Prescribing practices of veterinarians in the treatment of chronic musculoskeletal pain in cats

Abstract

Objectives Despite the high prevalence and increasing awareness of chronic musculoskeletal pain in cats, approved treatment options are completely lacking in the USA, and few other options have sufficient safety and efficacy data. Knowledge of current prescribing practices should inform future research of putative therapies. We aimed to determine which drug and non-drug therapies were being used by general practitioners for the treatment of musculoskeletal pain in cats and to understand demographic influences on prescribing practices. Methods We distributed a survey to 36,676 veterinarians who were members of the Veterinary Information Network in January 2017. Within 3 weeks, 1056 practitioners completed the survey. The survey included demographic and background information, questions on prescribing frequency and dosing regimen of 13 drugs and non-drug therapies and questions on preferred medication formulations and dosing frequencies. Descriptive statistics were used, as well as χ testing to evaluate relationships between demographic variables and prescription practices. Results Gabapentin was prescribed most frequently (71% of respondents), followed by joint supplements (67.8%), meloxicam (64.0%), opioids (62.6%) fish oil (62.1%) and polysulfated glycosaminoglycans (61.9%). Years in practice appeared to influence prescribing habits, with practitioners graduated for >20 years prescribing glucocorticoids more frequently than other age groups ( P = 0.0002), whereas recent graduates (<1 year) reported prescribing therapies less frequently across all categories. Conclusions and relevance These results show a contrast between therapies prescribed by practitioners and what is supported by evidenced-based literature. Future research evaluating the safety and efficacy of gabapentin should be prioritised.

The pharmacokinetics of gabapentin in cats

“…There are no approved medications for the treatment of chronic musculoskeletal pain in cats, and only a limited number of analgesic therapeutics with data about efficacy . Before the studies reported here, we surveyed veterinarians regarding pharmaceuticals and dietary supplements used for the alleviation of chronic pain in the cat . The most frequently prescribed treatment was gabapentin.…”

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

“…A large number of different treatments are prescribed for feline chronic musculoskeletal disease, often with little evidence to back up their effectiveness. 66 A multimodal approach involving therapeutics, environmental management and other complementary therapies has been described to manage feline chronic pain, 67 and is the focus of the following discussion. The effect of obesity on musculoskeletal disease is discussed later in the prevention section; suffice to say at this point that controlled weight loss should be part of the treatment programme for obese cats with established musculoskeletal disease.…”

“…67 Therapeutics A recent survey of predominantly North American veterinarians recorded the top five therapeutics prescribed for chronic musculoskeletal pain as being gabapentin (75%), joint supplement (67.8%), meloxicam (64%), opioids (62.6%) and fish oil (62.1%). 66 Therapeutics can be divided into analgesics and disease-modifying osteoarthritis (DMOA) drugs. Note that therapeutic licensing laws vary around the world.…”

“…67 < Non-steroidal anti-inflammatory drugs (NSAIDSs) Meloxicam and robenacoxib are the two most commonly prescribed NSAIDs for musculoskeletal disease. 66 In the UK, meloxicam is licensed for long-term use for chronic musculoskeletal disorders; robenacoxib is also licensed for use in chronic musculoskeletal disorders for up to 12 weeks. 68 Both have been shown to be effective in treating pain associated with musculo skeletal disease.…”

“…40 A 14-day trial using gabapentin at 10 mg/kg q12h showed an improvement as determined by a CSOM CMI, but a decrease in activity levels was noted, with sedation being the most common side effect. 46 < Opioids While it has been reported that opioids are commonly prescribed for chronic musculoskeletal pain in cats by North American veterinarians, 66 they are often only prescribed for short periods (8-10 days), which likely reflects the lack of a licensed opioid that can be easily administered at home. In addition, in the UK some opioids are a class B drug, restricting their availability and use.…”