which oral analgesics are safe and effective for at-home pain management in dogs and cats?

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Accepted Answer

For at-home oral analgesia in dogs and cats, an NSAID is the first-line agent for mild to moderate pain in both species, combined with buprenorphine oral transmucosal (OTM) when additional analgesia is needed. 1 NSAIDs are the cornerstone of outpatient pain management. Multiple NSAIDs are approved for chronic pain control in dogs in the United States, including grapiprant, which blocks the EP4 prostaglandin receptor and has demonstrated safe and effective reduction of osteoarthritis clinical signs. 2 No NSAID is approved for long-term use in cats in the United States, though meloxicam and robenacoxib are approved for long-term musculoskeletal pain control in cats in Europe. 2 NSAID therapy is generally administered for 3–7 days following oral/dental procedures, and can be extended in cats after aggressive oral surgery such as full-mouth extraction for chronic feline gingivostomatitis. 3 Renal, hepatic, and gastrointestinal toxicity are associated with NSAID use, though the true incidence is likely low. 2 Long-term NSAID use in dogs does not show increased organ-based toxicity with longer treatment duration and shows a positive trend toward increased efficacy. 2 Buprenorphine OTM is a practical and effective adjunct for home use in cats. The standard home dosing range is 0.03–0.05 mg/kg OTM two to three times daily. 4 Buprenorphine provides moderate analgesia with a duration of 4–8 hours depending on pain intensity, concentration, and dose, and adverse effects are generally mild. 4 Gabapentin (10 mg/kg PO q8h in dogs; 10 mg/kg PO q12h in cats) may provide benefit for pain with a neuropathic component, though published evidence supporting its use in acute pain is limited; it is better suited to naturally occurring chronic pain with a neuropathic component. 1 Tramadol is not recommended as a primary oral analgesic in dogs due to demonstrated lack of efficacy, and cats show a strong aversion to its taste. 2 Long-term oral opioids are not recommended for chronic pain in