In dogs, osteoarthritis, internal medicine problems, trauma, surgery, and cancer pain are conventionally treated with NSAIDs, but veterinarians often are less comfortable with treating pain using multiple therapies. Individual situations may make one therapy ineffective, however, and other therapies or combinations must be considered. This article shows, through two cases of chronic osteoarthritis and one case of osteosarcoma, how multiple therapy regimens can reduce or eliminate pain and provide quality-of-life benefits. Pain cases can be complex. The clinician must have a plan, an accurate diagnosis, knowledge of traditional and nontraditional drugs for chronic pain, and the ability to sort through all currently available methods for addressing specific conditions. Pain pointers, a dosage chart for analgesic drugs (see www.cliniciansbrief.com), and Q & A sidebars for each case provide a better understanding of how to design and implement a successful multimodal treatment plan.

COMMENTARY: What does one do when a single NSAID fails? Cutting-edge solutions are covered in this article, which includes a dosage chart listing both traditional and nontraditional drugs and suggestions for multimodal therapy.

Managing chronic pain in dogs: The next level. Hardie EM, Lascelles BDX, Gaynor JS. In: Managing Pain in Cats, Dogs, Small Mammals, and Birds. Wilmington, DE: The Gloyd Group, Inc, pp 71-84, 2003.