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

Dog Cancer Pain Control

Updated: February 5th, 2019

Summary

Dog cancer pain control is really important, especially because dogs hide their pain symptoms so well. Learn how to treat your dog’s pain.

dog cancer painPain is a problem for dogs with cancer because it causes such life quality loss. That’s why recognizing when your dog is in pain, and finding a way to control dog cancer pain, is a very important part of Full Spectrum Cancer Care.

Many guardians are surprised to find out just how many tools veterinarians have to help with their dog’s pain. In this article, we will look at both common and uncommon ways to help dogs with cancer feel more comfortable and pain-free.



FYI: You Might Need to Tweak Your Dog Cancer Pain Control Method

Sometimes a treatment or pain method will “work” for a while, but later side effects set in that force us to change course. In fact, ANY intervention you do can cause its own side effects.

  • Adding the krill or fish oil recommended in the dog cancer diet (chapter 14 of The Dog Cancer Survival Guide) may cause an upset tummy or loose stools, especially if you don’t introduce them slowly.
  • Prednisone, a steroid commonly prescribed to treat cancer, can cause ravenous hunger and thirst, and even weight gain and a pot belly.
  • Some of the pain medications below might cause excessive drowsiness.

Your veterinarian will help you to understand the potential side effects of each medication they recommend, and if they don’t volunteer the information, ask for it. But even with that foreknowledge, you might find that something just doesn’t work out for your dog in the long run.

Think of cancer as a chronic disease, not an ongoing emergency.

Whether it’s pain control or cancer treatment, it can be frustrating to realize that we have to try something else.

We want cancer to be “set it and forget it,” but the reality is the opposite. Thinking of cancer, and particularly dog cancer pain, as a chronic disease rather than an ongoing emergency is a better strategy. It helps you (and me as a veterinarian) keep a centered, more calm mindset.

So expect that you will have to tweak your treatments and pain control methods, and you will avoid disappointment later.

The good news is, after reading about the methods below, you’ll have advanced knowledge of options to discuss with your veterinarian or oncologist.

So, let’s look at some common and not so common ways to manage dog cancer pain.

NSAIDs

Veterinarians often use a common class of drugs called Non-Steroidal Anti Inflammatory Drugs (NSAIDs) to help decrease both pain and inflammation (which can also cause pain).

Common examples of NSAIDS are:

  • Metacam
  • Previcox
  • Deramaxx
  • Rimadyl

These meds are suitable for mild to moderate pain. Even if your dog isn’t in pain, your veterinarian may still use NSAIDs to reduce inflammation, which is commonly found with cancer.

They can impact the liver and the kidney, however, so your veterinarian may want to check liver and kidney values with blood tests.

It’s pretty easy for dogs to take these drugs by mouth. Metacam comes as a liquid. The others are tablets, some of which are chewable.

Narcotics

Another class of drugs commonly used to control pain in dogs is narcotics.

The most common these days is Tramadol.  Veterinarians like Tramadol for a couple of reasons:

  • It has been shown to have some antidepressant effects in humans, and it could be argued that some dogs with cancer may be depressed. It’s sort of a two-for-one this way.
  • Tramadol by itself at usual doses is good for mild to moderate pain.
  • At very high doses, Tramadol may be enough for severe pain, but high doses usually cause a lot of sedation or sleepiness.
  • To avoid that side effect, normal doses of Tramadol can be combined with an NSAID for a very nice “pain control cocktail” with few side effects.

Tramadol comes in a tablet.

Neurotransmitter Modifiers

There are a couple of neurotransmitter modifier medications that can help with certain pain syndromes.  These include gabapentin, amantadine, and Elavil.

These meds work on the neurotransmitters involved in pain signaling, the little chemicals that trigger nerves. They don’t necessarily reduce inflammation, for example, but they might reduce the pain associated with it.

These meds are better used for lower grade and/or chronic, long-term pain.  They can be combined with the other drugs above to smooth out and relax dog cancer patients. They come as tablets and in some cases liquid.


For more helpful information and tools, get a copy of the Dog Cancer Survival Guide

Tylenol with Codeine

Some vets like Tylenol with codeine for dog cancer pain.  In my humble opinion, I don’t care for it. The incidence of diarrhea, vomiting, and loss of appetite is pretty high, so it’s more of a “last resort” drug in my practice.

That said, Tylenol with codeine does indeed control pain very well in dogs, so if your veterinarian recommends it, it may be worth a try to see if your dog tolerates it.

Topical Medications

For pain that is localized, meaning just in one spot instead of all over the body, topical medications may aid in pain control. Your veterinarian may recommend ointments containing lidocaine or benzocaine, or topical preparations that contain cortisone.  I have also used DMSO gel for a nice local anti-inflammatory effect.

Fentanyl Patch

Dogs in severe pain may benefit from Fentanyl patches.  Fentanyl is a narcotic and carefully controlled, so it’s no joke. It comes in a patch that is applied to the skin so the drug goes right into the bloodstream.

Fentanyl patches last for about 3 days and often cause sedation, which is why they are used for severe pain, often at the end of life.

If your veterinarian gives you Fentanyl patches, please be sure that no one else uses the patch but your dog. Also make sure you get proper disposal instructions from your veterinarian.

Acupuncture

Acupuncture is good for low grade to moderate chronic pain. The idea of letting someone stick needles in your dog may sound weird or scary, but dogs don’t usually mind it. The needles are barely felt.

Make sure you go to a qualified veterinarian who is specially trained in acupuncture, which you can find by searching the American Holistic Veterinary Medical Association’s website.

Cold and Hot Therapy

There are several easy-to-do home pain remedies you can try for painful, inflamed, or too-warm areas:

  • Icing an area for ten minutes with a bag of frozen veggies (like peas) wrapped in a towel can be really helpful. You could also use a plastic bag filled with ice or a cold gel pack. Just make sure that you use a towel around the cold source, particularly if you are applying directly on the skin.
  • Cold compresses can also be helpful. To do this, simply take a washcloth or small towel and wet it with cold water. Wring it out and apply to the area, letting it sit for up to ten minutes. When the towel gets warm, the therapy is over. Repeat if necessary.
  • Hydrotherapy using cool or cold water may also help. Most dogs tolerate running cool water over the area.

To add warmth to a stiff, cold, sore area, particularly for more chronic low-grade or moderate orthopedic pain, try warm water. For example, use a warm gel pack (follow the instructions), warm compresses, or warm water to increase circulation and relieve pain.

Combine Pain Control Methods

Don’t be surprised that your veterinarian wants to use two or more methods to relieve your dog’s cancer pain. There are several different pain mechanisms, and not every method listed above works for every type of pain. Covering the bases with more than one medication or method is often a very good idea.

Just like we go at cancer using five different steps in Full Spectrum Cancer Care, using more than one pain reduction method is often the best way to go.

Reducing pain if it’s present is a real gift to your dog. That’s why I do everything I can as a veterinarian to keep cancer dogs as pain-free as possible, so their cells can focus on fighting cancer.

I hope this helps,

Best,

Dr D

Further Reading and References:

Kongara K, Chambers JP, Johnson CB. Effects of tramadol, morphine or their combination in dogs undergoing ovariohysterectomy on peri-operative electroencephalographic responses and post-operative pain. N Z Vet J. 2012 Mar;60(2):129-35. doi: 10.1080/00480169.2011.641156. PMID: 22352930

Lascelles BD, Gaynor JS, Smith ES, Roe SC, Marcellin-Little DJ, Davidson G, Boland E, Carr J. Amantadine in a multimodal analgesic regimen for alleviation of refractory osteoarthritis pain in dogs. J Vet Intern Med. 2008 Jan-Feb;22(1):53-9. doi: 10.1111/j.1939-1676.2007.0014.x. PMID: 18289289

Sjogren T, Long N, Storay I, Smith J. Group hydrotherapy versus group land-based treatment for chronic low back pain. Physiother Res Int. 1997;2(4):212-22. PMID: 9408932

Janssens LA, Rogers PA, Schoen AM. Acupuncture analgesia: a review. Vet Rec. 1988 Apr 9;122(15):355-8. Review. PMID: 3289254

Argoff C. Mechanisms of pain transmission and pharmacologic management. Curr Med Res Opin. 2011 Oct;27(10):2019-31. doi: 10.1185/03007995.2011.614934. Epub 2011 Sep 14. Review. PMID: 21916528

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Leave a Comment





  1. Judith Wilson on March 21, 2019 at 11:46 am

    My 9 yr old golden retriever has a mass inder his r front armpit removed.biopsey dx was squamous cell.Unfortunately it grew back larger.He now has 2 other sites,nose chest.can you recommend a topical creme to apply to these to reduce the pain and,maybe shrink or dry them?
    Thank you

    • Dog Cancer Vet Team on March 22, 2019 at 6:31 am

      Hello Judith,

      Thanks for writing! As we’re not veterinarians, we can’t offer you medical advice. That might be a question best asked of your veterinarian as they know your dog, and they will be able to recommend a cream and pain control that can work alongside your boy’s current treatment plan 🙂

  2. Linda obrien on February 8, 2019 at 10:27 am

    Hi my pup has nasal cancer I give her the k9 immunity capsules and some transfer factors and everpup and APOCAPS and omega 3 capsules my question is she has some infection in her skull nasal cavity she was sneezing a lot the vet have her zodon 264mg antibiotic can she still take the supplements. It’s the APOCAPS I was worried about as they contain grapefruit ? Many thanks

  3. Barb Emmett on February 5, 2019 at 7:49 am

    Great article. And I know you can’t talk about it, but CBD oil from a high quality company with dosages set appropriately for dogs can be part of a person’s full spectrum cancer care protocol.

  4. Norene on December 21, 2018 at 10:53 am

    I just found out the other day that my dog has a liver tumor and I was wondering what would be good for him to take as a supplement because he is not wanting to eat the science diet l/d dog food. I have bn cooking him boil chicken and rice with carrots and peas, but I know that it’s not enough nutrients for him. My. Vet prescribed some metoclopramide HCL 10 mg and Gabapentin 100. He will be 14 year’s old in March and we rescued him when he was only 8 weeks old, I love him and just looking for answer for him to help him with his quality of life. Thank you.

    • Dog Cancer Vet Team on December 24, 2018 at 8:42 am

      Hello Norene,

      Thanks for writing! We’re not veterinarians here in customer support, so we can’t offer you medical advice. However, we can provide you with information based off Dr. Dressler’s writing 🙂

      In the Dog Cancer Survival Guide, Dr. D writes there are many things that you can do to help your dog, such as conventional treatments, diet, nutraceuticals, mind-body strategies and immune system boosters and anti-metastatics. Here’s a link to the Dog Cancer Diet PDF that readers of the blog can get for free.

      There are many things that make a dog’s life great, from their perspective, and Dr. Dressle created a Joys of Life scale to help readers determine their dog’s quality of life. You can find out more on life quality in the articles below 🙂

      If you’d like to try some mind-body strategies, Molly wrote an amazing article on Magical Thinking and Dog Cancer that you may find helpful

      We hope this helps Norene!

      Warm wishes from all of us here! x

  5. Laurel McClendon on December 8, 2018 at 4:35 am

    Hello, my dog Annie has bone cancer. She’s out of her pain meds. And her vet will not fill until Monday and it’s Friday. Why are people like that? They don’t care if my dog suffers. What can I do for her over the weekend? Thanks

    • Dog Cancer Vet Team on December 10, 2018 at 7:35 am

      Hello Laurel,

      Thanks for writing, and we are sorry to hear about Annie. We’re not veterinarians here in customer support, so we can’t offer your medical advice. However, we can provide you with information based on Dr. Dressler’s writing 🙂

      As Dr. D writes in this article, different types of pain require different types of drugs. In Chapter 17 of the Dog Cancer Survival Guide, Dr. D writes that acupuncture, pamidronate (for osteosarcoma), warm or cool compresses, and gentle massage may help with dog cancer pain– check with your vet, or holistic vet first, to ensure that these options can work alongside your girl’s current treatment plan.

      We hope this helps!

  6. susan townshend on September 20, 2018 at 5:48 am

    my 8 year old dog has secondary cancer and is taking tramadol for pain relief .is it kinder to put her to sleep.

  7. LovesJESUS My GOD on April 14, 2018 at 10:49 am

    I had my dog on it for over 8 months. He had cancer, he was 16 years and 4 months old when we lost the battle thursday. I had to put him to sleep. I had just ordered his latest meds, so I have over 100 tabs that they won’t take back. never opened. Anhyway They were his saving grace. after just a week the cough went away, and he didn’t cough until the night before I had to have him put to sleep. Those along with extra support of cancer herbs and supplements, and a detox soup I would make him. He was also on a non GMO food/ Fromms. He got losts of herbs, and love. The hydrocod/homoa tabs though kept his cough and pain at bay. But I do believe the tumeric and other supplements helped too.

  8. Jackie on March 15, 2012 at 2:59 pm

    I saw you on facebook by one of the facebooker who share your article.
    My dog is dying of cancer in her lungs. she is gagging and coughing. How can I help her to feel comfortable? Thanks jackie

  9. Dori Demarbieax on March 8, 2012 at 2:11 pm

    If my dog is already taking Prevacox, is it safe to also add the Apocaps? Would it be too much anti-inflammatory ingredients in the mix?

    • Dr. Demian Dressler on March 16, 2012 at 12:55 pm

      Hi Dori
      for information about Apocaps, see:

      Can I give Apocaps with prednisone, prednisolone or other anti-inflammatory agents?

      You can, but with some caution. Apocaps has an anti-inflammatory effect, so we recommend reducing the dose of Apocaps by half if you are using prednisone or any NSAIDs.

      I would read the rest FAQ page too!
      Please be sure to have veterinary supervision with all treatment steps for your loved dog…
      Dr D

  10. Gordon Sandelier on March 8, 2012 at 5:35 am

    I lost my dog to lymphoma and sugar. We treated him for both. We had to put him down after six months. he was 10yrs. I learn alot from your E-mails.
    Thanks

    • Dr. Demian Dressler on March 15, 2012 at 4:06 pm

      I am sorry Gordon. Sending our sympathy
      Dr D

  11. vicky on March 7, 2012 at 10:10 am

    FOR PAIN, I HAVE USED RIMADYL-AND IT WORKS. THE PROBLEM IS I AM ALMOST OUT OF IT 3 MORE HALF A TABLET FOR A 50 LB DOG. HE IS 17 YRS OLD AND HAS COPD AND SKIN CANCERS–THAT A FEW OF THEM HAVED TURNED BLACK AND ONE –BLEEDS NOW AND THEN. HE ALSO HAS FATTY TUMORS. I HEARD—IBUPHROFEN–ADVIL IS THE SAME AS RIMADYL. CAN I USE THAT FOR HIM–SINCE RIMADYL IS SO EXPENSIVE–OR ARE THERE ANY ALTERNATIVES–I CAN USE–I AM ALSO USING CURAMIN–BY(TERRY NATURALS BRAND) STRONGER THEN OTHERS. CAN YOU PLEASE HELP ME AND HIM (BLUE) I KNOW HE IS IN PAIN–BECAUSE HE PACES SO MUCH! THANK YOU SO MUCH!!! vicky