ISFM, AAFP update guidelines on long-term NSAID use in cats

Managing chronic pain in cats should involve both pharmacological interventions and environmental modifications. Nonsteroidal anti-inflammatory drugs (NSAIDs) can benefit cats with chronic pain as an element of this multimodal approach, but there are a number of considerations.

A panel of veterinary experts in feline pain relief have developed revised guidelines for using NSAIDs in cats to ensure the best outcomes for cats, owners, and veterinary professionals.

Specifically, the International Society of Feline Medicine (ISFM) and the American Association of Feline Practitioners (AAFP) created the “2024 ISFM/AAFP Consensus Guidelines on the Long-Term Use of NSAIDs in Cats” to provide veterinary practitioners with decision-making tools for prescribing NSAIDs in situations of chronic pain to minimize adverse effects and optimize pain management for their feline patients.

“Chronic pain assessment using validated tools is paramount for monitoring the efficacy of long-term NSAIDs for pain management. Additionally, intertwining environmental modifications and paying attention to engaging emotions, can result in positive outcomes for cats in chronic pain,” the guidelines’ authors wrote.

Published in the April issue of the Journal of Feline Medicine and Surgery, the consensus guidelines are a valuable resource for veterinarians on the most widely used analgesic in veterinary medicine. As the guidelines state, “The unique feline metabolism must be considered when prescribing any medication for this species. Cats have deficient glucuronidation capabilities and are, therefore, at greater risk of toxicity when being administered drugs relying on this pathway for clearance (hence why paracetamol [acetaminophen] is contraindicated in this species).”

The guidelines provide information on the following areas:

• Mechanism of action of NSAIDs
• Indications for their long-term use in cats, including dental disease and neoplasia
• Assessing patient suitability and screening prior to prescription of NSAIDs
• Considerations for NSAID use in the presence of comorbidities
• Monitoring treatment efficacy
• Avoidance and management of adverse effects
• Considerations for anesthesia and surgery in cats receiving long-term NSAID therapy
• Cat-friendly techniques to reduce chronic pain in the clinic and at home

One point of emphasis in the guidelines is that NSAIDS are prescribed after appropriate screening and with the caregiver embraced as part of the team, being both informed and supported by veterinary professionals.

That’s why, along with guidelines for veterinarians, the ISFM has created guides for cat caregivers to provide information about important topics such as treating pain with NSAIDs, home modifications to help cats with arthritis, and increasing water intake for cats, which is helpful for many cats, including those taking NSAIDs or those with chronic kidney disease.

The AAFP also has a client brochure for treating chronic pain with NSAIDs in cats.

Much has been learned since the first consensus guidelines were published in 2010, according to Dr. Sam Taylor, head of veterinary specialists for ISFM and contributing author.

“Since then, multiple studies have examined the use of NSAIDs in cats, particularly those with comorbidities. These guidelines have examined this evidence and aim to provide practitioners with practical information on using NSAIDs for chronic pain management, along with tips and advice on working with caregivers to provide the best care for their cat,” Dr. Taylor said in a press release.

“With a focus on safety, efficacy, and responsible medication management, these guidelines aim to enhance the quality of life for cats while minimizing potential risks,” added Heather O’Steen, AAFP CEO, in the release. “We believe that these guidelines will serve as a vital resource in ensuring the optimal care and wellbeing of cats receiving long-term NSAID therapy.”

Previously, the ISFM published its “2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats” on the use of NSAIDs for acute pain conditions in cats.

A version of this story appears in the September 2024 print issue of JAVMA