Deadly, recalled pills still circulating in Pennyrile Region

A pain reliever that has been recalled and declared dangerous by the Federal Drug Administration is still circulating around southern Kentucky.

The drug marketed under the name Reumofan Plus is being distributed in Elkton and the broader Pennyrile Region, despite being recalled, and a local doctor's office says patients on the drug have had dangerous side effects, reports Nick Tabor of the Kentucky New Era.

Dr. Keith Toms of Generations Primary Care told Tabor three of his patients have taken the drug and had bad side effects. One patient had dangerous elevations of liver enzymes, and two diabetic patients had dangerous spikes in blood sugar.

The Food and Drug Administration has received reports of deaths, strokes, severe internal bleeding, dizziness, insomnia, high blood sugar and other problems associated with the drug since June. The manufacturer, operating under the names Reumofan Plus USA, LLC and Reumofan USA, LLC, announced a voluntary product recall last month, reports Tabor.

According to the FDA, undeclared ingredients in the drug, which is used as a treatment for muscle pain, arthritis, osteoporosis, bone cancer and other conditions, could result in serious illness. Tabor reports a FDA laboratory analysis of Reumofan Plus found that it contains diclofenac sodium, a non-steroidal anti-inflammatory drug, and methocarbamol, a muscle relaxant.

Tabor reports the FDA has issued an alert telling consumers to stop taking the drug immediately and consult a health-care professional. The agency also said it may follow up on the Reumofan recall with warning letters, seizure, injunction requests or criminal charges. (Read more)

A pain reliever that has been recalled and declared dangerous by the Federal Drug Administration is still circulating around southern Kentucky.

The drug marketed under the name Reumofan Plus is being distributed in Elkton and the broader Pennyrile Region, despite being recalled, and a local doctor's office says patients on the drug have had dangerous side effects, reports Nick Tabor of the Kentucky New Era.

Dr. Keith Toms of Generations Primary Care told Tabor three of his patients have taken the drug and had bad side effects. One patient had dangerous elevations of liver enzymes, and two diabetic patients had dangerous spikes in blood sugar.

The Food and Drug Administration has received reports of deaths, strokes, severe internal bleeding, dizziness, insomnia, high blood sugar and other problems associated with the drug since June. The manufacturer, operating under the names Reumofan Plus USA, LLC and Reumofan USA, LLC, announced a voluntary product recall last month, reports Tabor.

According to the FDA, undeclared ingredients in the drug, which is used as a treatment for muscle pain, arthritis, osteoporosis, bone cancer and other conditions, could result in serious illness. Tabor reports a FDA laboratory analysis of Reumofan Plus found that it contains diclofenac sodium, a non-steroidal anti-inflammatory drug, and methocarbamol, a muscle relaxant.

Tabor reports the FDA has issued an alert telling consumers to stop taking the drug immediately and consult a health-care professional. The agency also said it may follow up on the Reumofan recall with warning letters, seizure, injunction requests or criminal charges. (Read more)

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Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

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FDA likely to make hydrocodone painkillers harder to prescribe

Prescription painkillers containing hydrocodone should be placed in a more restrictive federal category, a Food and Drug Administration advisory panel of experts voted on Friday. The changes would be an effort to stem the tide of prescription painkiller abuse and addiction in the U.S., much of it in rural areas, beginning in Central Appalachia. Painkillers containing hydrocodone are the most widely prescribed drugs in the country.

Sabrina Tavernise of The New York Times reports the FDA is likely to adopt the panel's recommendations, which include limiting access to hydrocodone drugs such as Vicodin by making them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted. Only a hanwritten prescription from a doctor would be allowed, and pharmacists would be required to keep the drugs in special vaults.

Many said these changes would be a key step in reducing painkiller addiction. However, dissenters in the vote were concerned that this move wouldn't make a difference. Oxycodone, the main ingredient in the highly-abused painkiller OxyContin, has been classified in a restrictive category since it was first introduced on the market but it is still widely abused, dissenters said. They also said the change could create unfair obstacles for legitimate patients. (Read more)

Prescription painkillers containing hydrocodone should be placed in a more restrictive federal category, a Food and Drug Administration advisory panel of experts voted on Friday. The changes would be an effort to stem the tide of prescription painkiller abuse and addiction in the U.S., much of it in rural areas, beginning in Central Appalachia. Painkillers containing hydrocodone are the most widely prescribed drugs in the country.

Sabrina Tavernise of The New York Times reports the FDA is likely to adopt the panel's recommendations, which include limiting access to hydrocodone drugs such as Vicodin by making them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted. Only a hanwritten prescription from a doctor would be allowed, and pharmacists would be required to keep the drugs in special vaults.

Many said these changes would be a key step in reducing painkiller addiction. However, dissenters in the vote were concerned that this move wouldn't make a difference. Oxycodone, the main ingredient in the highly-abused painkiller OxyContin, has been classified in a restrictive category since it was first introduced on the market but it is still widely abused, dissenters said. They also said the change could create unfair obstacles for legitimate patients. (Read more)

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Poll shows depth of prescription drug abuse in Kentucky

By Molly Burchett and Al Cross
Kentucky Health News

One-third of Kentucky adults have friends or relatives who have experienced problems from abusing prescription pain relievers, and 8 percent have used pain medicine when it wasn't prescribed or for the feeling it caused, according to a statewide poll conducted last fall.

The Kentucky Health Issues Poll found that in Eastern Kentucky, 45 percent reported that prescription drug abuse have caused problems for friends or family members. In the 17-county Bluegrass Area Development District, which includes some Appalachian counties, the figure was 37 percent. It was 32 percent in Northern Kentucky, 31 percent in the seven-county Louisville area and 25 percent in Western Kentucky.

The poll found that young adults are more likely to have the problem. Among those 18 to 29 years old, 13 percent said they had used pain medicine when it wasn't prescribed or for the feeling it caused, and 49 percent said they had a friend or relative who had been affected.

The Foundation for a Healthy Kentucky, which co-sponsored the poll, noted that drug-overdose deaths in Kentucky correspond to a steep increase in the sales of opioid prescription pain relievers, which include OxyContin, Vicodin, Percocet and codeine. More than half of Kentucky adults in the poll reported being prescribed such drugs.

“While these types of medications are important for controlling pain in patients who need them, opioids also carry the potential for abuse,” said Dr. Susan Zepeda, President and CEO of the foundation. “Our state ranks sixth in the nation for prescription pain reliever overdose deaths, and these data provide a window on how many Kentuckians are impacted – directly or indirectly – by prescription misuse.” (Read more)

The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

By Molly Burchett and Al Cross
Kentucky Health News

One-third of Kentucky adults have friends or relatives who have experienced problems from abusing prescription pain relievers, and 8 percent have used pain medicine when it wasn't prescribed or for the feeling it caused, according to a statewide poll conducted last fall.

The Kentucky Health Issues Poll found that in Eastern Kentucky, 45 percent reported that prescription drug abuse have caused problems for friends or family members. In the 17-county Bluegrass Area Development District, which includes some Appalachian counties, the figure was 37 percent. It was 32 percent in Northern Kentucky, 31 percent in the seven-county Louisville area and 25 percent in Western Kentucky.

The poll found that young adults are more likely to have the problem. Among those 18 to 29 years old, 13 percent said they had used pain medicine when it wasn't prescribed or for the feeling it caused, and 49 percent said they had a friend or relative who had been affected.

The Foundation for a Healthy Kentucky, which co-sponsored the poll, noted that drug-overdose deaths in Kentucky correspond to a steep increase in the sales of opioid prescription pain relievers, which include OxyContin, Vicodin, Percocet and codeine. More than half of Kentucky adults in the poll reported being prescribed such drugs.

“While these types of medications are important for controlling pain in patients who need them, opioids also carry the potential for abuse,” said Dr. Susan Zepeda, President and CEO of the foundation. “Our state ranks sixth in the nation for prescription pain reliever overdose deaths, and these data provide a window on how many Kentuckians are impacted – directly or indirectly – by prescription misuse.” (Read more)

The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

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Painkiller epidemic was driven in part by drug makers' financial relationships with researchers who discounted the risks

For almost a decade, medical officials and experts claimed OxyContin rarely posed problems of addiction for patients. The drug's label, which was approved by the Food and Drug Administration, said addiction risks were small. Research published in the New England Journal of Medicine also said OxyContin wasn't addictive; so did a study in another journal, which OxyContin manufacturer Purdue Pharma reprinted 10,000 times. Since the drug first hit the market, it has fueled a large-scale swath of prescription pain killer addiction, beginning in Central Appalachia, that has grown into a national epidemic, especially in rural areas.

The epidemic was driven in no small part by doctors' lack of knowledge about OxyContin, which was perpetuated by the drug's manufacturer through false claims that became scientific consensus. But now, "Many in the medical profession have rediscovered the destructive power of opiates," and are calling that consensus into question, Peter Whoriskey of The Washington Post reports. "A closer look at the opioid painkiller binge, in which retail prescriptions have roughly tripled in the past 20 years, shows that the rising sales and addictions were catalyzed by a massive effort by pharmaceutical companies to shape medical opinion and practice."

Doctors were wary of prescribing painkillers to any patient except those with cancer for years. But manufacturers and some pain specialists "helped create a body of scientific research assuaging the long-standing worries about opioids and pushed to expand the use of the drugs in people with chronic pain: bad backs, arthritis, sore knees," Whoriskey reports.

Through an examination of key scientific papers, court documents and FDA records, the Post found that many of the studies claiming OxyContin wasn't addictive were supported by Purdue Pharma. The conclusions those studies reached were sometimes not supported by data, and when the FDA needed to develop an opioid policy, it turned to a panel of doctors who had financial relationships with Purdue Pharma and other drug makers. (Read more)

For almost a decade, medical officials and experts claimed OxyContin rarely posed problems of addiction for patients. The drug's label, which was approved by the Food and Drug Administration, said addiction risks were small. Research published in the New England Journal of Medicine also said OxyContin wasn't addictive; so did a study in another journal, which OxyContin manufacturer Purdue Pharma reprinted 10,000 times. Since the drug first hit the market, it has fueled a large-scale swath of prescription pain killer addiction, beginning in Central Appalachia, that has grown into a national epidemic, especially in rural areas.

The epidemic was driven in no small part by doctors' lack of knowledge about OxyContin, which was perpetuated by the drug's manufacturer through false claims that became scientific consensus. But now, "Many in the medical profession have rediscovered the destructive power of opiates," and are calling that consensus into question, Peter Whoriskey of The Washington Post reports. "A closer look at the opioid painkiller binge, in which retail prescriptions have roughly tripled in the past 20 years, shows that the rising sales and addictions were catalyzed by a massive effort by pharmaceutical companies to shape medical opinion and practice."

Doctors were wary of prescribing painkillers to any patient except those with cancer for years. But manufacturers and some pain specialists "helped create a body of scientific research assuaging the long-standing worries about opioids and pushed to expand the use of the drugs in people with chronic pain: bad backs, arthritis, sore knees," Whoriskey reports.

Through an examination of key scientific papers, court documents and FDA records, the Post found that many of the studies claiming OxyContin wasn't addictive were supported by Purdue Pharma. The conclusions those studies reached were sometimes not supported by data, and when the FDA needed to develop an opioid policy, it turned to a panel of doctors who had financial relationships with Purdue Pharma and other drug makers. (Read more)

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Generic OxyContin and Opana, headed for market soon, could make fight against pain-pill abuse tougher, McConnell says

With generic versions of the two most commonly-abused painkillers, Opana and OxyContin, coming on the market next year, police, hospitals and health clinics in Kentucky have voiced concern that "these generic crushable drugs lack the tamper-resistant gel coating of the brand-name drugs," says a news release from U.S. Sen. Mitch McConnell.

"Without this technology, addicts crush the pills in order to achieve an immediate heroin-like high from sniffing or injecting the painkillers," the release says. "If these generics come to market without the tamper-resistant coating, much of the work that law enforcement and health care providers have done to stem the tide of pain pill abuse in Kentucky will be lost."

McConnell's news release said he has asked the Food and Drug Administration to keep the crushable drugs off the market "until a workable solution can be found." McConnell, the Senate Republican leader, met Wednesday with the Department for Health and Human Services’ acting general counsel, Bill Schultz, to discuss the issue. (Read more)

With generic versions of the two most commonly-abused painkillers, Opana and OxyContin, coming on the market next year, police, hospitals and health clinics in Kentucky have voiced concern that "these generic crushable drugs lack the tamper-resistant gel coating of the brand-name drugs," says a news release from U.S. Sen. Mitch McConnell.

"Without this technology, addicts crush the pills in order to achieve an immediate heroin-like high from sniffing or injecting the painkillers," the release says. "If these generics come to market without the tamper-resistant coating, much of the work that law enforcement and health care providers have done to stem the tide of pain pill abuse in Kentucky will be lost."

McConnell's news release said he has asked the Food and Drug Administration to keep the crushable drugs off the market "until a workable solution can be found." McConnell, the Senate Republican leader, met Wednesday with the Department for Health and Human Services’ acting general counsel, Bill Schultz, to discuss the issue. (Read more)

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UK music therapy helps manage surgical anxiety, pain, recovery

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

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Improving treatment of chronic pain in cats

Winn grant W12-027
Development of outcome assessment instruments for chronic pain in cats
Investigator: Dorothy Cimino Brown; University of Pennsylvania

Cats are unique. They cannot benefit from the same pain fighting medications used in dogs, because they can cause serious side-effects in cats. It is crucially important that we identify pain fighting medications that are safe and effective in cats, so that we can relieve them from pain caused by such conditions as arthritis or cancer. Once a treatment option for pain is identified that might be useful in cats, studies must be carefully designed in order to prove that the potential new treatment option is effective. The greatest obstacle to designing such studies is the fact that we have not developed reliable ways to measure pain in cats. If we can not measure the pain, we can not prove that we are appropriately treating it. 

The goal of this study is to develop tools that can measure pain in cats and therefore appropriately design studies that will identify new treatments. The first tool is the Feline Brief Pain Inventory, which will be an owner completed questionnaire that will allow them to identify and report on how their cat behaves at home, focusing on the behaviors that are related to pain. The second tool is an activity monitor that can be worn on the cat’s collar while it progresses through its normal activities at home. We plan to identify how many days the monitor needs to be worn to collect data reliably. Ultimately the monitor might identify the improved activity that can be related to adequate pain control.

This project is available for sponsorship. When you sponsor a project, your name will be added to the list of the project's supporters on our website and in any publications we produce about the project. You will receive exclusive pre-publication reports on the progress of your chosen project as they become available, and a final report at its conclusion.

More on cat health:
Winn Feline Foundation Library
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Winn grant W12-027
Development of outcome assessment instruments for chronic pain in cats
Investigator: Dorothy Cimino Brown; University of Pennsylvania

Cats are unique. They cannot benefit from the same pain fighting medications used in dogs, because they can cause serious side-effects in cats. It is crucially important that we identify pain fighting medications that are safe and effective in cats, so that we can relieve them from pain caused by such conditions as arthritis or cancer. Once a treatment option for pain is identified that might be useful in cats, studies must be carefully designed in order to prove that the potential new treatment option is effective. The greatest obstacle to designing such studies is the fact that we have not developed reliable ways to measure pain in cats. If we can not measure the pain, we can not prove that we are appropriately treating it. 

The goal of this study is to develop tools that can measure pain in cats and therefore appropriately design studies that will identify new treatments. The first tool is the Feline Brief Pain Inventory, which will be an owner completed questionnaire that will allow them to identify and report on how their cat behaves at home, focusing on the behaviors that are related to pain. The second tool is an activity monitor that can be worn on the cat’s collar while it progresses through its normal activities at home. We plan to identify how many days the monitor needs to be worn to collect data reliably. Ultimately the monitor might identify the improved activity that can be related to adequate pain control.

This project is available for sponsorship. When you sponsor a project, your name will be added to the list of the project's supporters on our website and in any publications we produce about the project. You will receive exclusive pre-publication reports on the progress of your chosen project as they become available, and a final report at its conclusion.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Read the Cat Health News Weekly
Join us on Google+

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Maropitant for treatment of pain in cats

Final report, Winn grant 10-009
Treatment for visceral pain with the new NNK-1 receptor antagonist "maropitant" in cats
Investigators: Pedro Boscan, Eric Monnet, David Twedt, Sirirat Nyiom
Veterinary Teaching Hospital, Colorado State University

Maropitant (Cerenia, Pfizer Animal Health) is a new drug approved for the treatment of nausea in cats and dogs that also has the potential for analgesia. The investigators examined effects of two parameters on the amount of inhalant anesthetic drug required to maintain the anesthetic state during surgery. During surgical procedures like ovariohysterectomy (spay), the abdominal organs are manipulated. Notably, the ovaries and uterus are touched and moved, which can cause pain. This pain can affect the amount of anesthesia needed in order to prevent the pain sensation for the cat. However, extraneous factors may affect the levels of anesthesia needed as well. Some can actually decrease the amount of anesthetic drug needed to maintain the pain-free state. Since the goal of any anesthetic is to use the minimal amount needed to maintain the state, it is important to know how certain factors affect the drug level required.
     The parameters they evaluated were pregnancy (as many cats presented for spaying are pregnant) and the use of an antiemetic drug, maropitant  (many anesthetics can cause nausea and vomiting, thus it is important to know if these medications affect the amount of anesthetic drug needed). The investigators found that both parameters, pregnancy and the use of the anti-emetic drug decreased the amount of anesthetic required. This finding indicates that levels of anesthesia needed during spaying can be decreased in cats that are pregnant, as well as in cats receiving this anti-emetic drug. Additionally, in terms of the antiemetic drug, these findings may indicate that this drug is also useful in awake cats as an analgesic. Its apparent ability to minimize the pain of surgical manipulation could indicate that it will be useful as a pain medication for cats. This drug has very few side effects, and is approved for use in cats; thus, this study has added a safe drug to the choices available for treating pain in cats. As an aside, this study allowed the spaying of cats that likely would not have been possible otherwise, including feral and homeless cats. [MK] 

Related articles:
Hickman, M. A., S. R. Cox, et al. (2008). "Safety, pharmacokinetics and use of the novel NK-1 receptor antagonist maropitant (CereniaTM) for the prevention of emesis and motion sickness in cats." Journal of Veterinary Pharmacology and Therapeutics 31(3): 220-229.

More on cat health:
Winn Feline Foundation Library
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Final report, Winn grant 10-009
Treatment for visceral pain with the new NNK-1 receptor antagonist "maropitant" in cats
Investigators: Pedro Boscan, Eric Monnet, David Twedt, Sirirat Nyiom
Veterinary Teaching Hospital, Colorado State University

Maropitant (Cerenia, Pfizer Animal Health) is a new drug approved for the treatment of nausea in cats and dogs that also has the potential for analgesia. The investigators examined effects of two parameters on the amount of inhalant anesthetic drug required to maintain the anesthetic state during surgery. During surgical procedures like ovariohysterectomy (spay), the abdominal organs are manipulated. Notably, the ovaries and uterus are touched and moved, which can cause pain. This pain can affect the amount of anesthesia needed in order to prevent the pain sensation for the cat. However, extraneous factors may affect the levels of anesthesia needed as well. Some can actually decrease the amount of anesthetic drug needed to maintain the pain-free state. Since the goal of any anesthetic is to use the minimal amount needed to maintain the state, it is important to know how certain factors affect the drug level required.
     The parameters they evaluated were pregnancy (as many cats presented for spaying are pregnant) and the use of an antiemetic drug, maropitant  (many anesthetics can cause nausea and vomiting, thus it is important to know if these medications affect the amount of anesthetic drug needed). The investigators found that both parameters, pregnancy and the use of the anti-emetic drug decreased the amount of anesthetic required. This finding indicates that levels of anesthesia needed during spaying can be decreased in cats that are pregnant, as well as in cats receiving this anti-emetic drug. Additionally, in terms of the antiemetic drug, these findings may indicate that this drug is also useful in awake cats as an analgesic. Its apparent ability to minimize the pain of surgical manipulation could indicate that it will be useful as a pain medication for cats. This drug has very few side effects, and is approved for use in cats; thus, this study has added a safe drug to the choices available for treating pain in cats. As an aside, this study allowed the spaying of cats that likely would not have been possible otherwise, including feral and homeless cats. [MK] 

Related articles:
Hickman, M. A., S. R. Cox, et al. (2008). "Safety, pharmacokinetics and use of the novel NK-1 receptor antagonist maropitant (CereniaTM) for the prevention of emesis and motion sickness in cats." Journal of Veterinary Pharmacology and Therapeutics 31(3): 220-229.

More on cat health:
Winn Feline Foundation Library
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Pain Assessment in Cats

Brondani JT, Luna SPL, Padovani CR: Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats, Am J Vet Res 72:174, 2011

The importance of treating pain in cats has received more attention in recent years. There has been an inherent difficulty in identifying and quantifying the intensity of pain in cats due to the lack of available and validated pain assessment tools for this species. This could lead to veterinary practitioners providing less than adequate levels of pain relief. Reliability and validity of scoring systems are vital for use in recognizing pain, quantifying pain intensity, and evaluating treatment effectiveness. The purpose of this study was to refine and test construct validity and reliability of a composite pain scale used for assessing acute postoperative pain in 40 cats undergoing ovariohysterectomy. In a randomized, double-blind study cats received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). Respiratory rate and respiratory pattern were rejected after item analysis. Five dimensions were analyzed – F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]. Results indicated internal consistency was excellent for the overall scale and for F1, F2, and F3, very good for F4, and unacceptable for F5. Therefore, there is initial evidence of the construct validity and reliability of a multidimensional composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. [VT]

Related articles:

Hellyer P, Rodan I, Brunt J et al: AAHA/AAFP pain management guidelines for dogs and cats, J Feline Med Surg 9:466, 2007.

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Brondani JT, Luna SPL, Padovani CR: Refinement and initial validation of a multidimensional composite scale for use in assessing acute postoperative pain in cats, Am J Vet Res 72:174, 2011

The importance of treating pain in cats has received more attention in recent years. There has been an inherent difficulty in identifying and quantifying the intensity of pain in cats due to the lack of available and validated pain assessment tools for this species. This could lead to veterinary practitioners providing less than adequate levels of pain relief. Reliability and validity of scoring systems are vital for use in recognizing pain, quantifying pain intensity, and evaluating treatment effectiveness. The purpose of this study was to refine and test construct validity and reliability of a composite pain scale used for assessing acute postoperative pain in 40 cats undergoing ovariohysterectomy. In a randomized, double-blind study cats received a placebo or an analgesic (tramadol, vedaprofen, or tramadol-vedaprofen combination). Respiratory rate and respiratory pattern were rejected after item analysis. Five dimensions were analyzed – F1 [psychomotor change], posture, comfort, activity, mental status, and miscellaneous behaviors; F2 [protection of wound area], reaction to palpation of the surgical wound and palpation of the abdomen and flank; F3 [physiologic variables], systolic arterial blood pressure and appetite; F4 [vocal expression of pain], vocalization; and F5 [heart rate]. Results indicated internal consistency was excellent for the overall scale and for F1, F2, and F3, very good for F4, and unacceptable for F5. Therefore, there is initial evidence of the construct validity and reliability of a multidimensional composite pain scale for use in assessing acute postoperative pain in cats undergoing ovariohysterectomy. [VT]

Related articles:

Hellyer P, Rodan I, Brunt J et al: AAHA/AAFP pain management guidelines for dogs and cats, J Feline Med Surg 9:466, 2007.

More on cat health: Winn Feline Foundation Library

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Pain Management for Special Feline Cases

Mathews, K. A. (2008). "Pain management for the pregnant, lactating, and neonatal to pediatric cat and dog." Vet Clin North Am Small Anim Pract 38(6): 1291-308, vi-vii.

The majority of the information available to veterinarians on pain management for small animals is for the mature patient. Pregnant and lactating queens and neonates have received little attention or investigation. Unfortunately, this means that pain management is often avoided for these patients, due to concerns over adverse effects. The purpose of this review article is to focus on commonly available analgesics for these special patients. During pregnancy, opioids are the preferred analgesic for both women and animals. For example, opioids may be used to control pain associated with caesarean section with little or no effect on neonates. For lactating animals, opioids and non-steroidal anti-inflammatory drugs may be used. Opioids are also often used for pediatric patients, while non-steroidal anti-inflammatories are avoided in animals under 6 weeks of age. The risks and benefits of each class of drug, as well as a table of drugs and dosages are included. Dissemination of such information will help provide pain relief to some of the most vulnerable patients in veterinary medicine. [SL]
>> PubMed Abstract

Related articles:
Dyson, D. H. (2008). "Perioperative Pain Management in Veterinary Patients." The Veterinary clinics of North America. Small animal practice 38(6): 1309-1327.
>> PubMed Abstract

Robertson, S. and P. Taylor (2004). "Pain management in cats - past, present and future. Part 2. Treatment of pain - clinical pharmacology." J Fel Med Surg 6(5): 321-333.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Mathews, K. A. (2008). "Pain management for the pregnant, lactating, and neonatal to pediatric cat and dog." Vet Clin North Am Small Anim Pract 38(6): 1291-308, vi-vii.

The majority of the information available to veterinarians on pain management for small animals is for the mature patient. Pregnant and lactating queens and neonates have received little attention or investigation. Unfortunately, this means that pain management is often avoided for these patients, due to concerns over adverse effects. The purpose of this review article is to focus on commonly available analgesics for these special patients. During pregnancy, opioids are the preferred analgesic for both women and animals. For example, opioids may be used to control pain associated with caesarean section with little or no effect on neonates. For lactating animals, opioids and non-steroidal anti-inflammatory drugs may be used. Opioids are also often used for pediatric patients, while non-steroidal anti-inflammatories are avoided in animals under 6 weeks of age. The risks and benefits of each class of drug, as well as a table of drugs and dosages are included. Dissemination of such information will help provide pain relief to some of the most vulnerable patients in veterinary medicine. [SL]
>> PubMed Abstract

Related articles:
Dyson, D. H. (2008). "Perioperative Pain Management in Veterinary Patients." The Veterinary clinics of North America. Small animal practice 38(6): 1309-1327.
>> PubMed Abstract

Robertson, S. and P. Taylor (2004). "Pain management in cats - past, present and future. Part 2. Treatment of pain - clinical pharmacology." J Fel Med Surg 6(5): 321-333.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Read More

Control of Postoperative Pain in Cats

Benito-de-la-Vibora, J., B. D. Lascelles, et al. (2008). "Efficacy of tolfenamic acid and meloxicam in the control of postoperative pain following ovariohysterectomy in the cat." Vet Anaesth Analg.

This prospective, randomized, blinded and placebo-controlled study was performed at the University of Madrid, Spain to evaluate the effect of two non-steroid anti-inflammatory drugs (tolfenamic acid and meloxicam) on control of post-operative pain in cats. Sixty-nine client owned cats undergoing ovariohysterectomy were enrolled in the study. The cats were given a dose of either tolfenamic acid (Tolfedine, Vetoquinol), meloxicam (Metacam, Boehringer Ingelheim/Merial), or placebo pre-operatively and again post-operatively. Pain and wound sensitivity were assessed using standardized scales for up to 25 hours post-operatively. The meloxicam group was less painful than controls at 6 and 22 hours post-operatively; both treatment groups were less painful than controls at 25 hours. The number of cats requiring rescue analgesia did not differ between the groups. Cats receiving tolfenamic acid or meloxicam had decreased wound sensitivity compared to controls at all time points. The researchers conclude that both tolfenamic acid and meloxicam provide a similar analgesic effect for up to 24 hours post-operatively.
>> PubMed Abstract

Related articles:
Lascelles, B. D., M. H. Court, et al. (2007). "Nonsteroidal anti-inflammatory drugs in cats: a review." Vet Anaesth Analg 34(4): 228-50.
>> PubMed Abstract

Slingsby, L. and A. Waterman-Pearson (2000). "Postoperative analgesia in the cat after ovariohysterectomy by use of carprofen, ketoprofen, meloxicam or tolfenamic acid." J Small Anim Pract 41(10): 447-450.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Benito-de-la-Vibora, J., B. D. Lascelles, et al. (2008). "Efficacy of tolfenamic acid and meloxicam in the control of postoperative pain following ovariohysterectomy in the cat." Vet Anaesth Analg.

This prospective, randomized, blinded and placebo-controlled study was performed at the University of Madrid, Spain to evaluate the effect of two non-steroid anti-inflammatory drugs (tolfenamic acid and meloxicam) on control of post-operative pain in cats. Sixty-nine client owned cats undergoing ovariohysterectomy were enrolled in the study. The cats were given a dose of either tolfenamic acid (Tolfedine, Vetoquinol), meloxicam (Metacam, Boehringer Ingelheim/Merial), or placebo pre-operatively and again post-operatively. Pain and wound sensitivity were assessed using standardized scales for up to 25 hours post-operatively. The meloxicam group was less painful than controls at 6 and 22 hours post-operatively; both treatment groups were less painful than controls at 25 hours. The number of cats requiring rescue analgesia did not differ between the groups. Cats receiving tolfenamic acid or meloxicam had decreased wound sensitivity compared to controls at all time points. The researchers conclude that both tolfenamic acid and meloxicam provide a similar analgesic effect for up to 24 hours post-operatively.
>> PubMed Abstract

Related articles:
Lascelles, B. D., M. H. Court, et al. (2007). "Nonsteroidal anti-inflammatory drugs in cats: a review." Vet Anaesth Analg 34(4): 228-50.
>> PubMed Abstract

Slingsby, L. and A. Waterman-Pearson (2000). "Postoperative analgesia in the cat after ovariohysterectomy by use of carprofen, ketoprofen, meloxicam or tolfenamic acid." J Small Anim Pract 41(10): 447-450.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Read More

Lidocaine Patches for Cats

Ko, J. C. H., L. K. Maxwell, et al. (2008). "Pharmacokinetics of lidocaine following the application of 5% lidocaine patches to cats." Journal of Veterinary Pharmacology and Therapeutics 31(4): 359-367.

The use of lidocaine patches to provide local analgesia in cats is increasing. The patch (Lidoderm, Endo Pharmaceuticals) contains 700 mg lidocaine and is 10 cm x 14 cm. It can be cut to a desired size and may be applied to the skin on each side of a surgical incision for post-operative pain relief. Other potential uses include relief of pain from trauma and bruising. This study was conducted to evaluate the systemic and local absorption of lidocaine from topical patches in cats. In a random cross-over design, 8 two-year old cats received either intravenous lidocaine at 2 mg/kg or one lidocaine patch placed on the lateral thorax for 72 hours. Plasma was collected at specified time points and analyzed for lidocaine and its major metabolite. After patch removal, the skin at the site was biopsied and also assayed for lidocaine. The patch produced steady-state lidocaine plasma concentrations. The bioavailability of transdermal lidocaine was 6.3 +/- 2.7% and only 56% of the total drug reached the systemic circulation. Skin lidocaine concentrations were much higher than plasma concentrations. Plasma lidocaine concentrations remained well below systemically toxic concentrations, and no obvious clinical side effects were observed in any of the cats. The researchers conclude that the low systemic absorption rate coupled with high local lidocaine concentrations in the skin support the safe use of lidocaine patches in cats.
>> PubMed Abstract

Related articles:
Weil, A. B., J. Ko, et al. (2007). "The use of lidocaine patches." Comp Contin Edu Pract Vet 29(4): 208-216.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Ko, J. C. H., L. K. Maxwell, et al. (2008). "Pharmacokinetics of lidocaine following the application of 5% lidocaine patches to cats." Journal of Veterinary Pharmacology and Therapeutics 31(4): 359-367.

The use of lidocaine patches to provide local analgesia in cats is increasing. The patch (Lidoderm, Endo Pharmaceuticals) contains 700 mg lidocaine and is 10 cm x 14 cm. It can be cut to a desired size and may be applied to the skin on each side of a surgical incision for post-operative pain relief. Other potential uses include relief of pain from trauma and bruising. This study was conducted to evaluate the systemic and local absorption of lidocaine from topical patches in cats. In a random cross-over design, 8 two-year old cats received either intravenous lidocaine at 2 mg/kg or one lidocaine patch placed on the lateral thorax for 72 hours. Plasma was collected at specified time points and analyzed for lidocaine and its major metabolite. After patch removal, the skin at the site was biopsied and also assayed for lidocaine. The patch produced steady-state lidocaine plasma concentrations. The bioavailability of transdermal lidocaine was 6.3 +/- 2.7% and only 56% of the total drug reached the systemic circulation. Skin lidocaine concentrations were much higher than plasma concentrations. Plasma lidocaine concentrations remained well below systemically toxic concentrations, and no obvious clinical side effects were observed in any of the cats. The researchers conclude that the low systemic absorption rate coupled with high local lidocaine concentrations in the skin support the safe use of lidocaine patches in cats.
>> PubMed Abstract

Related articles:
Weil, A. B., J. Ko, et al. (2007). "The use of lidocaine patches." Comp Contin Edu Pract Vet 29(4): 208-216.
>> PubMed Abstract

More on cat health: Winn Feline Foundation Library

Read More