Episode 161 - Parenteral Pain Modifying Analgesics in Veterinary Medicine

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🎧 Host: Dr. Dr. Brett Beckman, DVM, FAVD, DAVDC, DAAPM

In this episode, veterinary pain management expert Dr. Mark Epstein explores the latest advancements in parenteral pain-modifying analgesics for chronic pain in dogs and cats. He breaks down the science behind ketamine, bisphosphonates, maropitant, and interventional pain therapies, providing practical dosing recommendations and real-world clinical insights.

What You’ll Learn in This Episode:
✅ How ketamine can be used beyond perioperative settings for chronic pain
✅ The role of bisphosphonates in managing osteosarcoma pain
✅ Maropitant’s potential as a pain-modifying agent
✅ The latest research on interventional pain therapies (steroids, PRP, hyaluronic acid)
✅ Practical dosing recommendations and safety considerations

Key Takeaways:
🔹 Ketamine for Chronic Pain:
Perioperative ketamine use is expanding into chronic pain management
Administered every two weeks for three to four doses
Research on subcutaneous infusion devices for continuous low-dose delivery
Anecdotal reports on monthly low-dose SC ketamine (0.5 mg/kg), but more studies needed
🔹 Bisphosphonates for Osteosarcoma Pain:
Zoledronate (Zoledronic Acid) is preferred over pamidronate—stronger, safer, and quicker
Standard dose: 0.1 mg/kg IV over 15 minutes (max 4 mg)
Best when combined with NSAIDs and radiation therapy for enhanced pain relief
🔹 Maropitant (Cerenia) Beyond Anti-Nausea:
May reduce central sensitization (wind-up pain) despite not being a direct analgesic
Some studies show benefits for neuropathic pain, GI pain, and post-op discomfort
New research into nanoparticle formulations for improved absorption
🔹 Interventional Therapies for Chronic Pain:
Saline alone can provide joint pain relief by diluting inflammatory mediators
Corticosteroids reduce inflammation but may harm cartilage—use cautiously
Hyaluronic Acid (HA) may not outperform saline in osteoarthritis management
PRP & stem cell therapy show promise, but protocols and effectiveness vary

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🔗 Unlock the Secrets to Pain Management – Yours Forever!
Loved today’s insights from Dr. Epstein? Take your knowledge to the next level with lifetime access to the full online course on pain management! Go to http://ivdi.org/pain and use promo code "pain" to start learning instantly!