Assessment of the effects of gabapentin on activity levels and owner-perceived mobility impairment and quality of life in osteoarthritic geriatric cats

Use of Gabapentin or Alprazolam in Cats during Postoperative, Short-Term Hospitalization

This prospective, randomized study aimed to assess the anxiolytic efficacy of gabapentin or alprazolam in cats during short-term postoperative hospitalization. Sixty cats were randomly assigned to three groups (gabapentin-treated [100 mg per cat], alprazolam-treated [0.125 mg per cat], or placebo-treated), with treatments administered twice daily for two days. Stress levels were evaluated using Cat Stress Scores, serum cortisol, and glucose concentrations. Pain scores, food consumption, and adverse effects such as sedation were also monitored. Fifty-five cats completed the study. Both medications demonstrated similar reductions in stress levels. Cats receiving gabapentin had lower pain scores, while those receiving alprazolam exhibited significantly increased food intake on the first postoperative day. However, both medications resulted in comparable levels of sedation. In the context of postoperative hospitalization, pharmacological intervention with anxiolytics could be effective in reducing stress levels. Despite potential side effects, gabapentin and alprazolam may contribute to an improved quality of short-term hospitalization for cats.

Uncoupling the CRMP2-CaV2.2 interaction reduces pain-like behavior in a preclinical osteoarthritis model

Osteoarthritis (OA) represents a significant pain challenge globally, as current treatments are limited and come with substantial and adverse side effects. Voltage-gated calcium channels have proved to be pharmacologically effective targets, with multiple FDA-approved CaV2.2 modulators available for the treatment of pain. Although effective, drugs targeting CaV2.2 are complicated by the same obstacles facing other pain therapeutics-invasive routes of administration, narrow therapeutic windows, side effects, and addiction potential. We have identified a key regulator of CaV2.2 channels, collapsing response mediator protein 2 (CRMP2), that allows us to indirectly regulate CaV2.2 expression and function. We developed a peptidomimetic modulator of CRMP2, CBD3063, that effectively reverses neuropathic and inflammatory pain without negative side effects by reducing membrane expression of CaV2.2. Using a rodent model of OA, we demonstrate the intraperitoneal administration of CBD3063 alleviates both evoked and non-evoked behavioral hallmarks of OA pain. Further, we reveal that CBD3063 reduces OA-induced increased neural activity in the parabrachial nucleus, a key supraspinal site modulating the pain experience. Together, these studies suggest CBD3063 is an effective analgesic for OA pain.

2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats

PRACTICAL RELEVANCE

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and are effective for the management of pain in cats. These Guidelines will support veterinarians in decision-making around prescribing NSAIDs in situations of chronic pain, to minimise adverse effects and optimise pain management. Information is provided on mechanism of action, indications for use, screening prior to prescription, use in the presence of comorbidities, monitoring of efficacy, and avoidance and management of adverse effects.

CLINICAL CHALLENGES

The cat's unique metabolism should be considered when prescribing any medications, including NSAIDs. Chronic pain may be challenging to detect in this species and comorbidities, particularly chronic kidney disease, are common in senior cats. Management of chronic pain may be complicated by prescription of other drugs with the potential for interactions with NSAIDs.

EVIDENCE BASE

These Guidelines have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM) and American Association of Feline Practitioners (AAFP). Information is based on the available literature, expert opinion and the panel members' experience.

Skin Disease and Behavior Changes in the Cat

The health of the skin and coat of a cat is connected to the behavioral health of the animal. Stressed animals can cause lesions to their skin and coat such as alopecia, ulcers, and self-mutilation. On the other hand, localized or systemic health problems can cause stress, or pain, and therefore can increase overgrooming and poor skin health. When treating overgrooming and related skin lesions, all the physical and behavioral causes must be addressed through a multimodal approach.

Knee Joint Osteoarthritis in Overweight Cats: The Clinical and Radiographic Findings

Despite a high prevalence of osteoarthritis (OA) reported in the domesticated cat population, studies on feline knee joint OA are scarcer. Knee joint OA is a painful, age-related, chronic degenerative joint disease that significantly affects cats' activity and quality of life. In dogs and humans, one may consider overweight as a risk factor for the development and progression of knee joint OA; therefore, this study aims to assess the severity of knee joint OA in the body-weight-related groups of cats concerning clinical symptoms and radiographic signs. The study was conducted on sixty-four (n = 64) cats with confirmed OA. The demographic data on sex, neutering, age, and breed were collected. Then, the body condition score (BCS) was assessed, and each cat was allocated to the underweight, normal-weight, or overweight group. Within clinical symptoms, joint pain, joint swelling, joint deformities, lameness, reluctance to move, and apathy were graded. Based on the radiographic signs, minor OA, mild OA, moderate OA, and severe OA were scored. Prevalence and co-occurrence of the studied variables were then assessed. Joint pain was elicited in 20-31% of the OA-affected joints, joint deformities in 21-30%, and lameness in 20-54%, with no differences between weight-related groups. Severe OA was detected in 10-16% of the OA-affected joints, with no differences between weight-related groups. Severe OA in feline knee joints appears with similar frequency in overweight, underweight, and normal-weight cats. However, the general prevalence of clinical symptoms and radiographic signs is different in overweight cats.

Gabapentin: Clinical Use and Pharmacokinetics in Dogs, Cats, and Horses

Gabapentin is an anticonvulsant drug, which presents an established clinical efficacy in human patients for the management of refractory partial seizures, secondarily generalized tonic-clonic seizures, and for the control of chronic neuropathic pain. Gabapentin was synthesized as a structural analogue of the inhibitory neurotransmitter GABA, with GABA-mimetic effects, able to cross the blood-brain barrier. In veterinary medicine, is extra-label used in combination with other treatments to control seizures when other drugs are no longer effective or become toxic or for neuropathic pain treatment and anxiety. This review aimed to clarify gabapentin use and pharmacokinetic aspects to promote conscious use in dogs, cats, and horses. In dogs, gabapentin was beneficial in the treatment of epilepsy, as well as chronic, neuropathic, and post-operative pain, as well as anxiety. In cats, it showed efficacy in post-ovariohysterectomy-related pain and in anxiety management. In horses, gabapentin has been administered as an analgesic for chronic pain management. In conclusion, when used in combination with other drugs, gabapentin can be considered an interesting therapeutic option for the treatment of neuropathic diseases and analgesia in postoperative and chronic pain. However, despite its beneficial use in different clinical settings, further trials and pharmacokinetic studies are needed for the definition of an effective dosage regimen through proper pharmacokinetic/pharmacodynamic correlation in dogs, cats, and horses.

Do owner-reported changes in mobility reflect measures of activity, pain and degenerative joint disease in cats?

OBJECTIVES

The aim of this blinded, nested case-control study was to compare cats with and without early owner-reported mobility changes using subjective and objective outcome measures (owner-completed questionnaires, orthopaedic examination).

METHODS

A total of 57 cats with and without early owner-reported signs of impaired mobility were allocated to the case (n = 30) and control (n = 27) groups, respectively. Participating owners completed one inclusion and two pre-visit questionnaires (Feline Musculoskeletal Pain Index, VetMetrica). Cats were then visited in their own homes, where they underwent an orthopaedic examination, an assessment of their body condition score and temperament, and the placement of an accelerometer on their collar for 2 weeks.

RESULTS

There was no significant difference between groups for age category, breed, sex, temperament and body condition score. Case cats scored significantly lower for the Feline Musculoskeletal Pain Index (P = 0.003) and the VetMetrica domain of Comfort (P = 0.002), but not Vitality (P = 0.009) or Emotional Wellbeing (P = 0.018). Total pain (P <0.0001), crepitus (P = 0.002) and thickening (P = 0.003) scores were higher in case cats, as was the presence of bilateral disease (P = 0.005, odds ratio 14) and the number of bilaterally affected joints (P = 0.001).

CONCLUSIONS AND RELEVANCE

Both the Feline Musculoskeletal Pain Index and orthopaedic examination were able to differentiate cats with early owner-reported signs of impaired mobility from healthy cats. VetMetrica Comfort domain scores indicated a compromised quality of life for cats with early owner-reported signs of impaired mobility compared with healthy cats. Being able to recognise signs of mobility impairment earlier would allow interventions aimed at slowing disease progression, thereby improving feline health and welfare.

Feline Osteoarthritis Management

Feline osteoarthritis is common; despite vague clinical signs, it can result in mobility impairment and quality of life concerns. An integrative approach to management may include analgesic medications, dietary modifications, nutraceuticals, environmental modifications, physical rehabilitation, acupuncture, and regenerative medicine. Management of concurrent disease and consideration for patient tolerance and owner compliance are critical in formulating a treatment plan in cats with osteoarthritis.

Effect of oral administration of gabapentin on the minimum alveolar concentration of isoflurane in cats

Objective

To determine if oral gabapentin decreases the minimum alveolar concentration (MAC) of isoflurane in cats.

Study design

Prospective, randomized, blinded, crossover, and experimental study.

Animals

A total of six healthy adult cats (three male, three female) aged 18-42 months, weighing 3.31 ± 0.26 kg.

Methods

Cats were randomly given oral gabapentin (100 mg cat^-1) or placebo 2 h before starting MAC determination, with the crossover treatment given at least 7 days apart. Anesthesia was induced and maintained with isoflurane in oxygen. Isoflurane MAC was determined in duplicate using an iterative bracketing technique and tail clamp method. Hemodynamic and other vital variables were recorded at each stable isoflurane concentration and were compared between gabapentin and placebo treatments at lowest end-tidal isoflurane concentration when cats did not respond to tail clamping. A paired t-test was used to compare normally distributed data, and a Wilcoxon signed-rank test was applied for non-normally distributed data. Significance was set at p < 0.05. Data are mean ± standard deviation.

Results

Isoflurane MAC in the gabapentin treatment was 1.02 ± 0.11%, which was significantly lower than that in the placebo treatment (1.49 ± 0.12%; p < 0.001), decreasing by 31.58 ± 6.94%. No significant differences were found in cardiovascular and other vital variables between treatments.

Conclusion and clinical relevance

Oral administration of gabapentin 2 h before starting MAC determination had a significant isoflurane MAC-sparing effect in cats with no observed hemodynamic benefit.

Does preappointment gabapentin affect neurological examination findings? A prospective, randomized and blinded study in healthy cats

OBJECTIVES

The aim of this study was to evaluate the influence of a preappointment oral dose of gabapentin on the neurological examination of cats.

METHODS

A prospective, randomized and blinded clinical trial was conducted in 35 client-owned healthy cats. Cats were scheduled for two appointments and randomly assigned to receive either a placebo or a 100 mg gabapentin capsule prior to the second veterinary visit. A neurological examination was performed during each visit, and the results were compared between groups. Normal/abnormal response rates for each test were based on the number of cats that allowed the test to be performed.

RESULTS

Gabapentin was administered to 17 cats. Gait and postural reactions were significantly affected in the gabapentin group. Comparing the gabapentin with the placebo groups, proprioceptive ataxia was identified in 4/17 (23.5%) vs 0/18 cats (P = 0.0288); paw placement deficits were seen in 10/11 (90.9%) vs 1/4 (25%) cats; table tactile placement deficits were identified in 13/17 (76.5%) vs 0/18 cats (P <0.0001); hopping deficits were seen in 5/17 (29.4%) vs 0/16 cats (P = 0.0185); and abnormalities on wheelbarrowing and extensor postural thrust were reported in 5/17 (29.4%) vs 0/18 cats (P = 0.0129). These results had no correlation with age or dose/kg received. No significant difference was noted in the assessment of level and content of consciousness, posture, cranial nerves and spinal nerves. No significant differences were noted in test compliance or examination duration.

CONCLUSIONS AND RELEVANCE

Gabapentin significantly altered gait analyses and postural reactions in this group of healthy cats. The administration of gabapentin could lead to false-positive results and, possibly, an incorrect identification of neurological lesions. In contrast, gabapentin did not impair the assessment of cranial nerves and spinal reflexes, which can be assessed in patients receiving the drug.

Development of Two Innovative Performance-Based Objective Measures in Feline Osteoarthritis: Their Reliability and Responsiveness to Firocoxib Analgesic Treatment

The metrological properties of two performance-based outcome measures of feline osteoarthritis (OA), namely Effort Path (Path) and Stairs Assay Compliance (Stairs), were tested. Cats naturally affected by OA (n = 32) were randomly distributed into four groups (A: 0.40, B: 0.25, C: 0.15, or D: 0.00 mg firocoxib/kg bodyweight) and assessed during baseline, treatment, and recovery periods. For Path, from an elevated walking platform, the cats landed on a pressure-sensitive mattress and jumped up onto a second elevated platform. Analysis included velocity, time to completion, peak vertical force (PVF), and vertical impulse. For Stairs, the number of steps and time to completion were recorded for 16 steps up and down in a 4 min period. Reliability was moderate to very good for Path and poor to good for Stairs. Different normalization methods are described in the manuscript. The placebo group remained stable within-time in Path, whereas treated cats trotted faster on the ramp (p < 0.0001), improved their PVF (p < 0.018) and completed the task quicker (p = 0.003). The percentage of cats completing the Stairs finish line was higher under treatment (p < 0.036), with huge effect size, the placebo group results being stable within-time. Both are promising performance-based outcome measures to better diagnose and manage feline OA pain.

Evaluation of a nutritional supplement for the alleviation of pain associated with feline degenerative joint disease: a prospective, randomized, stratified, double-blind, placebo-controlled clinical trial

OBJECTIVES

The purpose of this study was to evaluate the pain-alleviating and activity-enhancing effects of glucosamine/chondroitin sulfate (Dasuquin) in cats that had degenerative joint disease (DJD) and owner-noted mobility/activity impairment. We hypothesized that the nutritional supplement would produce pain-relieving and activity-enhancing effects in cats with painful DJD.

METHODS

In this prospective, randomized, stratified, double-blind, placebo-controlled clinical trial, 59 cats with DJD pain were assigned to receive a placebo (n = 30) or supplement (n = 29) for 6 weeks after 2 weeks of placebo. Outcome measures (at-home accelerometry and client-specific outcome measures [feline (CSOMf); Feline Musculoskeletal Pain Index (FMPI); quality of life (QoL)]; and veterinarian examination) were collected at days 14, 28, 42 and 56.

RESULTS

Twenty-seven cats in the treatment group and 30 in the placebo group completed the trial. Within the first 2 weeks (placebo administration to all cats), 78% of all cats had an improvement in CSOMf scores. Both groups showed significant improvement at most time points in CSOMf, FMPI, QoL and pain scores, with the placebo group showing greater improvement than the supplement group (significant for CSOMf [P = 0.01]). Overall, no differences in activity were seen between the groups. Cumulative distribution function analysis indicated that for most levels of activity, the placebo-treated cats were more active; however, the least active cats were more active on the supplement (P = 0.013).

CONCLUSIONS AND RELEVANCE

This study showed a strong placebo effect. The glucosamine/chondroitin sulfate supplement did not show pain-relieving effects when compared with placebo.

Initial exploration of the discriminatory ability of the PetPace collar to detect differences in activity and physiological variables between healthy and osteoarthritic dogs

Background

Accelerometry has been used to evaluate activity in dogs with osteoarthritis (OA) pain, especially in relation to effect of treatment; however no studies have compared accelerometry-measured activity in dogs with OA-pain and healthy dogs. The aims of this study were to (1) compare activity output from the PetPace collar with the validated Actical monitor and (2) determine if PetPace collar outputs (overall activity, activity levels, body position, and vital signs) differed between healthy dogs and dogs with OA-pain.

Methods

This was an observational, non-interventional study in healthy dogs and dogs with OA-pain. All dogs were outfitted with the PetPace collar and the Actical monitor simultaneously for 14 days. Output from these devices was compared (correlations), and output from the PetPace device was used to explore differences between groups across the activity and vital sign outputs (including calculated heart rate variability indices).

Results

There was moderate correlation between the PetPace collar and Actical monitor output (R² = 0.56, p < 0.001). Using data generated by the PetPace collar, OA-pain dogs had lower overall activity counts and spent less time standing than healthy dogs. Healthy dogs spent more time at higher activity levels than OA-pain dogs. Certain heart rate variability indices in OA-pain dogs were lower than in healthy dogs.

Conclusions and clinical relevance

The results of this study suggest that the PetPace collar can detect differences between healthy dogs and those with OA-pain, and that OA-pain negatively impacts overall activity levels in dogs, and especially higher intensity activity.

2022 AAHA Pain Management Guidelines for Dogs and Cats

These updated guidelines present a practical and logical approach to the assessment and management of acute and chronic pain in canine and feline patients. Recognizing pain is fundamental to successful treatment, and diagnostic guides and algorithms are included for assessment of both acute and chronic pain. Particularly for chronic pain, capturing owner evaluation is important, and pain-assessment instruments for pet owners are described. Expert consensus emphasizes proactive, preemptive pain management rather than a reactive, "damage control" approach. The guidelines discuss treatment options centered on preemptive, multimodal analgesic therapies. There is an extensive variety of pharmacologic and nonpharmacologic therapeutic options for the management of acute and chronic pain in cats and dogs. The guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

Pharmacokinetics and pharmacodynamics of repeat dosing of gabapentin in adult horses

Background

The repeated administration of high doses of gabapentin may provide better analgesia in horses than current clinical protocols.

Hypothesis and Objectives

Administration of gabapentin at 40 and 120 mg/kg PO q 12 h for 14 days will not alter serum biochemistry findings or cause adverse effects. Our objectives were to evaluate the effect of gabapentin on serum biochemistry, physical examination, and plasma pharmacokinetics of gabapentin.

Animals

Six healthy adult mares.

Methods

Horses received 40 and 120 mg/kg of gabapentin orally q 12 h for 14 days. Horses were examined and scored for ataxia and sedation daily. Serum biochemistry variables were analyzed before treatment and days 7 and 14 after gabapentin administration. Plasma disposition of gabapentin was evaluated after the first and last drug administration. Pharmacokinetic parameters were estimated using noncompartmental analysis.

Results

No changes occurred in physiologic or biochemical variables. Median (range) maximal plasma gabapentin concentrations (μg/mL) after the last dose (day 15) were 7.6 (6.2‐11) and 22 (14‐33) for 40 mg/kg and 120 mg/kg doses respectively. Maximal concentration of gabapentin was reached within 1 hour after drug administration. Repeated administration of gabapentin resulted in a median (range) area under the curve (AUC_{0‐12 hours}) last/first dose ratio of 1.5 (1.00‐2.63) and 2.92 (1.4‐3.8) for the 40 and 120 mg/kg regimens, respectively.

Conclusion and Clinical Importance

Our results suggest that horses tolerate gabapentin up to 120 mg/kg PO q 12 h for 14 days. The analgesic effect of the dosage regimens evaluated in our study warrants further research.

Comparative Multimodal Palliative efficacy of gabapentin and tramadol By Using Two Pain Scoring Systems in Cats Undergoing Ovariohysterectomy

The analgesic efficacy of the gabapentin-tramadol combination was compared with meloxicam-tramadol and tramadol perioperative analgesic regimens in cats brought to the clinic for ovariohysterectomy. Thirty adult cats belonging to comparable demographics (age, body weight), were enrolled into a randomized, blinded study after due consent from their owners into four treatment groups. A Gabapentin-Tramadol group (GT-group, n = 10), Meloxicam-Tramadol group (MT-group, n = 10), and a Tramadol group (T-group, n = 10) were formed. Gabapentin capsules at 50 mg were administered orally 2 hours before surgery while the rest received a placebo dose. Tramadol (2 mg/kg, IM) and meloxicam at (0.2 mg/kg, SC) were injected immediately prior to anesthetic premedication. Anesthetic protocol involved premedication with ketamine and xylazine, while anesthesia was induced using propofol. Inhalant isoflurane anesthesia was used to maintain a surgical plane. GT group scored lower on IVAS as well as CPS than MT group, and T group for up to 8 hours after surgery. The mechanical nociceptive threshold remained higher (98±0) for up to 12 hours postoperatively a nd serum cortisol concentrations remained significantly lower during the 24hr period. The addition of gabapentin to the tramadol regimen significantly improved analgesia and mechanical nociceptive threshold than when used on its own.

Clinical evaluation of the effects of a single oral dose of gabapentin on fear-based aggressive behaviors in cats during veterinary examinations

OBJECTIVE

To investigate the effects of a single oral dose of gabapentin on fear-based aggressive behaviors (FABs) in cats during veterinary examinations.

ANIMALS

55 healthy pet cats (26 with and 29 without a history of FAB during veterinary visits [FAB and untreated control groups, respectively]).

PROCEDURES

A standardized 9-step clinical examination protocol (with patient compliance scored from 0 to 9 according to the highest completed step) was tested on untreated control group cats. The protocol was then used in a double-blind, randomized, placebo-controlled, crossover-design trial in which FAB-group cats received owner-administered gabapentin (100 or 200 mg/cat) or placebo capsules 2 hours before the first of 2 veterinary visits and received the alternate treatment before the second visit ≥ 1 day later. Ease of administration (scored from 1 [very difficult] to 4 [very easy]) and adverse effects were recorded. Compliance scores were compared between treatments for the FAB group and between FAB and untreated control groups. Changes in scores between treatments for the FAB group were used to investigate associations between selected variables and the outcome of interest.

RESULTS

FAB group compliance scores after gabapentin administration (median, 9; range, 0 to 9) were significantly higher than scores after placebo administration (median 0.5; range, 0 to 7) and did not differ from scores for the untreated control group. Owner scores indicated capsule administration was easy. Adverse effects (most commonly drowsiness, myorelaxation, and ataxia) resolved ≤ 10 hours after detection.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested oral administration of gabapentin to cats 2 hours before a veterinary visit can reduce FAB during physical examination, enabling more complete evaluation.

Hemodynamic, Echocardiographic, and Sedative Effects of Oral Gabapentin in Healthy Cats

The study objective was to evaluate sedative, hemodynamic, and echocardiographic effects of cats receiving single-dose, oral gabapentin. A prospective, double-blinded, placebo-controlled, crossover study was conducted with 10 client-owned cats. Vital parameters, physical exam, blood pressure, echocardiography, and sedation scoring were performed at each visit within 2 hr of receiving either a placebo or gabapentin capsule. Vital parameters, blood pressure recordings, and echocardiographic measurements were compared between baseline, gabapentin, and placebo; interobserver agreement for sedation scoring and correlation between variables were also evaluated. Seven of 10 cats exhibited mild sedation within 120 min after receiving gabapentin, and no adverse events occurred. Significant differences were detected with two-dimensional fractional shortening (P = .022), left ventricular internal diameter in systole using M-mode (P = .014), and left atrial volume (P < .0001). Interobserver agreement for sedation scoring was near-perfect (κ = 0.84). No significant correlation was found for gabapentin dosage and sedation score. Single-dose oral gabapentin is well tolerated in healthy cats and produces a modest decrease in several echocardiographic parameters of systolic function; however, all affected variables remained within established reference ranges. These results suggest gabapentin may be an appropriate sedative to administer before echocardiography in cats necessitating mild sedation.

Species Differences in Metabolism of Soluble Epoxide Hydrolase Inhibitor, EC1728, Highlight the Importance of Clinically Relevant Screening Mechanisms in Drug Development

There are few novel therapeutic options available for companion animals, and medications rely heavily on repurposed drugs developed for other species. Considering the diversity of species and breeds in companion animal medicine, comprehensive PK exposures in the companion animal patient is often lacking. The purpose of this paper was to assess the pharmacokinetics after oral and intravenous dosing in domesticated animal species (dogs, cats, and horses) of a novel soluble epoxide hydrolase inhibitor, EC1728, being developed for the treatment of pain in animals. Results: Intravenous and oral administration revealed that bioavailability was similar for dogs, and horses (42 and 50% F) but lower in mice and cats (34 and 8%, respectively). Additionally, clearance was similar between cats and mice, but >2× faster in cats vs. dogs and horses. Efficacy with EC1728 has been demonstrated in mice, dogs, and horses, and despite the rapid clearance of EC1728 in cats, analgesic efficacy was demonstrated in an acute pain model after intravenous but not oral dosing. Conclusion: These results demonstrate that exposures across species can vary, and investigation of therapeutic exposures in target species is needed to provide adequate care that addresses efficacy and avoids toxicity.

2021 AAFP Feline Senior Care Guidelines

The '2021 AAFP Feline Senior Care Guidelines' are authored by a Task Force of experts in feline clinical medicine and serve as an update and extension of those published in 2009. They emphasize the individual patient evaluation and the process of aging, with references to other feline practice guidelines for a more complete discussion of specific diseases. Focusing on each cat encourages and empowers the owner to become a part of the cat's care every step of the way. A comprehensive discussion during the physical examination and history taking allows for tailoring the approach to both the cat and the family involved in the care. Videos and analysis of serial historical measurements are brought into the assessment of each patient. These Guidelines introduce the emerging concept of frailty, with a description and methods of its incorporation into the senior cat assessment. Minimum database diagnostics are discussed, along with recommendations for additional investigative considerations. For example, blood pressure assessment is included as a minimum diagnostic procedure in both apparently healthy and ill cats. Cats age at a much faster rate than humans, so practical timelines for testing frequency are included and suggest an increased frequency of diagnostics with advancing age. The importance of nutrition, as well as senior cat nutritional needs and deficiencies, is considered. Pain is highlighted as its own syndrome, with an emphasis on consideration in every senior cat. The Task Force discusses anesthesia, along with strategies to allow aging cats to be safely anesthetized well into their senior years. The medical concept of quality of life is addressed with the latest information available in veterinary medicine. This includes end of life considerations like palliative and hospice care, as well as recommendations on the establishment of 'budgets of care', which greatly influence what can be done for the individual cat. Acknowledgement is given that each cat owner will be different in this regard; and establishing what is reasonable and practical for the individual owner is important. A discussion on euthanasia offers some recommendations to help the owner make a decision that reflects the best interests of the individual cat.

Evaluation of prescribing practices for gabapentin as an analgesic among veterinary professionals

OBJECTIVE

To describe the prescribing practices for gabapentin as an analgesic within the veterinary community.

STUDY DESIGN

Anonymous online voluntary survey.

POPULATION

A total of 718 veterinarians within the United States and Canada, including general practitioners and diplomates of the American Colleges of Veterinary Anesthesia and Analgesia, Emergency and Critical Care, Surgery and Internal Medicine.

METHODS

An anonymous online survey was used to gather information about individual prescribing practices for gabapentin including frequency of use, reasons for prescribing and procedures for authorizing refill requests. Questions specific to gabapentin covered mechanisms of action, perceptions of efficacy and the potential for abuse in people. Dunn's test for multiple comparisons and pairwise Mann-Whitney U test were used to evaluate relationships between veterinary specialty and survey responses.

RESULTS

A total of 718 veterinarians responded to the survey, 528 (73.5%) answered all questions of the survey to completion. Frequency of prescribing was high with 365/529 (69.0%) of respondents prescribing gabapentin as an analgesic on a daily or weekly basis. Surgeons and general practitioners used gabapentin significantly more frequently than other groups, with surgeons more likely to prescribe gabapentin for postoperative pain. The most common reason [254/517 (49.1%)] survey respondents prescribed gabapentin as an analgesic was because administration of a non-steroidal anti-inflammatory medication was contraindicated for that animal. The majority of survey respondents [362/527 (68.7%)] considered the abuse potential of gabapentin to be low in people.

CONCLUSIONS AND CLINICAL RELEVANCE

Veterinary prescribing practices for gabapentin closely mirrored that of human physicians, with gabapentin being prescribed frequently and for uses largely unrelated to its labeled indication. The perception of the potential for abuse of gabapentin is low within the veterinary community.

A pilot study of transdermal gabapentin in cats

Background

Clinical use of gabapentin has increased; transdermal delivery in cats is incompletely studied.

Objective

To evaluate if gabapentin permeates feline skin in vitro and in vivo and to determine if pain scores improve after administration.

Animals

In vitro: cadaver skin from 6 cats; phase 1: 8 young, healthy client‐owned cats; phase 2: 15 client‐owned geriatric cats.

Methods

In vitro, gabapentin applied every q12h to ear or cervical skin in diffusion cells. Samples collected at 0, 2, 4, 12, and 24 hours after application. Phase 1: Cats assigned to 1 of 4 groups: 5 mg/kg or 10 mg/kg applied q8h for 5 days to either ear or cervical skin. Serum samples collected predose, and after 1 and 5 days. Phase 2: 10 mg/kg applied q8h for 5 days. Two validated pain scores recorded predose, and after days 1, 5, and 8. Serum samples collected predose, and after days 1 and 5. Samples were frozen at −80°C for concentration analysis utilizing a validated high‐performance liquid chromatography mass‐spectrometry method.

Results

Gabapentin was identified in all samples. Significant differences in gabapentin concentrations were observed from day 1 to day 5 (P < .02) and in pain scores from predose to day 5 (P < .05) and day 1 to day 5 (P < .05). No differences in pain scores were observed from predose to day 8 (P = .3).

Conclusions and Clinical Relevance

Gabapentin in a transdermal base penetrates feline skin in vitro, is absorbed systemically in cats, and may help decrease pain scores.

Owner evaluation of quality of life and mobility in osteoarthritic cats treated with amantadine or placebo

OBJECTIVES

The aim of the study was to determine if amantadine improves owner-identified mobility impairment and quality of life associated with osteoarthritis in cats.

METHODS

Using a blinded, placebo-controlled, randomized, crossover design, 13 healthy client-owned cats with clinical and radiographic evidence of osteoarthritis and owner-identified mobility impairment were studied. Cats received 5 mg/kg amantadine or placebo q24h PO for 3 weeks each with no washout period in between. Locomotor activity was continuously assessed with a collar-mounted activity monitor system, and owners chose and rated two mobility-impaired activities using a client-specific outcome measures (CSOM) questionnaire on a weekly basis. Locomotor activity on the third treatment week was analyzed with two-tailed paired t-tests. The CSOM scores were analyzed using a mixed-effect model and the Bonferroni post-hoc test. Owner-perceived changes in quality of life were compared between treatments using the χ2 test. Statistical significance was set at P <0.05.

RESULTS

Mean ± SD activity counts during the third week of each treatment were significantly lower with amantadine (240,537 ± 53,880) compared with placebo (326,032 ± 91,759). CSOM scores assigned by the owners were significantly better with amantadine on the second (3 ± 1) and third (3 ± 1) weeks compared with placebo (5 ± 2 and 5 ± 1, respectively). A significantly greater proportion of owners reported improvement in quality of life with amantadine compared with placebo.

CONCLUSIONS AND RELEVANCE

Amantadine significantly decreased activity, but improved owner-identified impaired mobility and owner-perceived quality of life in cats with osteoarthritis. Amantadine appears to be an option for the symptomatic treatment of osteoarthritis in cats.

Efficacy and Safety of an Anti-nerve Growth Factor Antibody (Frunevetmab) for the Treatment of Degenerative Joint Disease-Associated Chronic Pain in Cats: A Multisite Pilot Field Study

Background: Pain management for cats with degenerative joint disease (DJD) remains a critical unmet need. Recent work has shown promise for a feline-specific anti-nerve growth factor monoclonal antibody (frunevetmab) to deliver safe and effective pain management. Our objectives were to evaluate the efficacy and safety of frunevetmab administered twice using two administration routes (subcutaneous and intravenous) compared to placebo. Methods: This was a randomized placebo-controlled, double-masked study. After a week-long pain and activity baseline, 126 cats were randomized to receive injections of frunevetmab (IV then SC; n = 42 or SC then SC; n = 43) or placebo (IV then SC; n = 41) on Days 0 and 28. Owners completed questionnaires on Days 14, 28, 42, and 56. Accelerometry data were collected continuously throughout. Results: Owner questionnaire results showed significant improvement in frunevetmab-treated cats [compared to placebo; (p < 0.05)] at Days 42 and 56; no difference was found between routes of administration for frunevetmab. All groups had decreased objectively measured weekly activity from baseline; frunevetmab-treated cats had a mean decrease of 0.9%, while placebo-treated cats had a mean decrease of 9.3%. Treatments were generally well-tolerated. The majority of adverse events included dermatitis/alopecia related to activity-monitor collars; these occurred in a higher percentage of frunevetmab, compared to placebo, treated cats. Conclusions and Clinical Relevance: Treatment with frunevetmab provided improvements in owner ratings of mobility over treatment with placebo; these results were supported by objectively measured accelerometry. Frunevetmab has the potential to address a critical gap in the treatment of chronic pain in cats.

ACVIM consensus statement on pancreatitis in cats

Background

Pancreatitis in cats, although commonly diagnosed, still presents many diagnostic and management challenges.

Objective

To summarize the current literature as it relates to etiology, pathogenesis, diagnosis, and management of pancreatitis in cats and to arrive at clinically relevant suggestions for veterinary clinicians that are based on evidence, and where such evidence is lacking, based on consensus of experts in the field.

Animals

None.

Methods

A panel of 8 experts in the field (5 internists, 1 radiologist, 1 clinical pathologist, and 1 anatomic pathologist), with support from a librarian, was formed to assess and summarize evidence in the peer reviewed literature and complement it with consensus clinical recommendations.

Results

There was little literature on the etiology and pathogenesis of spontaneous pancreatitis in cats, but there was much in the literature about the disease in humans, along with some experimental evidence in cats and nonfeline species. Most evidence was in the area of diagnosis of pancreatitis in cats, which was summarized carefully. In contrast, there was little evidence on the management of pancreatitis in cats.

Conclusions and Clinical Importance

Pancreatitis is amenable to antemortem diagnosis by integrating all clinical and diagnostic information available, and recognizing that acute pancreatitis is far easier to diagnose than chronic pancreatitis. Although both forms of pancreatitis can be managed successfully in many cats, management measures are far less clearly defined for chronic pancreatitis.

Appetite-stimulating effect of gabapentin vs mirtazapine in healthy cats post-ovariectomy

OBJECTIVES

The aim of the study was to evaluate the appetite-stimulating effect of gabapentin by comparing it with mirtazapine in healthy cats in the first 8 h after ovariectomy surgery.

METHODS

This double-masked, placebo-controlled, prospective clinical trial included 60 healthy cats presented to the hospital for ovariectomy: 20 received gabapentin, 21 received mirtazapine and 19 received a placebo immediately before and 6 h after surgery. Food was offered at 2, 4, 6 and 8 h post-ovariectomy. After each meal, food intake was measured. Data were analysed using repeated-measure ANOVA and a linear mixed-model analysis. Post-hoc Tukey's honest significant difference test was performed for multiple comparisons.

RESULTS

Food intake increased in both treatment groups vs placebo. No statistically significant difference was found between cats treated with gabapentin or mirtazapine.

CONCLUSIONS AND RELEVANCE

Cats receiving gabapentin ate more than cats in the placebo group. Thirty percent of cats in the gabapentin group covered their resting energy requirements, while none of the cats in the placebo group did. Gabapentin and mirtazapine produced similar effects on food intake.

Feline musculoskeletal ageing: How are we diagnosing and treating musculoskeletal impairment?

PRACTICAL RELEVANCE

An understanding of the process of musculoskeletal ageing - which all senior and geriatric cats will experience - is vital to maintaining the health and welfare of our ageing cat population.

CLINICAL CHALLENGES

Assessment of the feline musculoskeletal system is not always straightforward. Diagnosis of impairment relies on input from owners and veterinarians in terms of visual observation, and clinical and orthopaedic examination, in addition to diagnostic imaging.

AUDIENCE

This review is written for the primary care veterinary team.

AIMS

The goals are to raise awareness and improve clinical diagnosis of musculoskeletal impairment as a result of ageing. The article also reviews therapeutic options and considers the evidence available for the prevention/deceleration of musculoskeletal ageing and impairment.

EVIDENCE BASE

There is good evidence of a high prevalence of osteoarthritis (OA) and degenerative joint disease (DJD) in older cats. There is also good evidence to indicate that functional impairment and chronic pain are sequelae of musculoskeletal disease. However, there is a paucity of information for what is best practice for the management and treatment of musculoskeletal impairment in a clinical situation. There is also a lack of evidence on how prevention of central stimulation of the nervous system caused by musculoskeletal impairment and, in turn the development of chronic pain, can be avoided.

Validation and Characterization of Platelet-Rich Plasma in the Feline: A Prospective Analysis

Objective: To quantitate key parameters of the platelet-rich plasma (PRP) product from a commercially available system¹ in healthy, adult felines.

Materials and methods: A prospective study was performed from January 2019 to April 2019. 11 adult, healthy cats were used to prospectively analyze a commercially available PRP system¹. A whole blood sample and a PRP sample that was processed immediately following blood draw according to the manufacturer's protocol were collected from each cat. The mean whole blood and PRP product platelet, RBC, WBC, neutrophil, monocyte, and lymphocyte concentrations were determined. The mean PRP product values were compared to the mean whole blood baseline values using a paired t-test with significance established at p = 0.05.

Results: Mean platelet concentration was significantly increased (p = 0.0155). Mean RBC concentration was significantly decreased (p < 0.0001). Mean neutrophil concentration was significantly decreased (p < 0.0001). There was no statistically significant difference in mean WBC, monocyte, and lymphocyte concentrations.

Clinical Relevance: The analyzed PRP system increased platelet concentration, while significantly reducing the RBC and neutrophil concentrations. Further study is warranted to determine the clinical applications and efficacy of PRP in felines, and the ideal concentrations of and relationships between platelets, red blood cells, and leukocytes needed for therapeutic effect.

Neurobehavioral Disorders: The Corticolimbic System in Health and Disease

The corticolimbic system (prefrontal cortices, amygdala, and hippocampus) integrates emotion with cognition and produces a behavioral output that is flexible based on the environmental circumstances. It also modulates pain, being implicated in pathophysiology of maladaptive pain. Because of the anatomic and function overlap between corticolimbic circuitry for pain and emotion, the pathophysiology for maladaptive pain conditions is extremely complex. Addressing environmental needs and underlying triggers is more important than pharmacotherapy when dealing with feline orofacial pain syndrome or feline hyperesthesia syndrome. By contrast, autoimmune limbic encephalitis requires prompt diagnosis and management with immunosuppression and seizure control.

Novel use of an activity monitor to model jumping behaviors in cats

OBJECTIVE

To develop methods to identify and characterize activity monitor (AM) data signatures for jumps performed by cats.

ANIMALS

13 healthy, client-owned cats without evidence of osteoarthritis or degenerative joint disease.

PROCEDURES

Each cat was fitted with the same AM, individually placed in an observation room, then simultaneously recorded by 3 video cameras during the observation period (5 to 8 hours). Each cat was encouraged to jump up (JU), jump down (JD), and jump across (JA) during the observation period. Output from the AM was manually annotated for jumping events, each of which was characterized by functional data analysis yielding relevant coefficients. The coefficients were then used in linear discriminant analysis to differentiate recorded jumps as JUs, JDs, or JAs. To assess the model's ability to distinguish among the 3 jump types, a leave-one-out cross-validation method was used, and the misclassification error rate of the overall categorization of the model was calculated.

RESULTS

Of 731 jumping events, 29 were misclassified. Overall, the mean misclassification error rate per cat was 5.4% (range, 0% to 12.5%), conversely indicating a correct classification rate per cat of 94.6%.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that the model was successful in correctly identifying JUs, JDs, and JAs in healthy cats. With advancements in AM technology and data processing, there is potential for the model to be applied in clinical settings as a means to obtain objective outcome measures.

Feline Neuropathic Pain

Neuropathic pain represents the extreme in maladaptive pain processing. In itself, it is a disease in which pain has become exaggerated in some combination of scope, severity, character, field, duration, and spontaneity. It is almost certainly an underappreciated, underdiagnosed cause of possible significant patient morbidity in cats. This article explores the basic mechanisms, recognition, known and suspect syndromes, and prospective treatment of feline maladaptive and neuropathic pain.

Analgesia: What Makes Cats Different/Challenging and What Is Critical for Cats?

Cats have unique anatomic, physiologic, and behavioral considerations that may influence analgesia and pain management. They present specific challenges that require an individualized, feline-specific approach. This article presents an overview of recent advances in feline pain management and their differences in relation to other species and evolves on its future challenges. The main specific anatomy and physiology of the cat and how it may affect analgesia is discussed. Validated pain assessment tools including the UNESP-Botucatu Multidimensional Composite Pain Scale, Glasgow Feline Composite Measure Pain Scale, and the Feline Grimace Scale are summarized.

Feline Chronic Pain and Osteoarthritis

This article reviews the current knowledge regarding osteoarthritis-related pain in cats as a structure in which to discuss the assessment of chronic pain in the research and clinical settings. The scientific evidence available for current and emerging drug therapies is described. The importance of environmental enrichment and positive emotions to reduce pain, stress, and anxiety as means to promote feline welfare and human-pet bond is discussed.