Pain Meds for Dogs: How to Manage Pain for a Dog With Cancer

Pain 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.

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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.

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

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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