Approach to analgesia in the feline geriatric patient
Abstract
The appropriate provision of analgesia is essential in all species. Pain causes intensification of the stress response, activates the sympathetic nervous system, affects food intake and metabolism, modifies behaviour and can adversely affect the immune response. If excessive pain is improperly managed, the sequelae can contribute to morbidity and mortality, particularly in already debilitated patients. In order to effectively manage pain, it is important to be able to recognize pain, utilize a multimodal approach and select appropriate analgesic drugs. Detection of pain, particularly chronic pain, can be difficult in cats and there are relatively few analgesic products licensed for long-term use in this species. Provision of effective analgesia in the geriatric cat can be challenging. This review aims to summarize how to first recognize the presence of pain in older cats and consider the pharmacological effects of ageing, and second how to adopt a multifaceted approach using the different classes of analgesics available.
In the UK it is estimated that there are currently approximately 2.5 million ‘senior’ cats (Gunn-Moore, 2003). Historically, it has been reported that UK veterinarians were less likely to use analgesics in cats compared with dogs in the peri-operative period (Capner et al, 1999; Lascelles et al, 1999). This finding is not limited to the UK (Raekallio et al, 2003; Hugonnard et al, 2004; Williams et al, 2005). For example 24.3% of veterinarians did not use analgesics after orthopaedic surgery in cats, in spite of the recognition that such procedures cause moderate to severe pain (Dohoo and Dohoo, 1996). Reasons for this trend may include:
In the presence of a noxious stimulus, detection of acute pain by the central nervous system may result in protective functions leading to rest, recuperation, guarding or avoidance which serves to minimize further injury and allow tissue healing.
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