More Ideas For Bone Cancer Pain: Pamidronate
ByI 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
Dr. Demian Dressler, DVM is known as the "dog cancer vet" and is author of Dog Cancer Survival Guide: Beyond Surgery, Chemotherapy & Radiation. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://DogCancerBlog.com.
6 Comments
July 29th, 2009 at 1:24 am
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
July 29th, 2009 at 3:05 am
The subject of the email that led me to this article was “Do preservatives in dog food cause cancer?”.
July 29th, 2009 at 3:06 am
Nevermind, it was the second article in the email. I was confused.
July 29th, 2009 at 7:39 pm
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
July 30th, 2009 at 7:20 am
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.
August 22nd, 2009 at 4:16 pm
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!