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

More Ideas For Bone Cancer Pain: Pamidronate

Updated: October 5th, 2018

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

Leave a Comment





  1. kathy on December 17, 2013 at 12:09 pm

    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.

  2. Cleo's Dad on November 13, 2013 at 7:57 am

    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.

  3. Alice on January 22, 2013 at 9:44 am

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

  4. Alice on January 22, 2013 at 9:42 am

    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 on January 29, 2013 at 7:01 pm

      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

  5. Cheryl DeLagrange on October 25, 2012 at 8:48 am

    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.

  6. SanDiego#1 on September 21, 2012 at 6:55 am

    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!!!!

  7. nbdavis on September 1, 2012 at 5:11 am

    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.

  8. margo p on January 4, 2012 at 9:52 am

    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 on January 4, 2012 at 3:04 pm

      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

  9. Marla on September 2, 2011 at 5:59 am

    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.

    • DemianDressler on September 6, 2011 at 8:21 pm

      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

  10. Jane on August 4, 2011 at 4:22 pm

    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

    • DemianDressler on August 8, 2011 at 1:01 am

      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

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