January 7th, 2010, 07:35 PM
We have a 3 legged cat about 1 year old, that lost his leg as a very young kitten. We have noticed that about 1 time per month, she will be very agitated growling and hissing. She is normally very cuddly and loving. The vet agrees with me that it is probably neurogenic pain from the loss of a limb and wants to start her on Gabopentin. Since her pain is intermittent we hesitate to start such a drug. Does anyone out there have experience with phantom limb pain and management in cats?
January 8th, 2010, 05:19 PM
Hi and welcome to the forum!
I have no experience with either amputations nor post-amp phamtom pain...
However, I did find a recent (2008) paper detailing the case of a rabbit that was treated at Cornell for phantom pain...in this paper there is a reference to a very interesting case of a cat that was successfully treated for phamtom pain a month after the amputation. You'll find it here http://dspace.library.cornell.edu:8080/bitstream/1813/13235/3/2008%20McDonald%20paper.pdf
The paper itself provides an excellent description of the cause of "phantom" pain in the first three pages...then, on p7, read onwards from "Outcome". The author is providing a case history of proper pain management using a multi-modal approach. If you continue reading through, on page 10 is the reference to the case of the cat: In a case study reported by the Australian Veterinary Journal, a 2-year-old male cat presented for neuropathic pain one month after an amputation procedure and possible sciatic nerve entrapment. The cat was hospitalized and treated with an intravenous administration of ketamine, lignocaine and morphine for 36 hours. The cat was discharged with buprenorphine to be given transmucosally for 2 days as well as amitriptyline to be administered for 21 days, and all signs of pain resolved.
This is the reference info for the case of the cat: O’Hagan, BJ. Neuropathic pain in a cat post-amputation. Aus Vet Journal 2006;84(3):83-86. http://www3.interscience.wiley.com/journal/119918253/abstract?CRETRY=1&SRETRY=0
What I find fascinating is that (from my understanding) the cat's treatment was simply the use of the same full regimen of pain control as would be appropriate for a surgical amputation - one month after the actual surgical procedure!
If I were in your position, I would certainly want to read the Australian paper,..I would ensure that my Vet read it as well...I might even get a second opinion (is there a Vet college with a specialist nearby?) I guess I'm wondering whether the use of Gabapentin by itself at this point (11 months after surgery?) will be effective...or, whether perhaps, like the Australian cat, your kitty should receive a full surgical pain control regimen (which did not include Gabapentin)...???
I really hope you keep us posted and especially post the outcome of all this...too many times I've seen interesting cases like this just disappear leaving us all to wonder....and, leaving no guidance for similar future cases.
January 20th, 2010, 10:53 AM
I guess I'm wondering whether the use of Gabapentin by itself at this point (11 months after surgery?) will be effective. [?]
Phantom nerve disease is one that we really wish those pets could TALK to us! That would be helpful.
Good idea Rustycat on the gabapentin:). I like this drug and have used in in various pets. Unfortunately there is not enough literature on it with the use in dogs and cats. The one concern that I have with this medication is that in humans, the effects only last about 4 hours. Many of the medical drug sources for pets have bid (twice daily) dosing. Both Plumb's Veterinary Handbook and the North American Companion Animal Formulary have once daily and three times daily dosing. If used, I would typically recommend the three times daily dosing in people.
Gabapentin affects the neurotransmitter GABA. It is excreted in the urine so should be used with caution with pets in renal failure. Overall it has low side effects with the most common being sedation. In humans, it can be given at very high doses safely.
One drawback is that it comes in dosing for humans and in capsule form. There is a liquid form that some pharmacies carry. I have had to have this compounded for cats before. Luckily the cost of gabapentin has greatly reduced over the last few years.
For phantom pain, along with other types of neuropathic pain, gabapentin is a great choice. Not only does it help pain, but by help reducing the nerves continuing to signal the brain about pain. Thus longer courses of gabapentin may, in some cases, help the pet overcome the phantom pain for good. With that said, I have also had a few people say that it did not work for their pet. So far, I have not had any pets with adverse side effects (:fingerscr)
I hope that helps. :pawprint: