Adrian DE, Rishniw M, Scherk M, Lascelles BDX. Prescribing practices of veterinarians in the treatment of chronic musculoskeletal pain in cats. J Feline Med Surg. 2018 Jul 1
Degenerative joint disease (DJD) is a common condition of both humans and domestic animals worldwide. Between 60 and 90% of domestic cats are affected by DJD, many of whom experience pain and limited mobility as a result of their disease. Despite this, many veterinarians struggle to identify and manage the pain and inflammation associated with DJD. A wide variety of therapeutic options are present to manage DJD, including anti-inflammatories, disease-modifying agents, opioids and other painkillers, and alternative modalities. Though many of these options are used clinically, none are approved in the United States for use in DJD in cats. Only three therapies have undergone rigorous trials to show efficacy; one joint diet, one NSAID (meloxicam) and a monoclonal antibody (frunevetmab).
The purpose of this study was to determine the prescribing practices of veterinarians for treatment of DJD. The study was designed as an online survey emailed to veterinarian members of an online veterinary community.
The survey was sent to 36,676 clinicians, of which 1056 completed the survey (2.9% response rate). Two clinicians had never prescribed pain control for arthritis in cats, for a total of 1054 data sets. 77% of respondents were female and 90.6 % were from the USA or Canada.
Data was collected on the number of cases of DJD seen, practice demographics, number of years in practice, and the medications or supplements most commonly prescribed. The rank-order percentages of drugs prescribed by respondents is below:
| Gabapentin |
71%
|
| Joint Supplement |
67.8%
|
| Meloxicam |
64%
|
| Opioids |
62.6%
|
| Fish Oil |
62.1%
|
| PSGAGs |
61.9%
|
| Robenacoxib |
50%
|
| Joint Diet |
41.6%
|
| Prednisolone |
34.4%
|
| Tramadol |
34%
|
| Methylprednisolone |
8.6%
|
| Amitriptyline |
7.5%
|
| Amantadine |
6.9%
|
| Other NSAID |
5.6%
|
| Triamcinolone |
1.4%
|
The median veterinarian prescribed four therapies for DJD (though not necessarily to each cat).
Practitioners with <1 year in practice were less likely to prescribe any medication. Those in practice for 6 to 20 years were more likely to prescribe therapy of any kind. Those in practice >20 years were more likely to prescribe glucocorticoids. Clinicians with <10 years experience preferred liquid formulations, and those >10 years preferred parenteral methods.
Gabapentin was the most prescribed medication. While this is an attractive drug to veterinarians due to many advantages (ie fairly inexpensive, safe, large therapeutic range, etc) it is interesting to note that it is not a medication that has been verified as an effective pain control in controlled studies.
A major limitation of this study was the possibility of sampling bias. Initial recruitment was sent to veterinarian members of a voluntary online community, and then those who chose to respond could potentially represent those veterinarians with an increased interest in DJD and pain control. As such, results may not be representative of the general veterinary community.
This study provides a good overview of the medications and prescribing practices of veterinarians treating feline DJD. The trends in use based on years in practice suggest that there may be experience or training aspects to use of therapies. The use of many off-label or unverified methodologies suggests that either further training or research is needed. (MRK)
See also:
Epstein ME, Rodan I, Griffenhagen G, et al. 2015 AAHA/ AAFP Pain Management Guidelines for Dogs and Cats. J Feline Med Surg2015; 17: 251–272.
Lascelles BDX, Robertson SA. DJD-associated pain in cats: what can we do to promote patient comfort? J Feline Med Surg. 2010; 12: 200–212.