Just like their human counterparts, dogs sometimes need help managing their pain. Dogs — like people– may have acute pain from an injury or a surgical or dental procedure. Or they may suffer from pain that is more chronic in nature, such as pain from arthritis or hip dysplasia, both of which can cause discomfort that ranges from moderate to severe. Dogs undergoing treatment for cancer and those with degenerative disc disease (IVDD) may also suffer from near-constant pain.
Seeing your dog in pain is heartbreaking. Fortunately there are medicines that can help.
In any of these circumstances, proper pain management can not only help keep your dog comfortable, but also allow him to participate in activities that promote healing and reduce emotional stress. Treatment will usually involve what veterinarians call multimodal therapy — two or more medications that work to control pain in different ways as well as nonpharmacologic interventions such as physical therapy, acupuncture and massage. Although the exact nature of the treatment will depend on your dog’s condition and the preferences of you and your vet, medicines will often include a nonsteroidal antiinflammatory medication such as meloxicam (Metacam, Loxicom) or carprofen (Rimadyl, Novox) and an opioid such as tramadol.
What Is Tramadol?
Tramadol (Ultram, Rybix, Zytram) is a synthetic (man-made) pain medication that has a similar mechanism of action to the naturally occurring opiates morphine and codeine. It is classified as a narcotic but is listed by the U.S. Drug Enforcement Agency as a Schedule IV drug, having “a low potential for abuse and low risk of dependence.”
Like other opioids, Tramadol works by interfering with the perception of pain by binding to opiate receptors in the brain, specifically a subset of receptors known as “mu” receptors, which have been shown to mediate both pain and reward. Tramadol is also a serotonin-norepinephrine reuptake inhibitor (SNRI), in the same class as the antidepressants desvenlafaxine (Pristiq),
duloxetine (Cymbalta), and Venlafaxine (Effexor XR). These medicines work to increase the amount of two important brain chemicals, serotonin and norepinephrine, in the space between brain cells. And while it’s unclear why or how they work, the use of SNRIs in humans has been shown to help ease depression and anxiety and improve mood.
Tramadol has been a staple of veterinary pain management for many years. It is usually given by mouth in the form of a liquid or a pill. That said, the liquid form of the medication must be compounded by a pharmacist, and is usually quite expensive. So most vets will recommend that all but the smallest dogs take Tramadol in pill form.
Tramadol may be compounded by a pharmacist into a liquid, but it is far more cost-effective to give the medicine in pill form.
According to the American Kennel Club, your vet may prescribe Tramadol for any number of acute and chronic conditions, such as:
- Post-operative pain
- Pain from an injury, such as a torn ligament
- Intervertebral disc disease
Additionally, it is sometimes prescribed to treat anxiety, a persistent cough, or a progressive spinal cord disease known as degenerative myelopathy, which causes gradual weakening and paralysis of a dog’s hind end.
Is Tramadol Safe?
Tramadol has a strong safety profile and a low incidence of adverse effects, according to Veterinary Practice News. Side effects are usually mild and transient, and include:
- Sleepiness or lethargy
- Dizziness, unsteady gait
- GI disturbances such as nausea, vomiting, loss of appetite, constipation or diarrhea
If side effects are especially severe or persistent, they can usually be managed by decreasing the dose of the drug.
With that said, Tramadol should be used with caution in older dogs and dogs with kidney or liver disease, since they may metabolize the drug more slowly and require a smaller dose. Tramadol has also been shown to lower the seizure threshold in humans, so dogs with a history of seizures should not be given the drug.
Tramadol should be used with caution in elderly dogs, who may metabolize it more slowly and need a smaller dose.
Tramadol may also interact with other drugs, particularly antidepressants. Unless specifically directed by your veterinarian, your should avoid giving your dog Tramadol if she is also being treated with any of the following medicines:
- Monoamine oxidase inhibitors (MAOIs) such as Phenelzine (Nardil) and Selegiline (Emsam)
- Selective serotonin reuptake inhibitors (SSRIs) such as Fluoxetine (Prozac),Paroxetine (Paxil) and Sertraline (Zoloft)
- Tricyclic antidepressants such as amitriptyline, desipramine (Norpramin) and Imipramine (Tofranil)
Giving these medicines concurrently with Tramadol may cause a condition known as “serotonin syndrome” brought on by too much serotonin in the dog’s blood stream, according to Barbara Forney, VMD, of Wedgewood Pharmacy. Serotonin syndrome is a life-threatening complication that can cause high fevers, tremors, sleepiness or restlessness, excessive sedation, confusion, loss of consciousness and even death.
VCA Animal Hospitals also cautions against using Tramadol in dogs who are taking;
- Antifungals for the “azole” class (fluconazole,clotrimazole)
- Other opioids
- Supplements containing SAMe
Because drug interactions can be serious and even life-threatening, always tell your vet about any medicines, nutritional supplements, vitamins or herbal preparations you currently give your dog.
Despite Tramadol’s wide margin of safety, overdoses can occur. Your dog might get into a bottle of her medicine, or your pet sitter might accidentally give her a double dose. Accidents happen. So it’s important that you know the signs of a Tramadol overdose and what to do if it occurs.
Because Tramadol is both an opioid and an SNRI, symptoms of an overdose aren’t always clear cut. Some things to watch for include:
- Excessive sleepiness or agitation
- Unsteady gait, falling down
- Constricted pupils
- Very slow breathing
- Slow heart rate
- A blue tinge to the tongue and gums
If you notice any of these changes in a dog who is taking Tramadol, you should suspect an overdose and immediately call your vet. If the dog is unresponsive and not breathing, or if his tongue and gums are blue, start CPR and call for help. Your dog will need emergency treatment immediately to reverse the effects of the drug.
An overdose of Tramadol is a medical emergency. Your vet may administer naloxone to reverse the narcotic effects and support respiratory function, and diazepam to control agitation or seizures.
Dependence, Tolerance and Withdrawal
Although the DEA classifies Tramadol as a Schedule IV substance with a low potential for abuse, it is a narcotic, and your dog will become physically accustomed to it if he takes it for a long period of time. (This is called dependence.) Your dog’s body will also adapt to the drug, and over time she may need a higher dose to achieve the same effect. (This is known as tolerance.) Additionally, your dog will almost certainly develop unpleasant symptoms if the medicine is abruptly stopped or the dose is decreased too rapidly. (Withdrawal)
If your dog is taking Tramadol for chronic pain, it’s important not to skip doses or try to wean her off the medication without your veterinarian’s help. Withdrawal symptoms are extremely unpleasant, but they can be avoided if you taper the dose of Tramadol slowly or replace it with a different opiate.
Is Tramadol Effective?
Although Tramadol has been in use in veterinary practice for over two decades, there has been considerable controversy about its use, especially over the past few years.This has come about not because Tramadol isn’t believed to be safe, but because research seems to indicate that it may not be effective in controlling dogs’ pain.
The reason for these concerns are twofold. First, preclinical research indicates that dogs can’t break down Tramadol into the active metabolite O-desmethyl-tramadol, which is largely responsible for its pain relieving effects, according to Veterinary Practice News. Additionally, recent studies have shown that dogs lack the specific M1 mu receptor that Tramadol binds to, which means it actually provides little pain relief. Dogs treated with Tramadol may appear sleepy and calm due to the sedating and mood elevating effects of serotonin, but they may still be in pain.
With that being said, many vets still rely on Tramadol for pain relief, so it will be up to you to advocate for your dog. According to Best Friend Veterinary Clinic in Grafton, Wisconsin, there are quite a few alternatives that may be a better choice to control your dog’s pain. These include:
- An NSAID such as carprofen or meloxicam in combination with a more effective opioid, such as hydromorphone, butorphanol, or buprenorphine. Methadone, which many lay people associate with treatment for opiate addiction, is actually also an effective medicine for managing chronic pain.
- Gabapentin, an anticonvulsant (medicine that controls seizures) is also used by doctors and veterinarians to treat many types of chronic pain.
- Amantadine, a medicine originally used to help lessen the severity of several strains of the flu, but has since been found to be very effective in treating chronic pain. Dogs (and humans) with chronic pain often develop a problem called “central sensitization,” in which the brain and spinal cord become hyperreactive, causing pain signals to be intensified. Amantadine seems to work by “turning down” these signals. It is particularly beneficial for dogs with spinal injuries or IVDD, diabetic neuropathy, amputations or burns. It can also be used in dogs with severe arthritis who are no longer responding to NSAIDS.
There are also intravenous medications and “nerve blocks” that your vet may use during and after surgical or dental procedures that can keep your dog comfortable for up to 72 hours. It’s a good idea to discuss these with your vet in advance of your dog’s scheduled surgery.
Your dog will be happier and healthier if her pain is well-controlled. And with so many options available today, it should be relatively simple to come up with a plan that works.
The Bottom Line
Tramadol is popular with many veterinarians, who have used it for nearly two decades to treat pain in dogs. It is very safe when given in prescribed doses, but it is habit forming, so it needs to be tapered gradually if you and your vet decide it is no longer right for your dog. There is also evidence that Tramadol may not work as well as it was once believed to control pain, but instead has more of a sedative effect. Therefore, it is important to discuss other options with your vet as well.