NEUTERING PAINKILLERS

The most important period for pain control is immediately before, during and after surgery. Effective combinations include injectable painkillers, oral medications, and cold therapy. The best oral painkillers are non-steroidal anti-inflammatory drugs (NSAIDS) and paracetamol (acetaminophen).

  • NSAIDS

    Many studies prove NSAIDs hit canine pain harder than any other oral medication. This is an unpopular truth - The average carer doesn't like the idea that 'doggy ibuprofen' is our best painkiller. Unfortunately, this disbelief has triggered misplaced faith in anticonvulsant drugs like CBD and gabapentin.

  • PARACETAMOL

    In the USA, paracetamol is called acetaminophen. A licensed paracetamol-codeine product called Pardale-V is available in the UK. Paracetamol has earned the right to be our first-choice rescue painkiller. Unfortunately, it suffers a similar limitation to NSAIDs - Carers struggle to accept that it’s more powerful than anticonvulsants.

  • UNLICENSED DRUGS

    If a drug or supplement is powerful enough to have an effect, it’s powerful enough to have adverse effects. This is a list of adverse effects suffered by people taking the purest form of a popular supplement. Tap here to learn more about this mystery drug.

  • COLD THERAPY

    Cold packs can reduce post-surgical pain and swelling. The effects are most profound when they’re applied immediately after surgery. Incorrect application of ice packs can produce adverse effects. Tap here to watch a video guide including information about safe cold therapy.

CALMING MEDICATIONS

Oral medications target pain and anxiety. The section below describes the second class of aftercare medications - calming drugs.

  • ‘Calm’ and ‘sedate’ are not the same. Calmness enhances wellbeing, whilst chronic sedation impairs wellbeing. Antidepressants like trazodone and fluoxetine have a proven calming effect on dogs. They work by increasing levels of the happiness hormone serotonin.

  • There are two anticonvulsant drugs which have gained unwarranted popularity in veterinary practice. These are gabapentin and cannabidiol (CBD). Both have a common undesirable side-effect called somnolence. I've listed the adverse effects of both drugs on the ACL surgery page.

FAQ

The only source you can trust completely is your own aftercare team. They supply written and verbal instructions which consider your pet's unique situation. Veterinary nurses combine years of training with a passion for animal welfare. Please call them if you don't understand the plan or you're worried about your pet. They will always want to help.

  • Nobody should offer a loved one medications without reading the data sheets. These are available online from drugs.com (USA) and NOAH Compendium (UK)

    • Renaissance physician Paracelsus observed that "solely the dose determines that a thing is not a poison". Anyone who's consumed too much chocolate or alcohol understands his point. Even an inactive placebo can cause vomiting and diarrhoea. This phenomenon is so well established that it has a name - the nocebo effect.

    • My approach to dogs with sensitive stomachs is to reduce the dose of the “poison”. I use a very low dose of a NSAID. Meloxicam is the ideal choice because it's a liquid. This formulation suits a gradually increasing dosing schedule. The very low dose protocol starts 2-3 weeks before surgery. This gives me enough time to gradually increase the dose. Paracetamol is my second choice. I switch to paracetamol if my patient reacts badly to low dose meloxicam. Paracetamol doesn't produce gastrointestinal side-effects and can be combined with low-dose meloxicam.

    • Gastroprotectants might make a small difference. The most popular choice is a proton pump inhibitor (PPI) called omeprazole. We don’t have much data documenting the impact of omeprazole-NSAID combinations in dogs. If a high-risk person takes omeprazole with their NSAID, there's only a 10% reduced risk of an ulcer. The impact of omeprazole is much lower for moderate-risk patients - 268 people would need to take omeprazole to prevent a single ulcer complication.

    • Picture a reunion between a dog called Frodo and his carer. Frodo was in a veterinary hospital receiving treatment for a non-painful condition. He was anaesthetised, but he didn’t need an operation. Frodo goes crazy whenever he greets his carer. After his hospital visit, Frodo whines and cries for the entire journey home. That evening, Frodo won’t stop whining. His carer knows he should’t be painful but she starts having doubts.

    • Frodo’s situation is very common. It’s called post-separation anxiety, and it poses a big problem for owners of dogs recovering from surgery. When dogs cry in a veterinary hospital or car, we chalk it off to anxiety. When it happens at home, owners are primed to suspect pain.

    • A surgeon and owner make a joint decision about the best time for a pet to return home. Surgeons take responsibility for deciding when to stop injectable painkillers. Owners offer advice about how much happier their dog will be at home. Pain control and psychological wellbeing are both important. This means there must always be a compromise. Even so, dogs shouldn’t return home until comfort levels are good.

    • The easiest way to distinguish pain and anxiety is to take a short walk. Use a confident, reassuring tone to encourage your dog. If whining was caused by pain, the walk won’t help. In theory, walking should make a painful dog whine more. If a patient seems happier on a walk, anxiety was the more likely culprit. Mild anxiety is treated with distraction tactics (e.g. walks and gentle play). Severe anxiety is treated with calming medications (e.g. trazodone).

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