and jumping dogs!). But that’s not what it was originally designed for.
Gabapentin is pharmaceutically classified as an anticonvulsant or anti-seizure drug. It blocks the transmission of certain signals in the central nervous system that lead to seizures. Then the researchers learned that some of these transmitters were involved in the biochemical cascade involved in pain perception, and doctors began to investigate their use in pain management.
Today gabapentin is best known and recognized for its ability to treat a specific form of pain called neuropathic pain. Neuropathic pain is caused by damaged nerves, either deep in the brain and spinal cord or in the peripheral nerves that extend outward from the brain and spinal cord. It is different from the pain transmitted from damaged tissue through healthy nerves. Examples of neuropathic pain are neck and back pain due to bulging intervertebral discs, pinched nerves, tumors of a nerve or tumors that press on nerves; some cancers; and toothache.
A perfect example of neuropathic pain in humans is fibromyalgia. You’ve probably seen the commercials for Lyrica, a treatment for this chronic, debilitating, painful nerve disorder. Lyrica is pregabalin, an analog of gabapentin. (By the way, pregabalin is also used in dogs. If your dog’s current pain history contains gabapentin but isn’t working well enough, ask your veterinarian about pregabalin.)
HOW IS IT USED?
Although gabapentin is believed to work best primarily in disorders associated with neuropathic pain, it is most commonly used as an adjunct or adjunct drug in the polypharmacy approach to treating chronic pain. It is rarely used alone as the sole pain reliever, even for neuropathic conditions such as neck and back pain.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are, and likely will remain, the first choice for treating veterinary pain. However, gabapentin is more often added when an NSAID alone doesn’t help enough. Gabapentin is so safe that it can be added to virtually any of the drugs currently used to treat pain in dogs. There is a recent study that shows gabapentin has a synergistic effect. When used in combination with another drug, such as the opioid pain reliever tramadol, the effects of both drugs are increased.
If you add gabapentin to a current pain log, you may see some effect within 24 hours, but not maximum effect for seven to 10 days. For this reason, dose adjustments are usually only made every few weeks. Be patient. Gabapentin has the potential to greatly improve your dog’s current pain management plan.
In addition, the addition of gabapentin, which has minimal side effects, sometimes allows a dose reduction of other drugs such as NSAIDs, which have potentially dangerous side effects, especially with long-term use. This is a huge plus for both your dog and your vet, who has taken an oath to “do no harm”.
What are the side effects? Not much. There is a possibility of mild sedation and muscle weakness, which increases with higher dosages. This side effect is usually minimal at the dosages typically prescribed for pain. Veterinarians actually take advantage of this side effect by using higher dosages of gabapentin in combination with other sedatives such as trazadone to improve the calming effects for anxious or aggressive patients in the veterinary clinic.
Gabapentin has a large margin of safety in dogs. It does no harm to your dog’s kidneys or liver, and is even safe to use with CBD products, although the mild sedative effects of both products may be enhanced.
However, there are a few important precautions:
* Do not primarily use the commercially available human liquid form of gabapentin. This preparation contains xylitol, the sweetener commonly used to sweeten sugar-free gum. Xylitol is extremely toxic and even deadly to dogs.
* Wait before giving gabapentin after giving antacids. If you regularly give your dog antacids such as Pepcid or Prilosec, you must wait at least two hours after giving the antapid before giving gabapentin, as the antacids reduce the absorption of gabapentin from the stomach.
* Never stop the cold gabapentin turkey if your dog has been on it for a while. This could lead to rebound pain similar to the wind up pain, as the pain is worse than ever. Because of this, gabapentin always taper gradually.
As you can probably see, I’m a huge gabapentin fan. It helps many of my patients with their pain, is safe and inexpensive. I most often prescribe it as part of my polypharmacy approach to treating chronic painful conditions like osteoarthritis and cancer. I prescribe it for a toothache. It works wonders for neck and back pain.
While gabapentin is not currently widely used for post-operative pain as its effectiveness in this area has been questionable, I am currently excited as a study is currently being conducted to evaluate its effectiveness preventively (before pain) in canine surgery. Many veterinarians already prescribe it so that their surgical patients can begin before the procedure because they have so much confidence in it.
Gabapentin is extremely safe and has the potential to relieve our dogs’ pain and improve their quality of life and enjoyment of life. If you were wondering why so many veterinarians keep prescribing this drug, there is your answer. We see results, plain and simple.