Chronic maladaptive pain in cats: A review of current and future drug treatment options

Abstract

Despite our increasing understanding of the pathophysiology underlying chronic or maladaptive pain, there is a significant gap in our ability to diagnose and treat the condition in domestic cats. Newer techniques being used to identify abnormalities in pain processing in the cat include validated owner questionnaires, measurement of movement and activity, and measurement of sensory thresholds and somatomotor responses. While some data are available evaluating possible therapeutics for the treatment of chronic pain in the cat, most data are limited to normal cats. This review details our current understanding of chronic or maladaptive pain, techniques for the detection and measurement of the condition and the associated central nervous changes, as well as an overview of the data evaluating potential therapeutics in cats.

Moving forward with detecting osteoarthritis in cats

“…When this happens, the spinal cord can become a pain generator, causing widespread sensory changes to occur throughout the body. 6 Such widespread somatosensory changes have been documented in cats with OA. 7 Once these changes have occurred, alleviation of pain becomes more diicult as there are now two targets for treatment: the joint and the central nervous system.…”

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

“…70,73,74 NSAIDs, however, may not be an appropriate analgesic if maladaptive pain is present. 75 Grapiprant is a new class of NSAID, which has recently been licensed for dogs with OA (Galliprant; Elanco). It is a prostaglandin E receptor 4 (EP4) antagonist and works by blocking prostaglandin E2 (PGE2) receptors.…”

“…Amantadine is an N-methyl-D-aspartate receptor antagonist and its action may be more due to prevention of central stimulation by a noxious stimulus, with a minimal effect on nociception. 83 These characteristics may make it a potentially good candidate for cases where OA is leading to chronic maladaptive pain, 75 although clinical data are lacking. Dosages of 3-5 mg/kg q12h PO are currently recommended.…”

“…66 < Amitriptyline Amitriptyline is a tricyclic antidepressant that inhibits reuptake of serotonin, norepinephrine and dopamine. 75 This medication is occasionally prescribed by veterinarians for chronic musculoskeletal pain in cats. 66 However, there is no evidence of its effectiveness for feline musculoskeletal pain, although it may be beneficial if maladaptive pain is present.…”

“…66 However, there is no evidence of its effectiveness for feline musculoskeletal pain, although it may be beneficial if maladaptive pain is present. 75 < Anti-nerve growth factor The release of nerve growth factor (NGF) following tissue injury stimulates sensory neurons, leading to the sensation of pain; anti-NGF antibodies block this neuronal stimulation. 84 Tanezumab (Pfizer), a human anti-NGF antibody, has been in development for a number of years.…”