Abstract
This issue of JFMS contains the first ever international consensus guidelines on the long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) in cats. This timely publication, which appears on pages 521–538 (doi:10.1016/j.jfms.2010.05.004), is a collaborative enterprise by the International Society of Feline Medicine (ISFM) and American Association of Feline Practitioners (AAFP). It has been compiled by a panel of world leaders in the understanding of pain in cats and, without doubt, is essential reading for all small animal veterinary surgeons.
It is interesting to reflect that although the first use of NSAIDs was probably by Hippocrates (some time between 460 BC and 377 BC), when he administered powder made from the bark and leaves of willow trees to help heal headaches, pains and fevers, it has taken until now for cats to gain the benefit of the long-term use of these drugs. Although NSAIDs have been available for dogs for many years, there has been a reluctance to consider their use in cats. While it is classically presumed that this relates to worries about potential drug toxicity, it is also likely that it stems from our inability to recognise pain in cats as easily as we do in dogs. This is perhaps not surprising, as cats tend to hide their pain. It's a strategy that makes perfect sense evolutionarily, as cats are solitary hunters and would have nothing to gain from showing pain — and plenty to lose (notably the risk of getting eaten by larger carnivores or primates).
The guidelines have been produced to help us all to use NSAIDs effectively and safely in cats. In their pursuit of this ambition the panel have covered much valuable ground:
To set the scene they consider how common chronic pain can be in cats, typically related to degenerative joint disease, idiopathic cystitis, trauma and cancer.
They then explain how and why NSAIDs can have such positive and, potentially, negative actions.
They consider the best ways of enhancing owner and cat compliance, make suggestions about sensible dosing frequencies, timing of medication and accuracy of dosing, and emphasise the importance of always using the ‘lowest effective dose’. They even cover the things that need to be considered when switching between NSAIDs.
They discuss the common concurrent conditions that, while not necessarily precluding the use of NSAIDs, require careful consideration in terms of pros, cons and potential complications — including renal disease, gastrointestinal disease, cardiovascular disease and liver disease.
They make a number of recommendations relating to the importance of pre-treatment screening, and the potential for interaction between NSAIDs and concomitant drug therapy (eg, glucocorticoids and anticoagulants).
They ultimately help to classify those patients that may have a higher risk of developing side effects, and hence need very careful monitoring during therapy.
They tabulate detailed dosing information for each of the NSAIDs that have so far been licensed in cats, as well as suggested monitoring protocols.
Although data are still limited and NSAIDs have only recently become licensed for long-term use in cats in some countries, the panel conclude that this group of drugs has a major role to play in the management of chronic pain in this species. However, they underline that careful patient selection, dose titration and ongoing monitoring for the early signs of toxicity are essential.
Guidelines panel members