Should You Give Your Dog Opioids for Pain?

Analysis by Dr. Karen Shaw Becker

oral opioids for dogs

Story at-a-glance -

  • Recent research suggests oral opioids may be ineffective pain management tools in dogs
  • In a 2018 study, the opioid drug tramadol was shown to be ineffective when given orally to relieve arthritis pain in dogs
  • Given the current opioid crisis in the U.S., it’s important for veterinarians to re-evaluate their use of oral painkillers to ensure they are used only when no other alternative exists or is effective
  • If your dog has a painful condition, his or her treatment will depend on what’s causing it; there are many nontoxic therapies that can be used alone or in conjunction with medications to alleviate pain
  • Myofascial pain — a type of muscle pain resulting from trigger points — is a common but frequently undiagnosed condition in dogs

There is mounting evidence that oral opioids are ineffective for managing pain in dogs. Since we have a very serious problem in the U.S. with human opioid abuse — including the fact that people sometimes abuse painkillers prescribed for their pets — it makes sense to re-evaluate the use of these drugs in dogs.

Toward that end, a team of veterinary clinical medicine professors at the University of Illinois College of Veterinary Medicine developed a free, online continuing education program for veterinarians. The program answers the need for additional training on regulatory issues for opioid prescribers, and at the same time cautions against unnecessary prescribing of oral opioids for dogs. It also offers advice on effective pain management strategies.

Veterinarians Should Re-evaluate Their Use of Oral Opioids for Dogs

Research suggests that dogs don't respond to the oral versions of painkillers in the same way people do. One such drug, tramadol, is routinely prescribed by veterinarians for dogs with painful conditions. However, in a study published in 2018, veterinary researchers evaluated the drug's ability to alleviate signs of arthritis pain in dogs, and found it ineffective.1

"We have lots of good evidence that dogs respond favorably to injectable opioids," says University of Illinois veterinary anesthesiologist Dr. Stephanie Keating, a pain management expert in veterinary clinical medicine and a co-creator of the continuing education program. "But the same is not true for the opioid tramadol when given orally."2

The leader of the 2018 tramadol study, Dr. Steven Budsberg, professor of surgery and director of clinical research at the University of Georgia College of Veterinary Medicine, pulls no punches when discussing the results:

"The data shows conclusively that tramadol is not an effective drug in treating the pain associated with arthritis in the dog, despite its common recommendation. This use of tramadol is a classic example of failing to acknowledge and control for bias when evaluating a potential treatment."3

The study compared oral tramadol with both a placebo and the nonsteroidal anti-inflammatory drug (NSAID) carprofen in 40 pet dogs with arthritis of the elbow or knee. The dogs received each of the three treatments in random order, with each treatment lasting 10 days.

They were evaluated using vertical impulse, peak vertical force, and Canine Brief Pain Inventory scores to assess their mobility and pain. The results showed no improvement when the tramadol was given.

"For years, we assumed that since tramadol worked in people, it would also work in dogs," Keating said. "It's inexpensive, it's easy to prescribe, and so it became commonplace.

Now that we're getting more evidence, we're thinking, 'Wow, it doesn't seem to be very effective and there's an opioid crisis. Maybe we should reconsider this'.'"

For the record, I have tramadol in my veterinary toolbox, in part because it can be beneficial in addressing the emotional component of pain. I use it with certain patients, in conjunction with other therapies, to alleviate mild pain and emotional wind-up. But as with all drugs, I use it only when it's absolutely necessary, for a short period of time and when it's demonstrated to be beneficial to the animal.

The U. of I. online continuing education program helps veterinarians better understand which drugs are best for management of specific types of pain, and also discusses complimentary therapies such as massage, exercise, padded bedding, and environmental enrichment.

Signs of Pain in Your Dog

Determining if your dog is hurting is all about picking up subtle cues. Generally speaking, a cat in pain will make herself scarce, whereas a hurting dog often wears a sad or tense expression. Canines don't typically whine or cry unless they're in tremendous pain, so here are some other signs to keep an eye out for:

Lack or loss of appetite

Not greeting you as usual

Trembling/shivering

Crouching

Not bearing weight on a leg

Taking longer than usual to urinate or defecate

Reluctance to climb up or down stairs

Excessive panting

What to Do if You Think Your Dog Is in Pain

How your canine companion's pain is managed depends on what's causing it, so it's crucially important to make an appointment with your veterinarian for a thorough exam.

Once your vet has evaluated your dog and depending on the root cause of his discomfort, there are a number of integrative therapies that blend nicely to reduce the amount of medications needed to manage pain, including:

  • Chiropractic
  • Therapeutic massage
  • Helping your pet stretch
  • Acupuncture
  • Laser therapy

There are also some newer therapies I've used with good success, including the Assisi Loop, a form of pulsed electromagnetic field therapy. In addition, there are a variety of beneficial supplements and dietary interventions you can incorporate, again depending on his diagnosis and treatment protocol.

A Type of Pain in Dogs You've Probably Never Heard Of

Myofascial pain, which is pain in the muscles that results from one or more trigger points, is common in dogs, but because it doesn't show up on x-rays or other diagnostic tests, it's often left untreated. The result is that many dogs suffer needlessly with significant, chronic muscle pain.

Trigger points, sometimes described as knots in the muscles, are focal points for inflammation and irritation. They may be in an active or latent phase. In the active phase, a trigger point may be very painful for your pet.

If pressure is applied, pain may radiate from the trigger point to other areas of your dog's body, such as down the limbs (this is known as referred pain). He may also have latent trigger points that are sensitive, but not as acutely painful as active trigger points.

However, even latent trigger points may lead to problems for your dog, including stiffness and restricted range of motion.

There are many situations that can lead to this type of muscle pain. Some of them may occur suddenly, such as an injury from an unexpected wrenching movement, a fall, or a blow to a muscle. Often, however, the development of such pain, and its related trigger points, is gradual.

Just like in humans, dogs may suffer from muscle pain as a result of overuse or muscle imbalance. For example, if your dog runs along a fence every day or favors a back leg due to arthritis, some muscles are being overused and others underused, leading to muscle imbalance and the development of trigger points.

When the pain and related dysfunction becomes chronic, it's known as myofascial pain syndrome (MPS). Unfortunately, MPS is rarely mentioned in conventional veterinary schools, so it's often overlooked and left untreated. As veterinarian Dr. Michael Petty notes in his article for dvm360:

"Myofascial pain syndrome is a difficult-to-diagnose and seldom-treated condition in dogs. This is despite the fact that it's been a recognized pain issue for more than 400 years and entered mainstream human medicine almost 80 years ago. It's rarely taught in the university setting and there are no books about it."4

Potential signs of myofascial pain include weakness, muscle tension and stiffness and lameness, or your dog may jump from pain or twitch if you happen to press on a trigger point. Without treatment, trigger points and myofascial pain can turn into a chronic and worsening condition.

Treating Myofascial Pain by Relieving Trigger Points

If you suspect your dog is suffering from myofascial pain, see an integrative veterinarian who is experienced at finding trigger points. Once they've been located, there are a couple of options for treatment.

One, which is fairly invasive, is dry needling. This involves using an acupuncture needle that is pushed through your pet's skin to stimulate the trigger point. This may release the tight muscle bands associated with the trigger point, leading to decreased pain and improved function.

Electro-acupuncture and acupressure may also be helpful for some dogs with myofascial pain. Cold laser therapy and ultrasound therapy may be beneficial for dogs who won't tolerate acupuncture. Another less invasive option is manual manipulation of trigger points using trigger point massage or trigger point therapy.

I have found that recurrent trigger point problems can be a result of an underlying chiropractic issue, so if your pet isn't getting better, consider getting a chiropractic evaluation.