Neuropathic pain

WSAVA guideline

Key findings

• Gabapentinoids first line (gabapentin or pregabalin), significant QoL improvement (Neuropathic card; §3.12).
• NSAIDs combined with gabapentinoids when inflammatory component suspected (card).
• Amantadine benefited OA dogs refractory to NSAIDs alone — implying a neuropathic component in some OA (card; Table 16).
• ⚠️ Opioids may exacerbate chronic neuropathic pain via neuroinflammation and glial amplification (card).
• Anti-NGF mAbs: uninvestigated in neuropathic pain, but benefit might exist (card).
• Start NSAID + ≥1 of gabapentin/pregabalin/amantadine/amitriptyline; trial-and-error may be needed; taper slowly while monitoring (card).
• Acute-on-chronic: hospitalise for LA blocks and/or IV lidocaine 1 mg/kg bolus + 30 µg/kg/min CRI (caution cats) or ketamine 0.5–1 mg/kg bolus + 2–10 µg/kg/min CRI + systemic opioids (card wording).
• Physical modalities (myofascial origin): heat/cold, acupuncture, trigger-point needling, stretching, massage, exercise — need further research (card).
• Neuropathic pain = severe-to-excruciating tier (GPC perceived-pain table, Table 11).

Drugs named in WSAVA’s own guideline text

As printed in WSAVA’s document, not this app’s own extracted data — see “Related drugs in this reference” below for that.

• Gabapentin (Dog)

  First-line chronic neuropathic pain

• Gabapentin (Cat)

  Chronic neuropathic pain; visit anxiety

• Pregabalin (Dog)

  Neuropathic pain (syringomyelia, IVDD)

• Pregabalin (Cat)

  Neuropathic pain; transport stress

• Amantadine (Dog & Cat)

  Neuropathic component; NSAID-refractory OA

• Amitriptyline (TCA) (Dog / Cat)

  Chronic pain adjunct

• Lidocaine IV (Dog (cat cautious))

  Acute-on-chronic hyperalgesia/allodynia

• Ketamine IV (Dog & Cat)

  Acute-on-chronic flare; central sensitization

• NSAID (inflammatory component) (Dog & Cat)

  Mixed inflammatory-neuropathic pain

• Opioids (short-term only) (Dog & Cat)

  Acute-on-chronic flares only

Recommendations

• Gabapentinoids first line

  Expert consensus (GPC)

• Add NSAID if inflammatory component

  Expert consensus (GPC)

• Start NSAID + ≥1 adjunct; trial-and-error

  Expert consensus (GPC)

• Taper slowly while monitoring

  Expert consensus (GPC)

• Amantadine for NSAID-refractory OA

  Cited veterinary evidence (GPC)

• Amitriptyline an option

  Expert consensus (GPC)

• Hospitalise acute-on-chronic for LA blocks ± lidocaine/ketamine CRI + opioids

  Expert consensus (GPC)

• Caution: opioids may exacerbate chronic neuropathic pain

  Stated caution (GPC)

• Include non-pharmacologic modalities

  Expert consensus (GPC); evidence limited

Related drugs in this reference (5)

The quoted line under each drug is its own already-extracted indication text that matched this condition — the reason it’s listed, not a paraphrase. Open a drug for its full species/route breakdown, calculator, and complete adverse-effect list.

Showing 5 of 5 linked drug records. Open a record for species, route and source details.

• AMANTADINE

  “Adjunctive treatment of chronic pain (osteoarthritis, neuropathic pain, osteosarcoma pain, "wind-up") when NSAIDs/opioids alone are insufficient; reduces opioid…”

  Source dose preview: 3–5 mg/kg, q24h, PO (Dog)

  Adverse-effect notes: Agitation/restlessness, loose stools, flatulence, diarrhea — Mainly early in therapy · Anxiety states, dry mouth — Occasional

• AMITRIPTYLINE

  “Behavior disorders (anxiety), adjunct for pruritus, neuropathic pain”

  Source dose preview: 1–2 mg/kg, q12h, PO (Dog)

  Adverse-effect notes: Sedation, anticholinergic effects (dry mouth, urinary retention, constipation) — Most predominant · Hyperexcitability, rarely seizures — Uncommon

• CARBAMAZEPINE

  “**3rd-line**: aggression (esp. refractory), psychomotor seizures, neuropathic pain — sporadic case-report efficacy only”

  Source dose preview: 4–8 mg/kg, q12h, PO (Dog)

  Adverse-effect notes: Sedation, ataxia, GI upset (class extrapolation) — Little veterinary data · Agranulocytosis/aplastic anemia (human idiosyncrasy) — The human monitoring burden

• GABAPENTIN

  “Chronic/neuropathic pain, adjunctive analgesia (incl. peri-op)”

  Source dose preview: 5–30 mg/kg, q8-12h, PO (Dog)

  Adverse-effect notes: Sedation, ataxia — Most common, dose-related · Withdrawal-precipitated seizures — With abrupt discontinuation

• PREGABALIN

  “Seizure adjunct; neuropathic pain (emerging use)”

  Source dose preview: Start **2 mg/kg** and increase by 1 mg/kg/week to target **3–4 mg/kg**, q8h (up to q12h), PO (Dog)

  Adverse-effect notes: Sedation, ataxia — Most common — usually transient with titration · Weight gain, peripheral edema — Human class effects