Dogs and pain medications

The bottom line

You can gauge the extent and location of your dog's pain by watching his behavior, mood, and response to being touched. Anything more than very mild pain requires examination by a veterinarian who can prescribe the most appropriate medication. Over-the-counter pain medications intended for humans should never be used in dogs without consulting a veterinarian.

Prevention Tips

Always talk to a veterinarian before giving any type of medication to a pet.
Follow pet medication instructions carefully.
Ask your veterinarian or pharmacist what side effects to look for and know which ones might require medical attention.
Keep all medicines securely shut away from children and pets.

This Really Happened

Case 1. A 50-pound dog ate 58 chewable 100-mg tablets of carprofen. A normal daily dose for the dog was 100 mg. The dog was vomiting and agitated when examined by a veterinarian who called their poison center. Treatment consisted of IV fluids and admission to a veterinary hospital. The dog was at high risk for kidney damage due to the large dose, but fortunately he recovered without complications.

Case 2. An owner administered half of a 200-mg ibuprofen tablet to a 7-pound dog. Two days later, the owner contacted a veterinarian because the dog was lethargic, vomiting, and having seizures. The dog was admitted to the veterinary hospital for emergency care and a poison center was called. The dog received anti-seizure medication along with IV fluids to prevent kidney injury. The owner could not be reached for follow-up.

Case 3. A 9-month-old, 50-pound puppy swallowed up to 5 naproxen tablets. This dose was considered potentially life-threatening. The dog was admitted to a veterinary intensive care unit approximately 3 hours after the ingestion. His remaining stomach contents were evacuated, and 85% of the absorbed naproxen was removed from the blood using a specialized technique called plasma exchange. On the second day, the dog was very hyperactive and vomited black material repeatedly, but no seizures occurred and his kidneys were spared damage. By the third day, the dog was well enough to be sent home (from Kicera-Temple et al.).

Dogs and pain

It is very upsetting to see your dog in pain. You want to help, right? Pain can affect your dog's ability to function normally and enjoy life. You might see a reduced ability to exercise, difficulty standing and walking, decreased appetite, and licking or biting at the site of pain. Fortunately, there is good information about what works best to treat canine pain. The sooner a dog's pain is treated the less likely it is to worsen.

There are two common types of pain that your dog might experience. The first kind is acute pain, which can result from injuries such as surgery or trauma. Chronic pain lasts longer than acute pain and can be associated with progressive diseases like arthritis or cancer. The origin and type of pain help determine what type of treatment is best.

How to read your dog's body language

Watching your dog's behavior and movements can give you clues about the severity of his pain. The International Veterinary Academy of Pain Management has published a pain scale that ranges from 0 to 4, with 4 being the worst level of pain:

0 No pain: Happy and normal. Interested in surroundings
1 Mild pain: Happy, but somewhat unsettled or restless. Reacts to pressure application at the site of pain
2 Mild to moderate pain: Uncomfortable, may whine or cry. Flinches or pulls away when touched at the site of pain
3 Moderate pain: Limping, or shifting body position to protect the site of injury. The dog might resist moving or might react to pressure at the site of injury with a harsh cry or growl.
4 Moderate to severe pain: Unresponsive to surroundings; difficult to distract the dog from its pain. The dog cries without being touched and can react aggressively to application of pressure at the site.

If your dog exhibits pain symptoms resulting in a score of 2, 3 or 4, you should contact a veterinarian for further evaluation and treatment. All FDA-approved medications for canine pain are available by prescription only. Your veterinarian might recommend an over-the-counter (OTC) supplement such as glucosamine, an herbal remedy such as cannabidiol (CBD), or a non-drug therapy like acupuncture or therapeutic exercise.

Medications used to treat pain in dogs

With numerous effective pain medications available for your best friend, it is vital to know about their safety and best uses. Some might be prescribed for home administration to your dog. Others are likely to be given in a veterinary hospital or office. The table below lists information on commonly used pain medications for dogs.

	Representative drugs	Common uses	Adverse effects
NSAIDs (non-steroidal anti-inflammatory drugs)	Carprofen Deracoxib Firocoxib Robenacoxib Meloxicam Grapiprant	Pain accompanied by inflammation: Acute pain from surgery, injuries Chronic pain such as osteoarthritis – common in senior pets	Vomiting Diarrhea Loss of appetite Rare GI ulceration Rare kidney or liver toxicity
Opioids	Morphine Hydromorphone, oxymorphone Methadone Fentanyl Meperidine Buprenorphine Tramadol	Moderate to severe pain: Acute pain with surgery (injectable forms) Acute pain during recovery from surgery or trauma (oral forms) Chronic pain from cancer or terminal illness	Vomiting Constipation Panting Sedation Dizziness
Local anesthetics	Lidocaine cream, gel, spray, patch, injection Many others available	Local anesthesia: Topical use numbs the skin and mucous membranes Injection or patch for pain during and after surgery or procedures	Skin irritation
Ketamine		Adjunctive drug: Added to opioids and/or NSAIDs for increased analgesia and sedation in surgery, trauma, or chronic pain	Vomiting Vocalization Muscle tremors
Gabapentin		Neuropathic pain: Due to nerve damage Due to chronic pain conditions Pain that does not respond to NSAIDs or opioids Osteoarthritis pain	Drowsiness Unsteadiness (ataxia)
Dietary supplements	Omega-3 fatty acids (EPA & DHA) Glucosamine and chondroitin	Osteoarthritis pain: Supplements have anti-inflammatory effects Modest benefits	Mild GI side effects

Can you give your dog OTC pain relievers made for humans?

Human medications for pain are usually not a safe choice for treating canine pain. Because each dog's pain is unique, a veterinarian should always diagnose and treat your best friend. Your veterinarian might recommend a doggie-dose of acetaminophen or aspirin under very special circumstances. However, keep in mind that these medications are not approved for use in animals and can be dangerous if not administered correctly. (As an important note, cats must never be given acetaminophen.)

Acetaminophen is an analgesic (treats pain), but it does not reduce inflammation. A veterinarian might use it in combination with other analgesics or anti-inflammatory drugs to treat a dog with chronic pain. Acetaminophen has the advantage of not causing as many GI side effects as anti-inflammatory drugs. To avoid toxicity, a veterinarian must always be consulted about the appropriate dose of acetaminophen for a dog. Symptoms of too much acetaminophen include vomiting, diarrhea, swelling of face and paws, and difficulty breathing. Liver damage is a serious complication of excessive acetaminophen doses in dogs and can usually be seen within 24-36 hours after ingestion. If you suspect your dog has gotten too much acetaminophen, it is important to get treatment immediately.

Aspirin, ibuprofen, and naproxen are NSAIDs found in many homes. A veterinarian might rarely okay the short-term use of coated aspirin, but aspirin carries a much greater risk of side effects (such as GI bleeding) than NSAIDs that are developed specifically for dogs. The same warning applies for ibuprofen and naproxen. As little as a half tablet might cause significant toxicity. Symptoms such as vomiting, diarrhea, and even GI bleeding and kidney injury can occur. NSAIDs developed for humans can reach higher levels and last longer in animals, so the best rule is to give only the safer veterinary products to your furry friend.

Are there alternatives to medications?

Evidence-based research justifies an important role for non-pharmacologic approaches in canine pain management. Several of these are considered mainstream options and are important in a pain treatment plan. An example would be applying an ice pack or heating pad to the painful area. Assuring that your dog gets plenty of rest and avoids too much jumping or running is also essential. If necessary, keep him in a confined space to permit healing to occur. Gently massaging the painful area might help increase circulation and ease pain.

CBD: another option for canine pain management?

Cannabidiol, or CBD oil, is extracted from cannabis and hemp plants. It lacks THC, the psychoactive chemical that produces the "high" of marijuana. Anecdotal evidence, such as owner testimonials, has claimed that CBD might have anti-inflammatory and analgesic actions in dogs. A small scientific study has shown reduced pain and greater mobility for some dogs with osteoarthritis that received CBD for a month. Dogs that received a placebo showed no improvement. These results are only preliminary, so much more information is needed to assess the benefits and precautions for using CBD in dogs. Side effects such as drowsiness, stomach upset, and abnormal liver enzyme tests have been reported. CBD can also interfere with the breakdown of certain medications leading to drug interactions. There aren't a lot of answers right now, but CBD could offer another option for pain relief down the road.

(Dr. McCament-Mann acknowledges the substantial contributions of pharmacy students Rochanda Chee, Alex Ho, Adan Magallanes, Neha Parmar, Hien Pham, and Kimberly Yeh)