Non-steroidal Anti-inflammatory Drugs or NSAIDs’ role in pain management has increased dramatically recently, moreso in companion animals. Alleviating pain is not only a professional obligation (recall the veterinarians pledge to ‘‘the relief of animal pain and suffering’’) but also a key contributor to successful case outcomes and enhancement of the veterinarian-client-patient relationship. A commitment to pain management identifies a practice as one that is committed to compassionate care; optimum recovery from illness, injury, or surgery; and enhanced quality of life.¹

All NSAIDs, except for acetaminophen (also named paracetamol), are antipyretic, analgesic, and anti-inflammatory. They are routinely used for the relief of pain and inflammation associated with osteoarthritis in dogs and the use of NSAIDs for the relief of perioperative pain in companion animals is standard practice.              

In general, NSAIDs provide only symptomatic relief from pain and inflammation and do not significantly alter the course of

pathologic damage. As analgesics, they are generally less effective than opioids and are therefore generally indicated only against mild to moderate pain in people. However, in veterinary medicine, NSAIDs also find use in management of severe pain, optimally in combination with an opioid.²

Meloxicam is an oxicam NSAID available as an oral syrup and injectable solution. It is approved for use in dogs² and the only NSAID labeled for use in cats in the United States.³ While in Europe, meloxicam is approved for use in dogs, cats, cattle, and horses. ²

The discovery of the two isoforms of COX (COX-1 and COX-2) has advanced understanding of the mechanism of action and potential adverse effects of NSAIDs. COX-1, expressed in virtually all tissues of the body (eg, gut and kidney), catalyzes the formation of constitutive prostaglandins, which mediate a variety of normal physiologic effects, including hemostasis, GI mucosal protection, and protection of the kidney from hypotensive insult. ²

In contrast, COX-2 is activated in damaged and inflamed tissues and catalyzes the formation of inducible prostaglandin, including PGE₂, associated with intensifying the inflammatory response. COX-2 is also involved in thermoregulation and the pain response to injury. Therefore, COX-2 inhibition by NSAIDs is thought to be responsible for the antipyretic, analgesic, and anti-inflammatory actions of NSAIDs. However, concurrent inhibition of COX-1 may result in many of the unwanted effects of NSAIDs, including gastric ulceration and renal toxicity. Because NSAIDs vary in their ability to inhibit each COX isoform, a drug that inhibits COX-2 at a lower concentration than that necessary to inhibit COX-1 would be considered safer. This concept has propelled the development of the “COX-2 selective” NSAIDs. ²

A potent inhibitor of prostaglandin synthesis, meloxicam is used for the treatment of acute and chronic inflammation associated with musculoskeletal disease and for the management of postoperative pain. In dogs, a one-time loading dose of 0.2 mg/kg, PO, is recommended, followed by 0.1 mg/kg/day, PO. Once a therapeutic effect is seen, the dosage can be titrated to the lowest possible dose.²

COX-1:COX-2 ratios reported for meloxicam suggest the drug is COX-2 selective, with in vitro canine whole blood assays indicating it is 2.7- to 10-fold more selective for COX-2. Once absorbed, meloxicam is highly protein bound (97%) and has a relatively long elimination half-life (>12 hr). GI safety appears to be greater for meloxicam than for nonselective NSAIDs, and meloxicam has been shown to be chondroneutral in rodent studies.²

As per safety and efficacy, Yocum et al (2000) concluded from their study that meloxicam is a safe and effective medication for the symptomatic treatment of osteo-arthritis (OA). The data support consideration of 7.5 to 15 mg of meloxicam once daily to treat the pain and stiffness of OA, with gastrointestinal tolerability comparable to that of placebo.⁴

Regarding the use of meloxicam in cats, Ingwersen et al (2012) did a study on efficacy and safety of 3 versus 5 days of meloxicam as an analgesic for feline onychectomy and sterilization. The results showed that the patients that received meloxicam preoperatively had statistically better gait/lameness scores than those that received meloxicam postoperatively, supporting the principle of preemptive analgesia.⁵

These are just some of the studies conducted on pets as to the effectivity, efficacy and safety of meloxicam. Results  showed that this newer generation NSAID is effective as pain management component for companion animal medicine. Meloxicam is believed to reduce disease morbidity, facilitates recovery, enhances quality of life, and solidifies the relationship among the veterinarian, client, and pet.

But as practitioners it is an important thing with pain management in clinical practice to educate our clients on the fact that it is a team effort, with the pet owner functioning as an integral part of the team. We should educate them on their part. Thus, a convenient and easy to administer product will be a great help in achieving an effective pain management program for pets.

References:

1  Mark Epstein, DVM, DABVP, CVPP (co-chairperson), Ilona Rodan, DVM, DABVP (co-chairperson),

Gregg Griffenhagen, DVM, MS, Jamie Kadrlik, CVT, Michael Petty, DVM, MAV, CCRT, CVPP, DAAPM,

Sheilah Robertson, BVMS, PhD, DACVAA, MRCVS, DECVAA, Wendy Simpson, DVM., 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats*, J Am Anim Hosp Assoc 2015; 51:67–84. DOI10.5326/ JAAHA-MS-7331

2 Susan E. Aiello, DVM, ELS (Editor-in-Chief), Merck Veterinary Manual, 2015

3 Carroll GL and Simonson SM., Recent developments in nonsteroidal antiinflammatory drugs in cat, J Am Anim Hosp Assoc. 2005 Nov-Dec;41(6):347-54.

4 Yocum D, Fleischmann R, Dalgin P, Caldwell J, Hall D, Roszko P., Safety and efficacy of meloxicam in the treatment of osteoarthritis: a 12-week, double-blind, multiple-dose, placebo-controlled trial. Arch Intern Med. 2000 Oct 23;160(19):2947-54.

5 Walt Ingwersen, Ronald Fox, Gail Cunningham, and Martha Winhall, Efficacy and safety of 3 versus 5 days of meloxicam as an analgesic for feline onychectomy and sterilization. Can Vet J. 2012 Mar; 53(3): 257–264.