Relief for Chronic Pain and Nighttime Restlessness in Senior Dogs due to Arthritis and/or Tumor

Night time Restlessness Might be Due to Pain or Drug Interaction

Drug Interaction?- Bailey's alternative medicine vet thought it was worth a try to discontinue the Velvet Antlers that she had suggested long ago, and that she too takes. She prescribed Velvet Antlers to help build and maintain muscle mass in Bailey, since she feels that it helped her rebuild muscle following the debilitating effects of a car accident. Bailey's back end is really skinny, probably because of his arthritis, and we were hoping the Velvet Antlers would slow further muscle deterioration. I think it worked to help maintain Bailey's muscle mass.

Last week, when I came in to Bailey's acupuncture appointment exhausted and at the end of my rope because of Bailey's increased nighttime restlessness, Dr. M. suggested that we stop the Velvet Antlers. She said that she thinks that the chemical compound may be interacting with the tramadol prescribed by Bailey's regular vet to relieve any discomfort he may have from his arthritis and the growing tumor on his left side, with the unintended side effect of causing nighttime restlessness. So, Bailey went off the Velvet Antlers, at least for now. We agreed that pain relief was more important than muscle mass at this stage in Bailey's life.

Additional Drug Changes by Bailey's Regular Vet

My next move was to call Bailey's regular vet to discuss Bailey's nighttime restlessness and my resulting exhaustion. The other Dr. M. (confusing- but I don't want to use their names without their express permission, because I am not a vet and whatever they say gets filtered through my lay brain and may be sort of distorted, as much as I try to get it right) said that he doesn't want to sedate Bailey, but that working on pain management may also have the benefit of making the nighttime restlessness less severe. He said that he'd like to try another drug in addition to the tramadol to make Bailey feel better and get better rest at night. He prescribed 100 mg gabapentin twice a day in addition to the twice a day 50 mg dose of tramadol that Bailey already takes. He suggested a 5 to 7 day trial of this drug combination, which is what he gives his own dog.

The Changes in Drug and Supplements Given to Our Senior Dog over Time

Bailey's drug and supplement therapies have gradually been shifting to reflect his changing condition. The various glucosamine and condroitin supplements used to help arthritis discomfort have been replaced by heavier drugs like Metacam as the arthritis got worse. Bailey's increasingly large tumor has required additional changes in his medications, both because of the nighttime restlessness and because of the more urgent need for pain relief at this stage in Bailey's life. Bailey's condition has changed and so have priorities in his care. His tumor is inoperable and he will be 16 years old in January so we are in more of a hospice mode now. Bailey's comfort is our primary focus.

The New Drug Lineup: Tramadol and Gabapentin

Bailey's vets know that I need to understand and research everything they tell me and they are very patient with me. They both spell things out and explain things at length and then I go home and look things up myself. So, here is my interpretation of what all of this means.

Tramadol

Again, this is all as I understand it from a lay point of view. Tramadol is a human drug that is being used more and more in veterinary practices for pain relief. I have read over and over that tramadol is a drug that sort of falls between the non-steroidal anti-inflammatory drugs (NSAISs) like Rimadyl that some dogs can't tolerate, and heavy duty narcotics like morphine. NSAID drugs are pain inhibiting drugs that somehow interfere with enzymes that cause pain and inflammation. Heavy duty narcotics like morphine are opiates that stimulate opiate receptors in the brain and some of these drugs have the helpful benefit of pain relief, but unfortunately can cause hallucinations, sedation and heart and respiratory difficulties.

Tramadol seems to fall somewhere between the NSAIDs and the narcotics. Tramadol stimulates "mu" receptors in the brain and somehow cause pain relief without sedation or addiction. It has side effects, but most of them are mild and rare, including sedation at high doses and constipation and nausea. Tramadol is a human drug but our regular vet stocks it and we get it at his office.

Gabapentin

Gabapentin was originally developed as an epilepsy drug but now it's widely used for pain relief. It's a human drug that is being used by lots of vets now. Our vet doesn't stock gabapentin, so he called a prescription in to our human pharmacy. Gabapentin is often used to treat neuropathic pain. It may help to deepen sleep and reduce nighttime arousals. It may also help agitation and anxiety. Gabapentin has some side effects such as dizziness and drowsiness.

Gabapentin is being used increasingly to treat chronic pain in dogs, particularly neuropathic pain and pain associated with malignancies. It is often used in combination with other pain relievers so lower doses of both drugs can be used, presumably to minimize the side effects of both.

Bailey's Trial Period on Tramadol and Gabapentin

Bailey is on these meds twice a day, 12 hours apart. His dosage is 100 mg gabapentin and 50 mg of tramadol. Bailey weighs about 58 pounds now (we're trying hard to get high quality calories into him which is a big change from the days where we tried hard to keep him at a svelte 62 or 62 pounds to help his arthritis).

Our goal is to treat Bailey's discomfort and at the same time, reduce his nighttime restlessness. The theory is that if the restlessness is caused in part by discomfort, if Bailey is more comfortable, he will rest better. I have been told that we may have to tweak dosages and that we are hoping to make things better, but that we won't achieve perfection. So far so good. He seems less agitated and he's not waking up as much. Last time, when we tried changing the tramadol schedule to help with the nighttime restlessness, I thought the change did the trick. If it did, it only lasted a few days and then Bailey was up again at night over and over. I really hope this drug combination works better.

19 comments:

Anonymous said...

Oh this sounds so like my Huckleberry,13YO and diabetic and arthritic. He has been on tramadol for over a year . But occasionally he has these restless days/nites where he cant get comfortable and paces and paces. I am often tempted to give another dose of pain meds, but I dont unless the vet thinks it may work. I know its pain that keeps him up at nite and I feel so bad.
Good Luck w/Baily

Senior Dog Central (Old Dogs Rule!) said...

Thank you for commenting. And good luck with Huckleberry.

Cindy said...

Hi....my Penny is really in alot of pain right now. she is 12. She has lots of arthritis in her hind and front legs and lumbar. Stenosis and spurs also. She is on Rimadyl, tramadol and now gabapentin. She also has a large tumor in her liver. She was taking just the tramadol 50 mg ....her dose was 1-1/2 up to three times a day...we only used it at night.....then we went to 1 gabapentin 100 mg once a day....the problem was she walked like she was dizzy and drunk....now we give her a half tramadol and half the gabapentin... It's not enough...she is groaning, kicking her back legs and stretching out her front legs and can't get comfy at all. Tonight I gave her whole tramadol and not sure what else to add. Vet said to play with the dose till we find a happy medium. Can you give any advice. My email is mdb719@cox.net Thank you for the article

Anonymous said...

Hi Cindy,
Sorry to hear about your Penny! I also had an older dog (12 as well) and it tore me appart. I did find comfort in a product from seniorpetrelief.com called makaryia. It is basically all natural and properly dosed. It helped relieve alot of suffering for my pet. Also lots of love and attention! Good Luck!

Anonymous said...

My dog got anxiety on tramadol and gabapentine together. It was prescribed for his back pain. I never give him both, I will give him one or the other depending on his needs. It seems like the meds combined made his pain worse or something. I won't do that to him again.

Robert Freeman said...

,Jake, Labrador Retriever, 93 lbs., turning 13 yo in May 2013. Disease's: Hip dysplasia, Osteoarthritis, Cushing's Disease, and suffering with chronic and severe pain. For several years now he's been treated with 1) tramadol,150mg, twice/day 2) Gabapentin, 400 mg twice/day 3) Novox,100mg twice/day 4) Omeprazole (generic Prilosec),40 mg in morning. 5) Dasuquin w/ MSM, one tab/day 6) Duralactin (OTC anti-inflammatory for long term pain management) 1.5 tabs twice/day. Working with my vet, and after much research on my part, it took quite some time to tweak the doses to the levels that work, and they have been extremely effective and without side effects. I must emphasize that, simultaneously, I also rely on "alternative medicine," primarily Traditional Chinese Medicine (TCM), using herbal medicine and acupuncture, but for the purposes of this blog will not go into this here. After reading the posts on this site I am not surprised that most are significantly "undertreating" their pets. I have found over the years, and after three dogs, that most all vets are not very good at treating our best friends chronic and severe pain. I suggest you all do your research (there is tons of material on the internet) and then push your vet to do the right thing! Best of Luck!!

Anonymous said...

My German Shepard, Dixie, is 13 yrs old. She has terrible hip dysplasia and has little muscle tone left in her rear quarters.

I have her on Rimadyl and Tramodol a couple times a day, the Tramadol helps her with a good nights sleep.

I want Dixie to be comfortable and not in pain, it's so hard to tell, they don't show their pain like humans can, I wish she could talk to me and tell me where it hurts!

I got her thru this past winter and with spring here I hope the nicer weather can be of some comfort, warm sun and being outside where she loves to lay. I don't know what I will do when that dreadful day comes....

Theo said...

My dog is a 15 year old (this May 1)Collie/Husky mix.

Recently, he started to stumble while standing in place, like a tree falling down.

Last September(2012) his hind quarters gave out, so vet started first month on Metacam and Gabapentin.--Gabapentin, in the case of Nerve damage; Metacam, for the arthritis, which was found in the x-rays in his hip area.

After a month, we tried him off Gabapentin and he was fine. This seemed to rule out neurological issues.

Then, I researched a product called DGP (dog gone pain), a natural product to treat arthritis/joint health. The vet wanted to put him on Metacam for "the rest of his life". However, I was concerned about the side effect, which could cause damage to his organs.

At first, I had my dog on Metacam and DGP; and then I weaned him off the Metacam. For over 6 months, he's been on DGP alone and he's been doing quite well.

Until recently, he started to stumble as described above. It doesn't seem to be Vestibular disease because he doesn't lean his head to one side or the other; and, he's eating.

It's confusing to me because yesterday I took my dog to a large public park where we walked for some time; and we can walk around the large block in our neighbourhood.

Tonight, I took him out for a relatively short walk. As we approached the driveway, he stood still, and then fell down on his side. He got up, but it's a very frightening sight to see him fall like this.

I called my vet who said that she could prescribe him TRAMADOL for the pain, citing that there are few side effects.

I don't really know what I'm asking, just wanted to share where I'm at and what can be done to help this situation.

Thank you.

Anonymous said...

Tramadol makes Cassidy (15 YO Husky) anxious- she paces a lot as it is. Gabapentin and Rimadyl seems to work best, sometimes also Acepromazine (sedative) at night- sometimes she just cant settle down.

pj said...

My dog maggie is 16 1/2 and on gabapentin. I see she is comfortable but I also notice the falling over her feet a lot more...but she was doing it before hand....now she just
experience the pain. She has laser and water treatment to keep her moving. It is just the last days of love to keep her moving.

Anonymous said...

To all, say strong for yourself and of course, that furry love of your life. My precious Tommy a rescue terrier mix passed peacefully at his home on Dec 22 2012. He was 15 and dealing with spinal arthritis. I miss him so, every day. Last month My Tori-girl left us. I had to make the call due to her having aggressive rt. knee/hip bone cancer. Towards the last 3-4 months, I was becoming very frustrated with the meds our vet was prescribing...Tori was having very restless/anxious nights. I tried over and over to have her prescribed something other than Tramadol and prevacoxx(potent anti-inflammatory) Being a 90 pound chessybay/lab mix, steps were her worst enemy. She got along a bit slower, but fine on basically 3 legs( she had minimal usage of her rt. hind leg. But one day, one I dreaded, came when she could no longer utilize the three legs and herleft hind leg gave out. Treating her with increased anti-inflams and methocarbamol and of course, Tramadol. Which by the way negatively effects the liver. I could see how frustrated she was, having to be lead around with a towel slung under her belly---every time she needed to go out or just to be out and sit, look and wonder how her life had once been. These big girls and guys seem to stay in terminal puppy stage!!! Anyway, my want is for research to develop palliative care meds for when it come near to end of life - when there is no quality to be found, only sadness and suffering. I love you all and share in your losses.

Anonymous said...

I have an 8-9 yr old Blue Healer/Corgi Mix (Hershey.
She had it pretty rough in her previous life (on the streets of Detroit).
She has severe back arthritis and possible degenerative neck/nerve issues.
For three years, she's been on Gabapentin/ Glucosamine/ Fish oil and occasionally Methacarbonal and Rimadyl for leg discomfort.
This seems to have stopped her "pain episodes" and she sleeps well.
3 months ago she suffered some ligament damage in her rear leg. Upping the Gabapentin didn't seem to help.
We switched to Tramodol and the relief was almost immediate!
From that point she showed almost no signs of pain in her behavior and was sleeping well again.
The challenge then was to restrict her activity because she didn't seem to realize she was injured.
Today her activity seems normal.
Thank you, Tramadol!

Sharon Fox said...

Good read. . Thanks!

ceci said...

Hello to all,

It's been a rough weekend! I have a min pin about to turn 12. She has had a very healthy life, until last friday when she started complaining about excrutiating back and neck pain. Also, when walking, she would only turn to one side. We took her to three different vets, one of them a Neurologist. She started taking tramadol, mathocarbanol, and prednisole. Apparently her pain was gone yesterday, but she had this terrible anxiety where she would pace around the house constantly and would cry out of anxiety while lying down.
I took her to the vet last night one more time just in case and before they closed. I told her about research I had done and that there was another pain med which started with a "g". (at this point I was just exhausted, after two nights without sleeping and 5 different vet appointments!)Aniway, this new doctor told me to get her off Tramadol and to start Gabapentin in order to stop her anxiety.
Well I am going to start giving it to her once we get up. She is nowp snoring next to me and that is all I can ask. we are waiting for the tramadol to fade away to start the new medicine. I will keep you posted. We just put her on the floor. Her pain is back... anxiety apparently is no longer there. I will give her Gabapentin right now and we will see. If anyone can let me know about any other pain killer we should try, I will really appreciate it!!! Good luck to all!!

Cecilia
chepiba24@gmail.com
West Covina, California

Shelley said...

My dog was on Tramadol and Rimadyl and was falling down. Neurologist ruled out problem there and said it was the Tramadol that was causing it with not enough food. We switched to Gabapentin and Rimadyl instead of the Tramadol and she is doing much better, no more falls. I also put a heating pad on low under her arthritic areas at night and she sleeps like a baby, no kicking the walls or tossing and turning.

Maria Del Amo said...

Hello to all,

Your comments all sound so familiar and it is good to see that you are not alone. Max is a 17 1/2 Aussie and I have had him since he was 4mo old. I love him to pieces and I only want for him to be comfortable and to have a decent quality of life.

I have pretty much tried every single drug listed on this post. I can only tell you to consult with your vet as far as dosage is concerned. He's is on Deramxx and Gabapentin. We just Added the Gaba recently because he was having restless nights. Not only we kept us up all night but wore himself out.

The Gabapentin seems to be working to alliviate his anxiety, restlessness and pain. However, I wonder if the vet gave me too much of a dosage. He's on 100mg x2 a day. In the morning is not a problem because it helps him sleep and rest during the day. But at night, he is dizzy and clumsy. At his age, the last thing I want is for him to break a hip or a leg. I wonder is I should be giving him less. I will call my vet and confirm.

It is hard to see our furry kids get old. My only advise is not to be selfish. Be realistic and understand that what is most important is their well-being. I lost my Sheltie two years ago in a very sudden way. But, she had a heart condition and was sick. Dealing with a senior dog takes patience, extreme love and compassion. But remember that is their quality of life that you need to be looking after. Good luck to you all and your furry babies.

Rhonda Kendrick said...

I have my 14 year old Sydney on Tramadol, Gabapentin and Rimadyl. She does well on certain days and not so well on others. After reading all of your posts I will definitely put Syd down before she becomes like any of your dogs. People, our babies are in pain. Why do you watch them suffer?????

Anonymous said...

Hi all- I know some of these posts are older but if Tristan (14 or 15 yr old Newfie/Lab Mix) and I can help-
Tristan has been on Tramadol for approx. year now. We tried Rimadyl and he didn't tolerate it well. He then had Gabapentin added as his condition deteriorated. He was loosely diagnosed with throat cancer last spring adding onto his arthritis. We have done all we can to make his end time as comfortable as possible.
I have a very close relationship with my animals. In every case I have been intro'd to them in dream before they physically come into my life and I dream of them passing before they leave. My husband has faith in this connection but when it comes to their passing refuses to let go. We had another senior 5 yrs ago that developed fast growing tumor on his side (later found out he had bone cancer which metastasized into soft tissue). We thought it was arthritis and treated accordingly. He had a fantastic life but had indicated in his last year that he was tired and in pain. When he went to vet for tumor- vet recommended surgery immediately. Hubby jumped at opportunity to "save" him. Bootu didn't want the surgery, neither did I - we were outvoted. As He was led back to surgical suite he dug in and I had to lead him back- he gave me a look like "this is not what our agreement was." I betrayed him- I live with that look every day. Bootu got through the surgery. He has left with a foot worth of incision in a Y pattern and lots of pain. He had to be euthanized 4 days later. I have promised my other animals that when the time comes- I will not betray them as I did Bootu.
Tristan will be euthanized tomorrow. My hubby and I had words about this and after lots of tears and the word selfish coming up- we are in agreement. My heart is breaking and I keep second guessing the decision.
Listen to your animals - walk for a day in their situation- would you want to live like this? I am NOT pushing for guilt free euthanasia- it should never be an easy decision- but these guys have been our best friends- we need to be that for them.
I will take any prayers for my Tristan to go easy to his Summerland, where no doubt his bud Bootu is waiting...
Thanks

Laurie in Alberta said...

I fully agree with everything you have said here. Unconditional love on our part means not allowing unnecessary and prolonged suffering because we cannot bear to part with them. It is the silent pact that we make with our animal companions when we agree to take them into our lives. They will give us their all, and we will love them and comfort them and let them go when we are unable to guarantee them a good quality of life without unendurable pain.