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,