Pain Relief Options for Veterinary Bone Cancer
Dear OncoLink "Ask The Experts,"
My Yellow Lab just turned 9 (June) years old and was diagnosed back in March with bone cancer - front leg, upper part of her shoulder. She is on Gabapentin, Tramadol, and Previcox. She is still eating, drinking and in good spirits, but is walking with a considerable limp. Is there any other pain medication or treatment for pain that would help her? While she is with us, we want her quality of life to be the best it can be under the circumstances.
Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:
Bone cancer, whether a primary tumor arising from the bone itself, or metastatic lesions that have spread to the bone from another primary site, is considered to be a very painful condition. A combination of oral medications, including anti-inflammatory drugs (such as a variety of veterinary-specific NSAIDs), narcotics and narcotic type medications (such as fentanyl patches, codeine by itself or in combination with acetaminophen, and tramadol), and adjunctive medications (including drugs like amantadine and gabapentin) are the mainstay of treatment. Often these medication regimens need to be switched around and adjusted as a patient's condition changes. For instance, a dog might stop benefitting from one particular NSAID, but may still have a good response to other NSAIDs. For some medications, there is a wide dose range, with more pain relief being provided at higher dosages. The trade-off is that there are also more side-effects (including potentially serious side effects) at higher dosages.
Radiation therapy is effective in alleviating pain associated with bone tumors in the majority of dogs and has been used successfully in veterinary patients for many years. Bisphosphonates (a drug that helps decrease destruction of bone by the cancer cells and is typically given intravenously once every several weeks) have more recently been used to treat cancer-associated bone pain in dogs and have shown some promise.
However, it should be noted that neither radiation therapy nor bisphosphonates will alleviate pain that is associated with a bone fracture at the area of the tumor. Prior to either of these treatments, radiographs (X-rays) of the affected bone should be taken to evaluate if a fracture is present. Once a fracture is present, there are few options that will be effective in decreasing pain. In some patients, a splint (either commercially available or custom-made) might stabilize the fracture and help minimize pain. In a very select group of patients, the benefits of an orthopedic surgery to repair the fracture with a bone plate might outweigh the risks.