Where Do We Go from Here? Future Treatment Strategies
for Chronic Pain
Tamara Grubb, DVM, MS, Dipl., ACVA
extraits d' un article elsevier paru en février
Drugs on the Horizon
Although not a complete list (not even close to being a
complete list), a sampling of drugs currently used in human
medicine10,11 that have not yet reportedly been tried in veterinary
medicine includes cyclobenzaprine (a muscle relaxant
with a chemical structure similar to tricyclic antidepressants),
venlafaxine and milnacipran (serotonin reuptake inhibitors),
topiramate (an anticonvulsant drug with efficacy against mi-
graine headaches), and tizanadine (a centrally acting alpha-2
agonist). Another drug currently being used to treat chronic
pain in humans, tapentadol, is a centrally acting analgesic
with a dual mode of action similar to that of tramadol (muopioid
receptor agonism and inhibition of norepinephrine
reuptake).12 Drugs not yet clinically available but in the final
phase of clinical research include the cyclooxygenase-inhibiting
nitric oxide-donating drugs (e.g., naproxcinod) that
have the efficacy of the parent NSAID but with greatly reduced
side effects.13
Many other compounds are currently
being researched for the control of chronic pain in humans
and will, hopefully, rapidly make their way to veterinary
patients.
There are also new drugs on the veterinary horizon. For
instance, a new NSAID, robenacoxib,14 has been launched
outside the United States for the treatment of chronic pain
in dogs and acute pain in cats.
Also launched outside of the
United States is the NSAID mavacoxib, which is a sustained-
release NSAID approved for chronic pain in dogs.
No published research studies are available for mavacoxib,
but information at the marketing company’s web
site reveals that 1 dose of mavacoxib appears to control
pain for at least 30 days. Finally, new delivery methods for
opioids are currently in the final phase of approval in the
United States
Hopefully, there will be many more products
in the near future.