Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide.

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More Ideas For Bone Cancer Pain: Pamidronate

I have been getting questions about control of pain for bone cancer in dogs, so I thought this might be a useful post.  Life quality is central in any type of cancer treatment plan, and therefore pain control is critical.

Osteosarcoma is the number one cancer affecting bone in dogs.  It usually affects large or giant breed dogs.

Rottweilers, Irish Wolfhounds, Greyhounds, Golden Retrievers, Mastiffs and more are examples of some breeds with genetic tendencies making them at higher risk for  osteosarcoma.

There is an association between spaying and neutering dogs early in life and osteosarcoma development, in particular in Rotts.  Other breeds have shown this correlation as well.

One of the difficulties with this type of tumor is the pain it produces.  It often first shows up as limping, since the most common site for osteosarcoma occurring  is the long bones of the limbs.

Many times dog lovers will see  a limp, only to be shocked later upon receiving the diagnosis following X-rays or bone biopsy.

This pain can be difficult to control.  Common drugs used would be metacam, previcox or deramaxx.  These are all anti-inflammatory drugs than control moderate pain and inflammation.

Usually these are combined with narcotic-type drugs like Tramadol, codeine or long-acting morphine.

Other choices used in combination with these drugs are gabapentin, amitriptyline, or amantadine.  These drugs are newer neurotransmitter modifiers.

A patch containing the narcotic Fentanyl can be applied every couple of days to the skin.  It is delivered to the blood through the skin (transdermally).

If your vet is not talking to you about options like these, please be bold and start asking about them. Be your dog’s primary health advocate!

Another option which is not given much attention at many veterinary clinics is called pamidronate (Aredia). This usually is a second or third line drug but I think you should know about it.

Pamindronate was looked into in some detail by Dr. Tim Fan, who I remember back at Cornell when he was an intern years ago.

This drug is used to slow bone breakdown, which is another advantage with bone cancer.  It was shown to help roughly one in four dogs with bone pain due to osteosarcoma.

Down sides include the proportion of dogs that do not respond (about three out of four), and the fact that it needs to be given as an IV injection in the vet’s office.  The oral form  (pills) are not well absorbed in dogs.

Kidney markers should be checked with the use of pamidronate.  One in 33 dogs had kidney marker increase with its use.

The dogs that do better on it get repeat injections every 28 days.

In spite of the drawbacks of pamidronate, this is another option for dogs experiencing bone pain that should be considered, especially those dogs whose pain is not being relieved with other therapies.

Keep pamidronate in mind and remind your vet if your options are shrinking.  For more details about osteosarcoma, see The Dog Cancer Survival Guide.

All my best,

Dr D

About the Author: Demian Dressler, DVM


Dr. Demian Dressler, DVM is known as the "dog cancer vet" and is author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://www.DogCancerBlog.com.

  • Sue Johnson

    I currently have my Welsh Pembrooke Corgi on Tramadol after being on Deramax but was told not to give them together. How do I know when the pain in not being controlled? Is panting (But not constant)and restlessness a sign of pain? I have a strap that I use to get him around with but other than that he stays on his memory foam mattress but rolls from side to side frequently. His appetite is still good and he has lost some weight (but he needed to anyway) but not a lot. He is 11 yrs old and very much loved and I want him to be comfortable but dread the thought of putting him to sleep permanently. He was diagnosed on April 23 of this year. Thanks so very much for your help through all of this. Sue

  • Jeffrey

    The subject of the email that led me to this article was “Do preservatives in dog food cause cancer?”.

  • Lynne

    Hi Dr. Dressler,

    Our sweet young Mastiff mix, Oly, was diagnosed with osteosarcoma of the ribs last September. We had surgery and just finished our 6th Carboplatin treatment. I have been giving Oly Lutimax for a couple of months now with our oncologist’s permission, 10 days on and 10 days off as advised in the Dog Cancer Survival Guide (and alternating with Artemisinin). This morning I noticed that Lutimax contains Xylitol, which I have read is poisonous to dogs. I am somewhat panicked. Did you know that Lutimax contained Xylitol? Have I been poisoning Oly?

    • Dr. Dressler

      Dear Lynne
      This question comes up from time to time. Many things are toxic to dogs in large amounts but not in small amounts. An common example is sodium chloride (table salt). Xylitol is another one of them. If you would like a Xylitol-free preparation, the folks at SynoRx can help. Apocaps is another source of Xylitol-free luteolin that will be arriving soon…
      Best,
      Dr D

  • Lynne

    Thanks so much Dr. Dressler. I will look forward to the Apocaps becoming available. You have been very instrumental in our treatment of Oly, and he’s doing remarkably well. We love him so much, we really cannot thank you enough.

  • Denise

    What are your thoughts on the use of Zoledronate for bone cancer pain management? We tried Pamidronate but it did not seem to have any effect. As of right now, my dog is getting by on Tramadol, Metacam, and Gabapentin. However, our oncologist suggested he might respond better to Zoledronate.

    Though my dog limps and tries to avoid putting his full weight on his hind leg, he still enjoys a good quality of life (though we have limited his exercise to short walks only). I am debating whether or not to go through with the Zoledronate treatment for the following reason… Though most of the literature I have read on it suggests the drug can decrease bone invasion (in effect controlling the tumor), I came across one study (performed on mice) that found that even though the drug managed to strengthen bone, it actually increased metastases to the lungs in certain models.

    We tried a course of palliative radiation therapy which seemed to do more harm than good. Despite the high success rate associated with this type of therapy for pain relief, my dog could barely stand and was tripping all over the place after the treatment. Seeing as how he is managing fairly well at the moment, I fear giving him a treatment that does not have a lot of research to back up its efficacy (like Zoledronate) might make matters worse- particularly if it speeds up metastases. On the other hand, I don’t want to withhold something that might help him and it seems like it would be good to target the bone invasion earlier rather than later.

    Any advice would be much appreciated. Thank you so much.

    • Dr. Dressler

      Dear Denise,
      The realm of what an oncologist deals with daily includes Zoledronate. The best choice for you, quite honestly, is to have a frank discussion about this treatment, including your fears, with your oncologist, who is familiar with your dog and is managing the case. You could also bring up Amantadine as another possibility.
      Best,
      Dr D

  • Tracey Routeldge

    My dog was diagnosed in early January with osteosarcoma in her front limb. Currently she is on Metacam and Gabapentin an assortment of supplements and a strict diet.
    Her leg has begun to swell to a heart breaking size. Soaking helps a bit…. Do you have any suggestions to help reduce swelling? Tracey

    • Dr. Dressler

      Dear Tracey,
      have you looked into Apocaps? I cannot make a medical claim here, but I can suggest you inform yourself and your vet.
      I assume surgery to help your dog’s life quality is not an option? The problem is not swelling, but is the cancer itself. What about Samarium (quadramet)? Palliative radiation?
      These would be my first thoughts.
      All my best,
      Dr D

  • Jill Brown

    My 9 year old Red Bone Coon Hound has osteosarcoma in his jaw and my vet has told me that there is no treatment for him. I want to keep him pain-free for as long as I can. Right now he is on Tramadol. How will I be able to tell when he need something stronger. What are the signs that a dog is having a lot of Pain. Casey is loved like a son and I want him to have tthe best quality of life that I can give him. I love him as much as if I had given birth to him. Thanking yo in advance for your help. Jill

    • Dr. Dressler

      Dear Jill,
      This is a great question and I will write a blog post just for you. Have you read the guide and looked into Apocaps?
      Typically jaw pain can be seen with difficulty eating or mouthing toys. Overall life quality should be assessed too:
      http://www.dogcancerblog.com/pain-in-dog-cancer-and-life-quality-part-2/
      Other drugs for pain include the anti inflammatories, gabapentin, amantadine, and more. Acupuncture can help. Touch base with your vet on these.
      Best,
      Dr D

  • melissa

    URGENT HELP NEEDED. My dog Autumn on Feb 20 diagonsed with Osteosarcoma on her rib. Did not do surgery due to diagonosis of only 4-6 monthes with surgery & chemo. She is on Proxicam and doing great. Carafate, probiotics, arthemisisin, krill fish oil and
    k-9 immunity. Tried Tramadol again, she is limping bad again. She gets diaharhia, low body temperature and panting. Please any suggestions on a pain medicine that works with the Proxicam well. Gaberpentin does not work for her either. When first diagonosed they gave her a steriod and an Roboxin and they do not work. Thank you, Melissa

  • Lori

    My nine year old German Shepherd, Trooper, was diagnosed with bone cancer on July 5, 2010. My vet put him on 10 mg/day of Piroxicam for pain and 20 mg/day of Famotidine to prevent stomach upset. We were told he only has approximately 3-6 mos. of life left. I was devastated and felt like I couldn’t just sit back and watch the cancer slowly take him without giving it a fight. That is when I came across Acocaps. I immediately ordered a bottle and started him on them, giving three capsules, three times a day according to the directions. I have switched his diet to a high animal protein diet with 75% of his food being the high animal protein, the other 25% is Science Diet’s Nature’s Best dry food. I have also added sardines and wild Alaskan salmon oil to his diet. I have continued to give the pain med and stomach med..not really sure if I should be doing that, but he seems to be tolerating it well with the Apocaps. My question is…He was due for his monthly heartworm medication (Interceptor) yesterday. Should I give that to him? Our vet did not give his annual parvo/dhlp vaccine when we were told he had the bone cancer and I understand if she thought it would be pointless if he only has 3-6 mos., but if with the help of Apocaps, he is given more time…should he take the Interceptor monthly and should I ask the vet to give him his vaccines? Our vet has not heard of Apocaps so was unable to advise me. Also, thank you, thank you, thank you for giving me some hope in knowing that Trooper (and I) will not go down without giving this cancer thing a real fight!

  • Lori

    Should my german shepherd who was diagnosised with bone cancer and is taking Apocaps continue to take his once a month heartworm (Interceptor) medication?

    • TAG

      Do you have current information on the Metronomic Protocol? What about the “Navy Protocol”?

      I have a 10 year old golden retriever (Tag) who has Osteosarcoma; doing well (stable) 6 months post diagnosis. He is just taking medication.

      Thanks, Tag :-)

  • Jane

    Dr Dressler
    PLEASE HELP
    My beloved rottie Joe aged 9 after an x-ray on 22nd June 2011 was diagnosed with arthritis by my vets. He had acupuncture by the same vet (who then went on holiday) on vets return I took Joe’s right back for more acupuncture but mentioned leg was swollen (as is with arthritis). The vet was concerned and checked his x-ray to see if he had missed something – he had their was clouding on the right back femur and his ‘off the cuff’ comment was that he had missed the extensive periosteal reaction down the right femur and pelvis. He said he would refer us to a specialist. We went the next day and the specialist couldnt believe the vet had missed it and as he was a surgeon he advised amputation (this is going off the original x-ray taken 6 weeks ago). two days later Joe my handsome boy is now limping at the front end and I believe the cancer has spread. Although he is booked into for amputation I really believe it is unfair to put him through this. I have to be kind to my beloved darling Joe and feel it is more fair to him to put him out of his pain. MY QUESTION IS – IS THERE AN ALTERNATIVE ROUTE ? I seriously don’t know if I can cope without him – I appreciate this is a very strong reaction but I love him so much I am sure others with sympathise with my feelings

    • http://DogCancerBlog.com DemianDressler

      Dear Jane,
      I a sorry to hear about Joe. We need to look closely at this.
      I am wondering about how we are defining alternative route? If you mean something that will remove these cells to the extent that surgery will, the answer is no. However, I would first suggest another X-ray, as well as one of this forelimb and chest, and lab work. It would be uncommon for bone cancer to spread to another bone without spread elsewhere in the body first, and if this is the case there would be little point in putting Joe through this procedure. We need to assess the affected leg and the rest of the body before doing anything.
      Secondly, I think you are facing a lot of emotional pain right now- delayed treatment being one factor, and your Joe’s plight being the hardest part. I might suggest some of the emtional management exercises in the Guide that are designed to help discharge these difficult emotions so you are able to be Joe’s most effective guardian.
      Don’t forget diet, apoptogens, immune support, and the other approaches to help canine cancer patients too.
      best
      D

  • Marla

    We lost Bella, our 17 month old female yellow Lab to Osteosarcoma of the shoulder in February 2011. When she was finally diagnosed, it had spread to her lungs and other parts of her body. The pamidronate infusions seemed to help her with pain and keep the bone from deteriorating. It did give her a couple of months of better quality of life.
    I have a bottle of Apocaps with 55 pills left in it, that I willing to donate to someone that could use it. I don’t know if this is allowed on this site, just trying to help someone. If allowed, please email me and I will gladly send it to you.

    • http://DogCancerBlog.com DemianDressler

      Dear Marla,
      So sorry to hear your Bella passed. As far as sharing your left-over supplies, I think that is great. For those who are interested, Marla’s e-mail is:
      mshurn@sbcglobal.net
      Best
      D

  • margo p

    Hello we are located in Long Island, NY and wanted to know where the nearest vets would be located to offer pamindronate for our 10 year old St Bernard with OS? Thanks so much!

    • Dr. Susan Ettinger

      Hi. You can look for an oncologist using http://www.acvim.org. I am also in Westchester at the Animal Specialty Center – in Yonkers. You could book an appointment with me (914-457-400), and I can help you personally with the treatment. There are some newer bisphosphanates that can also be considered. Whereever you end up going, good luck!!
      Best, Dr E

  • nbdavis

    My 13 year old 61 pound black lab mix was diagnosed with osteosarcoma of her right front shoulder after she developed a limp. The diagnosis was confirmed by an x-ray, needle biopsy and blood work. The lungs are clear.. She has never been sick a day in her life and is otherwise very healthy. She is taking tramadol and Rimadyl. She had a Pamidronate infusion on 08/08/12 and Carboplatin therapy on 08/22/12. She is scheduled for amputation on 09/21/12. She is not limping anymore and I think she may be one of the few dogs where Pamidronate is successful. I am now questioning my decision for amputation and wondering if I should continue with the infusion and chemotherapy instead.

  • SanDiego#1

    My 7 year old female Doberman was diagnosed with Osteosarcoma in her rear leg. it has metasticized to her lungs and chest. Unfortunately, the gen Vet that was treating her totally missed this and was doing accupinture and Chiro adj for a back issue.. She got worse with each treatment. My Internal Specialist started her about 2 weeks ago on Pamidronate Infusions. She is also on Tramadol, Gabepentin and low dose of Pred. She cannot take NSAIDS as she has IBS. The pain seems to be better. Now we are noticing she is wetting her bed at night.. I am insisting that our Specialist do Kidney markers just to be sure. No one can give me a time frame for this. She has some very good days and some fair days..Could the Pred be contributing to the wetting? It definitely helps her pain and appetite!!!!

  • Cheryl DeLagrange

    I was just reading an article re horse slaughter and “dark cutting”. This is when the animal is not killed properly which in equines cant be done in the kill box, evidently the brain causes a massive cortisol and adrenalin release to the muscles which in horses is much larger b/c of the flight response they have. In beef if the levels are too high the meat cant be used for human consumption and is punted to the petfood industry. OK if it causes cancer in humans why wouldn’t it do the same to our companions. This is a dirty little secret of the slaughter and pet food industry.

  • Alice

    My Gino will be 9 yrs on March 18, 2012. He is a German Shepherd white purebread. He was in perfect health and then goyt the sudden lump on his front paw (wrist) and began to limb. We thought he was hurt in the yard, Two weeks later he hits the paw or twists it and screams, we take him to vet. In Nov 2012 he was diagnosed w/ aggressive Osteosarcoma. We decided against amputation, after learning that it had Probably not spread to his lungs. We went to a Vet college in Athens, GA (much cheaper) and he had two Radiation treatments. These were so successful, that his lump has shrunk a little, he stopped limping after one treatment. He is his old self. He is Apocaps, turmeric, and now fish oil, CoQ10 with A & E. I am giving more protein to him and less carbs. Making him lamb and carrots or bison and carrots. He still gets glocosomeine (Dasuquin w/ MSM) and I added Calcium with Vit D and Vit K2 also. Anyway due to his age, we decided not to amputate. Now we will look at Biophosphonates, but I worry about his kidneys..After 1 week of radiation, we took him off Tramadal and Rimadyl, so Radiation works for this, ? is How long will it last..cost was $1650 for 4 radiations and 1 xray, everything included

    • Dr. Demian Dressler

      Dear Alice,
      radiation can give several months of pain control. I’m worried about the supplement program- it is a bit off. Have you read the Guide? are you using a beta glucan supplement? i would cut the coQ and if you want extra curcumin do that as opposed to turmeric. Also i’d cut out the A and E with apocaps. Carrots are starchy (cancer food).
      I hope this helps.
      Dr D

  • Alice

    I meant Gino’s B-day is March 18, 2013..oops

  • Cleo’s Dad

    We have a German shepherd, 12 years old, with bone cancer, and have decided, because of her age, to avoid amputation and chemo. We are being advised on having her treated with pamidronate, and followed with radiation. Is it feasible to treat her with pamidronate, and then begin a course of Artemisinin? We understand that radiation and don’t combine well, but what about waiting on the radiation to see if the herbal method helps?
    Thanks for your help.

  • kathy

    I am in same place as you were a year ago. How did things turn out for your 7 yr old Dobie Mine is the same age.

  • Jeffrey

    Nevermind, it was the second article in the email. I was confused.

  • Anonymous

    Sue, good question. I will address this in the next blog post. By the way, there is no interaction between Tramadol and NDSAIDS like Deramaxx. They are used together frequently in veterinary medicine.
    Best,
    Dr D

  • Helen Morrill

    What dog food would you recommend,particularly to avoid those things that could contribute to the development of cancer? (I am always concerned about food color, preservatives, by-products but wonder if htt is enough). I current feed my two precious Bichons, Rascal And Resi, Blue Buffalo weight control. (No preservatives, food color or animal by-products).

    Thanks so much for your help.

  • robert

    I might be bitter, but we just learned that our 8 year old Boerboel was diagnosed with osteosarcoma. Second dog we lost to the cancer! Always fed with “better” dog food-Nutro Large Breed. I am determined to investigate and study and hopefully prove the link between dog food ingredients and cancer. Shame that vets are not standing up against the food manufactures and addressing their concerns. They tell me they see a tremendous increase in rate of cancer. What else could it be? We have no chlorine or fluoride in the water (yes, please research what they do to humans), don’t use chemicals on our lawn, it has to be the food or vaccines. Please question and verify! The oncology center we brought our dog, quickly wanted to do CT-scan, because they weren’t 100% sure based on the X-rays ($1300 vs. $200). I had to request chest X-rays to make sure the cancer didn’t metastasize in the lungs before they could finally do their CT-scan. I think a lot of this is about money! Poor data, poor outcomes yet a lot of cash going to docs for a small ray of hope we have for our dogs! We are not giving up, but not counting on “chemical” medicine anymore! Pain management and immune boosters are the options we are pursuing. Please question and do your research!