Tramadol for treatment of pain in dogs

I was interested to read the recent report¹ on the lack of effectiveness of tramadol in treating pain in dogs with chronic osteoarthritis and thank the authors for emphasizing the need for science-based treatments in veterinary medicine. I hope further appropriately controlled evaluations of therapeutic modalities, both new and tried-and-true, continue to see publication. I must admit to being a little dismayed by the authors’ results, as I have used tramadol for years to manage acute (eg, postoperative) and chronic pain in dogs on the recommendation of respected and trusted colleagues, board-certified specialists, and continuing education speakers. As anyone experienced in pain management can attest, multimodal treatments are generally preferable, and I hope future studies will look into the value, or lack thereof, of using medications such as tramadol in addition to, rather than instead of, NSAIDs and other analgesics.

Clinical experience and judgement are essential in the practice of veterinary medicine, but all knowledge is contingent on new scientific evidence. I appreciate that well-done studies can be costly and time-consuming but hope that investigators will continue to provide this kind of science-based information and that my colleagues will reflect on our oath to use our “scientific knowledge and skills for the benefit of society through the protection of animal health and welfare.”²

Edward L. (Bear) Thompson, dvm

Thousand Oaks, Calif

The authors respond:

The authors thank Dr. Thompson for his thoughtful letter regarding our study showing a complete lack of effectiveness of tramadol in dogs with pain and dysfunction due to chronic osteoarthritis. Dr. Thompson brings up 2 points that we would like to discuss.

The first point is Dr. Thompson's comment that he used tramadol on the recommendation of respected and trusted colleagues, board-certified specialists, and continuing education speakers. Many clinicians use the exact same sources to help guide patient treatment. However, one of the tenets of evidence-based medicine is that “expert opinion” is the weakest form of evidence when making clinical decisions about patient care. Unfortunately, drugs like tramadol have been recommended by all of the aforementioned individuals without clinical trials to support their use. It is incumbent on everyone who provides these types of treatment recommendations to know and understand the supporting data—or lack thereof—before disseminating them. Many clinicians, if they critically looked at the information used in the daily treatment of patients, would likely be shocked to find just how little clinical data are truly available to support current recommendations.

The second point that Dr. Thompson brings up is the need for more clinical trials. No truer words have ever been spoken. Yes, these trials take time, dedicated investigators, and a considerable amount of money. To that end, we would like to acknowledge the support that our project received from the Morris Animal Foundation, which provided nearly 75% of the funds to make this study happen. Without the Morris Animal Foundation's support, tramadol would still be seen as a viable treatment by many clinicians for the foreseeable future. Dr. Thompson hopes that more studies will be done, but the authors know that for this to happen, more money must be made available to clinical investigators. Our profession can be an important contributor to that end, and the authors hope that our study encourages more donations be made to entities that support clinical research, like the Morris Animal Foundation. Quality research requires adequate funding, and often the monetary costs can be substantial. It is important that veterinarians be part of the solution.

Steven C. Budsberg, dvm, ms

Department of Small Animal Medicine and Surgery

College of Veterinary Medicine University of Georgia Athens, Ga

Bryan T. Torres, dvm, phd

Department of Veterinary Medicine and Surgery

College of Veterinary Medicine University of Missouri Columbia, Mo

Highlighting animal involvement in human mental health definitions

Because of the growing evidence of a link between animal abuse and other forms of violence, the FBI's National Incident-Based Reporting System began in January 2016 collecting detailed data from participating law enforcement agencies on acts of animal cruelty, including gross neglect, torture, organized abuse, and sexual abuse. Before this change, crimes that involved animals were lumped into an “all other offenses” category.¹ Acceptance of this link has also spurred the development of a national directory of abuse investigation agencies by the National Link Coalition.²

Over the past 30 years, there has also been a substantial increase in evidence highlighting the involvement of pet animals, typically as proxies or victims, in a broad range of human mental health conditions, including Munchausen's by proxy,^3,4 malingering by proxy,⁵ health anxiety by proxy,⁶ and so-called extended suicide.⁷ As a result, we believe that a greater emphasis should be placed on the inclusion of animals in both diagnosis and treatment of people with psychological disorders. Given the increased emphasis on recognizing and reporting animal abuse as well as other human mental health conditions that may impact people and animals, it is imperative that those in leadership positions support efforts to disseminate accurate, timely information on these topics for human and veterinary medical professionals as well as the public at large. As part of this effort, we suggest reporting of animals as potential victims or proxies when relevant.

James A. Oxley, mres

Measham, Swadlincote, England

Lori Kogan, phd

Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences

Colorado State University Fort Collins, Colo