# Pain Medication Experiences



## krsbunny (Feb 7, 2009)

I am interested in hearing the experiences (good and bad) that folks on this forum have had treat a variety of types of pain (GI, dental, post-surgical, arthritis, other), what medications seem to work (and not work) for each of these, side effects you have observed personally or have heard about from others, etc. I am interested in input from individual pet owners as well as breeders, show people, rescuers, and others like me who fall into the "none of the above" category. If anyone has veterinary articles or posts they can direct me to (or share) it would be most appreciated. I am also interested in good (but not excessively technical) articles on the physiology of pain (in any species) and use of Banamine for colic in horses.

Of particular interest is whether your vets use (or have ever used) Banamine to treat GI pain. If they have used it in the past, but no longer do, Iwoudl be interested in knowing what they switched to and the reasons behind the change.

My personal experience with Banamine is that it has truly been a "life-saver" in several cases of severe GI pain. The vets here allow those of us with several rabbits (whether we are affiliated with a "rescue" group or not) to have Banamine on hand at all times. Yet I have friends in other parts of the country who cannot find a vet who will prescribe it.

Kathy Smith


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## Maureen Las (Feb 7, 2009)

I live in southwest Wi on the border between Mn, Ia and Wi. The vets in this regions are not rabbit saavy in general. There are a lot of county fairs and 4H here and although it is changing somewhat rabbits are still livestock. I have noted that several vets have very specific rabbit knowledge in one area alone and may not have other very basic knowledge. For example the only vet that has the abilityto flush a tear duct in a rabbit (also did cancer surgery on one of mine) has never heard of critical care . Only one vet know that a probiotic should be used with antibiotics. One clinic has done 100's of shelter spays/neuters very successfully but only uses 2 antibiotics?

The only pain meds I have been give are meloxicam and Rimadyl. the Rimadyl was for dogs and i was told to chop off pieces of the pill.Since I am not originally from here this really pist me off and the clinic managed to get meloxicam from another clinic. 
I do travel to Madison to a dentist (Dr Bill Gengler) from the University of Madison to have Beau's teeth done. Even there they only have given meloxicam for him, however, it was enough and Bill Gengler is excellent. 
The vets here are very very reluctant to think outside the box and use only the most common meds for rabbits.I have 7 rabbits and have been lucky cross my fingers) not to need pain meds often. 


I know very little about banamine other than in horses it can cause kidney problems if the horse in not hydrated and also that it can cause such a feeling of well-being for an injured horse that it can mask more serious poblems.

No vet here would ever prescribe it for a rabbit.

This a weekend , Kathy and just wait you will get a lot of responses to your request.

Maureen


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## naturestee (Feb 7, 2009)

My vets have prescribed Metacam, Tramadol, and Butorphanol for my rabbits.

I have had a problem with Metacam with my dwarf hotot Fey. She was prescribed it after getting stitches for a nasty belly cut she got during a bonding session gone wrong. She (and her sister) does have chronic GI problems which are often called megacolon and are attributed to her breed. The first few days I noticed that Fey would refuse to eat and act like her tummy was uncomfortable until about 12 hours after her daily Metacam dose. I double-checked the prescription and it was the average amount for her weight. When giving it to her, I would first feed her veggies so she wouldn't have meds on an empty stomach and then give her the Metacam mixed in pumpkin which she willingly ate. Within the hour she'd be sitting uncomfortably, refusing food, eyes wide, but not pressing her belly to the floor like with gas. Discontinuing the pain meds eliminated the problem.

My dutch boy Loki gets Metacam after his molar grinds, which have been every 4 months since last spring. He tolerates it well.

When I was at the vet with Myheart this week (Luna's kidney stones checkup), he said that at the latest conference he was at one of the discussions was on how Metacam seems to be causing GI problems more often than previously realized and it's something to watch for. My first thought was "Hey! You didn't believe me when I told you Fey had tummy problems from it two years ago!"

I've only had Tramadol prescribed when an 4 year old foster bun seemed unable to deal with the pain from her spay with just Metacam. Tramadol= much happier bunny, no problems. 

Butorphanol was for a nasty fall + head trauma in Dora, a tiny orphaned baby. She seizured upon hitting the floor (head first) and now has occasional slight head tilt, mainly when stressed or overly excited. So pretty much that means that she has some small amount of permanent neurological damage. The Butorphanol reduced her pain quite a bit, but also made her so woozy that she couldn't do much. After two days she began to function better when she was due for another dose than when she was drugged up and so we discontinued it. It was very necessary the first two days though, as evidenced by tooth grinding when the meds were wearing off.


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## TreasuredFriend (Feb 7, 2009)

Disabled Karla was prescribed Rimadyl. Our vet thought it would be good to try another pain reliever, and drop out the metacam doses because she had been on metacam since 2005. The pain helps with the times she motors herself about on the carpeted floor, when she's not in a sling or cart, or her husbun decides to stand on her disabled legs to assert his affection.

Into the picture of pain relief program comes Rimadyl, Tramadol, later Gabapentin. A blood test was performed which reported Karla was anemic (internal bleeding?). Sucralfate was suggested to coat her stomach from possible ulcer reaction. She would pull her head away when I wanted to administer certain meds and I took this as a sign that Karla was displeased. Her eyes looked horrible and she was miserable the first week to weekend in December after a measurable time still taking Rimadyl. I withdrew Rimadyl, and returned to metacam. Her sparkle is back. Hooray! The fur on her side which was thin and scraggly regained its luster and grew back beautifully. Amazing. Removed Rimadyl, and her hair became luxurious again. Would Rimadyl cause such a reaction?
:nerves1Rimadyl and Karla may not be the best combination.
Sorry that I do not have experience with Banamine, Kathy.

Karla's managed program (for muscle wasting concerns and arthritic sore joints) is metacam, amantadine mixed with cherry flavor, and Buprenex injections - all as needed for pain symptoms.
She pulls her head away at Amantadine now. Dr. B. will do another blood test for liver response shortly. kim k on etherbun notes that her bunns have been on metacam for years, so we stick with meloxicam (metacam).

Buprenex prescribed at 30 units 2x a day in rear leg muscle for 4.4 lb. Karla.
She gets loopy and becomes a space cadet with the 15 units, once a day. Buprenex is given when required after post-activity sessions. When I hear mild tooth-grinding.
30 units right off the bat scared the heck outta me! Seemed like a huge amount (compared to the insulin I draw up daily in a 3/10 cc syringe) to put into Karla.
Metacam .20 - .25 once a day, with wet greens.

Q. Should metacam always be administered with food and water? Yes/no?

p.s. I watch her eyes for feedback,


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## naturestee (Feb 7, 2009)

Re: giving Metacam with food, that is something I have heard about numerous times (via bunny boards and various non-vet sources) to prevent stomach ulcers although I don't know how much it helps. I do it as a precaution, especially if I know the bun isn't eating much due to dental issues/stasis. It did not help prevent Fey's reaction. There certainly isn't any harm in feeding before giving Metacam or in mixing it into food (I did get permission from the vet to mix with food). Mixing it into food simply reduces stress for Fey, especially at that time as she had only been with me a few months and was still learning that humans are not the enemy.

Does your vet also check for kidney function when she checks Karla's liver values? I know Metacam can cause kidney issues and it was part of the discussion with the vet this week when considering Luna's kidney stones/infection/failure treatments. Myheart did choose (and I agree) to give Metacam as the vet felt the problems should be significantly reduced by the regular sub-q fluids she needed anyway.


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## ra7751 (Feb 7, 2009)

Hi,

I deal with pain meds all the time. Here is my thinking on the rabbit safe analgesics.

NSAIDs-This includes Metacam (Meloxicam), Banamine, Rimadyl, Aspirin, etc. Some of these drugs are very rough on the GI tract like Tylenol, Motrin and Ibuprofin. Can cause gastric ulcers. Banamine is used with GI issues sometimes but I prefer to use an antibiotic since with GI issues you also generally have a bacterial imbalance. Metronidazole is both an antibiotic and an anti-inflammatory and my experience is that it is better than Banamine. Metacam is the most often prescribed NSAID for moderate pain and/or inflammation. Generally very compatible with rabbits. Should not be used when the animal is dehydrated or for long term. If used under these conditions, which shoudl be under the supervision of a vet, the liver and kidney values should be closely monitored. Use with steroids is contraindicated.

Butorphenol (Torbugesic)-Excellent opiate. Great pain meds. Problem in a rabbit is that it burns outusually in less than 2 hours. Few vets use this drug due to it'sshort effectiveness duration.

Buprenorphine (Buprenex)-The best all around for moderate to severe pain. Safe for use long term. Longacting....up to 12 hours per dose. Can be administered orally (absorbed thru the membranes of the mouth,sub-q or IM. Usually causes drowsiness during early dosing...which isn't always a bad thing.

Toradol-An excellent alternative to Buprenex. Not a controlled drug but still requires a prescription. It seems to be available now in suspension and infusion.

In extreme cases of pain, it is possible to use an NSAID with either Buprenex or Tramadol without any unacceptable side effects.

Randy


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## krsbunny (Feb 7, 2009)

Thanks Randy! Interesting comment about the GI issue andantibiotics. Do you have any experience with sulfasalazine? Also, I forgot to mention that the vets here do not give Banamine for more than 3 days (Dr. Allan now prefers not more than 2-3 doses).

I have used Metacam several times and, honestly, have never felt it to be that effective. Have had both good and bad experiences with opiods.

Since you mention steroids not being used with NSAIDs... what are your thoughts on using steroids in rabbits? Many people I've heard from say their vets would "never"try steroids ... even in cases like cancer and severe paralysis where the only alternative they are offering is euthanasia. To me, these seem like situations where the potential risk is worth taking.

Again, thanks for sharing your experience.

K


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## ra7751 (Feb 7, 2009)

The antibiotic and the tie in with the GI issues really freak people out. The problem in a GI event is that the beneficial bacteria starts to die and the pH changes drastically. This allows harmful bacteria, primarily Clostridium. to grow....the beneficial bacteria controls the bad stuff so when the good stuff dies, the bad stuff has free roam. Metronidazole is very effective at controlling Clostridium. Metronidazole also has those anti-inflammatory qualities and if memory serves me correctly, it is often used in people with IBS. This situation happens with things like stasis and/or ileus or can be the result of penicillin and/or cephalosporins used orally. 

Generally NSAIDs should not be used more than 3 days....and if you research many of my posts I have repeatedly said that. Unfortunately, these drugs have a reputation of being perfectly safe....not so as they really stress the liver and kidneys in all species including humans. While I am not the biggest fan of Metacam, in my non-professional opinion it is the best all around NSAID with a rabbit....the most positive effects while offering the least exposure to undesirable side effects.

I have never had any problems with opiates at all. With some of the extreme cases I get, including wildlife, opiates are the only way to go.

Steroids have generally fallen from favor from nearly all vets except in very limited situations...in fact we were discussing just that today at the emergency clinic. The problem with steroids is that they basically crash the immune system. We know rabbits already have a very weak and unstable immune system and they also have several "nasties" lurking for the chance to make an appearance. I have used steroids in rabbits but it should always be something that is fully scrutinized before implementing. It would almost have to be my "Hail Mary" treatment....the one of last resort. Do I want to use them? No. Would I use them? If necessary I would.

Randy


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## naturestee (Feb 8, 2009)

Randy, I wasn't aware that Metronidazole was an anti-inflammatory also. My vet does use that for GI issues if Clostridium is indicated in fecal tests. It's one of many drugs Dora was treated with during her many GI issues when she was a few weeks old. I had asked for pain meds for her too but the vet was afraid to give her something that's rough on the kidneys considering her age, health, and the number of meds she ended up being on.


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## ra7751 (Feb 8, 2009)

It is anti-inflammatory in the GI. It is a very unusual drug...it's also an anti-parasitic, anti-protozoal, it can pass the blood/brain barrier (think EC...it's a protozoa) and it can treat anaerobic bacteria. It just tastes really horrible. But it is an amazingly useful drug.


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## naturestee (Feb 8, 2009)

My vet flavored it so Dora took it willingly from a syringe. She actually took most of her meds better than she took milk! What the vet didn't have was the drug that binds to Clostridium's toxin. They can only get it in large amounts from the local hospital and usually don't think it's worth it.

Sorry to drive this further off topic, but it's anti-protazoal also? She was getting a second med (sulfa drug? have to check) at the same time for coccidea.


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## ra7751 (Feb 8, 2009)

I think you are talking about Questran. Odd thing with that drug....you have to overhydrate to make it work. Or does it work? We use hydration to flush toxins in wildlife (cow's milk or opossums nursing dead moms). It might be more beneficial to just hydrate rather than to add another drug that is very expensive and that's benefit is up to debate.


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## ra7751 (Feb 8, 2009)

Sulfa is the accepted treatment for coccidia. Problem with Sulfa is that it can lead to pretty nasty GI upsets...and has been linked to Tyzzer's Disease. I prefer to use Metronidazole (it also treats giardia and trichomonas) or Ponazuril. In reality, it is the immune system that eventually will take down coccidia.


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## naturestee (Feb 8, 2009)

I thought Sulfa drugs were considered safe? And yes, it was a sulfa drug. Funny thing is her GI issues were better until after the prescription ended for both drugs, and her gas/diarrhea was then found to be caused from her cecum not emptying properly and no unusual critters were in her fecals.

Too bad you were swamped with wildlife when this all happened!
:threadhijacked:


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## tonyshuman (Jul 14, 2009)

So what is the consensus on aspirin and ibuprofen? We have members all over the world, and sometimes the typical drugs we give our rabbits for pain are not available. Aspirin and ibuprofen are usually available everywhere, but are they too damaging to the GI tract?


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