Join the forum discussion on this topic!When you’re new to the cat or dog amputation recovery journey, you will quickly learn that pain management is not a one-size-fits-all process. If your new Tripawd is struggling with pain control, and Gabapentin is not working, you may want to talk to your vet about another nerve pain medication called Pregabalin. Here’s why.
Pain control after amputation surgery has come a long way in most places.
Today, many vets are following the latest AAHA Pain Management guidelines, or close to it. New amputees come home with at the very least, a 7-to-10-day course of anti-inflammatory medication and Gabapentin to help ease nerve pain.
But during the first couple of weeks after surgery, pain control often needs to be adjusted. Sometimes it needs to be changed altogether. So if you find that your pet appears to be suffering from phantom leg pain and you’ve already adjusted their Gabapentin dosage, it’s worth talking to your vet about Pregabalin.
Because he had an interest in food, we managed to give him a Pregabalin, and all I can say is: wow. That stuff is AMAZING! The Gabapentin has never been able to manage his PLP completely but 40 minutes after giving the Pregabalin, he was more himself than he’s been in the last five months (he even played with his toys a little). Plus, he went the whole night without one PLP episode – something that hasn’t happened since this situation started. He did have another PLP episode this morning but, again after a Pregabalin, he is completely settled. My point: the Pregabalin has given us hope.
Arnold’s story: French Bulldog with Phantom Limb Pain
Why Try Pregabalin for Amputation Pain in Dogs and Cats?
Similar to Gabapentin, this anti-epileptic medication also known as Lyrica in human medicine, is now being viewed by some human physicians and veterinarians as a better source of nerve pain relief than Gabapentin.
Pregabalin acts on pain receptors exactly the same way as Gabapentin. But is more potent and more predictable with its response. And unlike Gabapentin, it doesn’t require as high of a dosage to see clinical effects. A veterinary form of this human medication can be used in dogs and cats, but with close veterinary supervision.
It’s more predictable, has a faster absorption, and with fewer doses
According to one Pregabalin study, Pregabalin has the potential to provide better pain relief in fewer doses.
- Faster absorption
- More predictable in its effect. A pet’s plasma concentration is proportional to the dose administered (which is not true for Gabapentin)
- Has an increased pain receptor affinity, which means lower doses are needed when compared to Gabapentin
- Has a terminal half-life of 7 hours. This makes a twice a day administration possible. Versus Gabapentin, which often works best when dosed three times daily).
Research on Pregabalin for Dogs
A study in dogs undergoing surgery for intravertebral disc disease and received 4mg/kg of pregabalin twice a day had lower pain scores when compared to dogs that did not receive any (Schmierer et al., 2020).
Another study evaluated the use of pregabalin (5mg/kg BID) in dogs suffering from Chiari-like malformation and showed increased tolerance in thermal and mechanical hyperalgesia and allodynia tests together with an improvement in owner-recorded pain scores (Sanchis-Mora et al., 2019). Gabapentin and Pregabalin as Analgesics, North Downs Specialist Referrals, Bletchingley, United Kingdom
What about Pregabalin for Cats?
Yes, Pregabalin can be used for cat amputation pain, but only with your vet’s guidance. Interestingly, in April 2024, Pregabalin now comes in an oral solution (brand name: Bonqat, by Zoetis). It is now being marketed as an anti-anxiety medication for cats because that’s how it was studied. Although it has not been studied extensively for treating cat amputation pain, it is worth a discussion with your vet.
Pregabalin is worth discussing with your veterinarian.
Once your vet approves using Pregabalin for Tripawd amputation pain, they can start taking it right away. Unlike NSAIDs, Pregabalin does not require a “washout” period to switch from Gabapentin.
Keep in mind that you may receive some pushback if you ask for this medication. Why? Two reasons:
- Pregabalin is more costly than Gabapentin, and has the same side effect risks.
- This medication is also classified as a controlled substance, so some veterinarians may not be enthusiastic about prescribing it.
But if your new Tripawd’s medication need is not being met, advocating for your new amputee is more important than ever to give the pain relief they deserve.
I’m hoping I misunderstood the descriptions of the studies. The first one reads “A study in dogs undergoing surgery for intravertebral disc disease and received 4mg/kg of pregabalin twice a day had lower pain scores when compared to dogs that did not receive any” Are they saying that the control group received no pain meds at all? Or that they received something other than pregabalin?
The second one reads “Another study evaluated the use of pregabalin (5mg/kg BID) in dogs suffering from Chiari-like malformation and showed increased tolerance in thermal and mechanical hyperalgesia and allodynia tests together with an improvement in owner-recorded pain scores” Did they deliberately inflict “thermal and mechanical hyperalgesia and allodynia” (read: pain) on these dogs??? I honestly can’t figure out any other way to read it.
As both a Tripawd pet owner (7 1/2 year-old Borzoi, 15 months post-surgery for osteosarcoma and doing really well!) and a scientist of 40+ years experience, I’m really hoping you can tell me that none of these animals were deliberately tortured in the name of science.
Hi Laurel! Thanks for reading and sharing your concerns, totally get it. Here is a link to the first study, “Randomized controlled trial of pregabalin for analgesia after surgical treatment of intervertebral disc disease in dogs.” In it, the abstract states “Dogs were randomly assigned to two groups, with the placebo group receiving opioids alone and the pregabalin group receiving opioids plus pregabalin.” So yes, they were given opioid pain control. For the second study, “Pregabalin for the treatment of syringomyelia-associated neuropathic pain in dogs: A randomised, placebo-controlled, double-masked clinical trial,” it states that “Eight dogs with symptomatic CM/SM were included in a double-masked, randomised, crossover placebo-controlled clinical trial. All dogs received anti-inflammatory drugs as base-line treatment during placebo or pregabalin phase of 14±4 days each.” So these dogs in the study already had symptomatic disease that required (and received) pain relief for the study. Hope this answers your questions and concerns. Thanks for caring!
This is wonderful news. Two (2) years ago, our beautiful cat lost one of her back legs (to cancer) and had a very difficult time with Gabapentin. It is great to know there is another option now available. I love keeping up with Tripawds. Thank you for all you do and share with the Tripawd community.
You are so welcome Ann! Let us know if it helps. I hope so!