Solving Your Dog’s Pain — Traditional Pain Relievers

 Let’s take a quick skim through traditional pain meds currently used in dogs.  Note that these observations are mine alone and so you should take them with a grain of salt, but they are based on many moons in vet clinics treating pets like yours.  I’m saying they’re right, and it’s my website :).

• TRAMADOL– an old standby.  Worthless.
• GABAPENTIN — Probably 2-3/10 on the pain relief scale, so not very potent by itself.  Most common use is standalone for spinal pain, or in combination with other pain relievers for more significant pain.  Can cause significant sleepiness.  Very safe in almost all patients.
• NSAIDs — Carprofen, Deramaxx, Metacam — Day in and out, the best widely used pain relievers.   Probably 7-8/10 on the pain relief scale.  Can create or worsen GI issues, liver and kidney problems.  Act via COX inhibition.  Can be a benefit in cancer therapy, as they (especially Deramaxx) have been proven to reduce tumor blood supply.  Stop if you see loss of appetite, vomiting, or diarrhea.
• GALLIPRANT — an NSAID generally considered SAFE for dogs with GI upset, liver or kidney problems.  Probably 5-6 out of 10 on Kevin’s pain relief scale, so not as potent as the COX inhibitors above… but safer for sensitive pets.

If you boil all that down, here’s what you get.
-The pain relievers that don’t work all that well are safer.
-The pain relievers that DO work well carry more risk.  True in both humans AND pets.

Solving Your Dog’s Pain — What About Librela?

 LIBRELA reduces pain in a way totally unlike ANY of the other drugs mentioned above.  It’s a biological molecule synthesized in the lab which inhibits a pain-transmitting molecule called Nerve Growth Factor, or NGF.  NGF is one of the primary pain modulators in both humans and pets, and there are several similar molecules in late stage development for the human market.  Learn more about NGF inhibitors here.

Before Zoetis introduced LIBRELA to the US market, they did safety/efficacy studies in both the EU and the US.  In both studies, LIBRELA was found to be safe and effective in reducing osteoarthritis pain.  Here’s the FOIA version of those studies.  The primary side effects noted were a) local inflammation, b) skin problems, and c) interestingly, urinary tract infections.

So, does LIBRELA work?  I’m not in clinical practice anymore, but I still hang out with vets who are smarter and better looking.  And here’s what they say:

• LIBRELA is VERY effective at reducing arthritic pain in most dogs.
• It may take two injections to achieve maximal pain relief benefit (note that this was also mentioned in the studies above, so no surprise)
• And there are some dogs for which LIBRELA just doesn’t seem to work.

The most common side effect seen is pain and swelling at the site of injection.

Now, if you looked at the internet you would think that LIBRELA has caused widespread death and destruction in the dog world.  And, to be clear, there are probably pets that LIBRELA DID hurt or kill due to some weird and idiosyncratic reaction.  
However, like most things in the social media world… you ONLY hear the horror stories and not the ones where folks live happily ever after.  One or two people with a megaphone (like Twitter or FB) can sound an awful lot like a crowd.

HERE’S WHAT YOU MUST REMEMBER ABOUT LIBRELA AND EVERY OTHER PAIN MEDICATION ON THE MARKET.   By the time pets or humans need pain relief, they are… by definition… no longer absolutely healthy.  Osteoarthritis is generally a disease of older individuals, who often come with other diseases like liver or kidney problems, heart disease, or cancer.  Thus a pet running into kidney or heart failure while on LIBRELA  is always sad… but may not be caused by LIBRELA, or any other medication, at all.  Maybe they’re just a sick pet who happened to be on LIBRELA.

And here’s one more thing to understand:  LIBRELA is, by drug standards, a baby with, let’s say, 100k or so injections given across the US.  So far, it seems like the risk/benefit ratio is tolerable.  But like every other drug or surgery, we need numbers for more accurate analysis.  By the time it has been given a million times, we’ll have a VERY good idea about its benefits and whether there are patients who should not be started on it.  Time will make us smarter.

WOULD I USE LIBRELA IN MY OWN DOGS TOMORROW?  YES, I WOULD.  But I would do so only if they…

• had breakthrough pain on the existing oral meds which have been around for dozens of years because, as an old fart, I believe that old drugs are better understood, or
• if they had health issues that prevented my use of the oral NSAIDs.