Pain management for dogs and cats — WSAVA 2022 adapted for small clinics

WSAVA considers pain the “4th vital sign” — yet how many clinics in Southeast Asia routinely score every patient? Opioids are available in Thailand but restricted in Vietnam. Gabapentin is easy to buy but rarely used for pain.

4 key principles

1. Systematic pain assessment — use validated pain scales
2. Multimodal analgesia — combine drug classes, lower individual doses
3. Preventive analgesia — treat pain before it starts (pre-/intra-/post-op)
4. Individualize — by species, age, comorbidities, drug availability

Pain scales — which one

Tool	Species	Validated?	Best for
Glasgow CMPS-SF	Dog	✅ Strongest	Protocol-driven clinics
Feline Grimace Scale	Cat	✅	Very easy to implement
CSU Canine	Dog	Teaching tool	Quick start

NSAIDs — backbone of analgesia

Drug	Dog	Cat	Notes
Meloxicam	0.2→0.1 mg/kg	0.05-0.1 SC, 0.01-0.05 PO	Label varies by country
Carprofen	4.4 mg/kg/day	Not recommended routine	GI/renal monitor
Robenacoxib	1-2 mg/kg	1-2.4 mg/kg (labelled!)	One of few NSAIDs labelled for cats

⚠️ Paracetamol is contraindicated in cats — fatal methemoglobinemia.

Opioid availability in SEA

Drug	Thailand	Malaysia	Vietnam
Morphine	✅ Widely used	✅ With permit	⚠️ 3-copy Rx, 7-day limit
Tramadol	✅ Most common	✅	✅
Buprenorphine	⚠️ Limited	✅ Psychotropic permit	⚠️ Difficult

Reality: Tramadol + NSAID is the most common acute pain combo in SEA.

Adjunctive drugs

Drug	Indication	Dog dose	Cat dose
Gabapentin	Neuropathic, chronic, anxiety	5-10 mg/kg BID-TID	5-10 mg/kg BID
Amantadine	Wind-up/chronic, NSAID add-on	3-5 mg/kg SID	3-5 mg/kg SID

Pain signs checklist

Dogs

☐ Posture/gait change | ☐ Decreased activity | ☐ Decreased appetite | ☐ Wound licking | ☐ Whining | ☐ Restlessness | ☐ Praying position (abdominal pain)

Cats

☐ Ear/orbital tightening | ☐ Hunched posture | ☐ Hiding | ☐ Unusual silence | ☐ Hissing | ☐ Decreased grooming | ☐ Decreased appetite

Cats hide pain better — Feline Grimace Scale helps detect early.

Practice management software like VetGo integrates pain scoring — record pain scores each visit, trend charts for follow-up.

---

Sources: WSAVA Pain Guidelines 2022, AAHA 2022, Merck Vet Manual.