Amitriptyline: a possible good neuropathic painkiller for the Pomeranian
Treating Chiari-like malformation and syringomyelia
A potentially better treatment has been found for two neurological conditions common in small dog breeds: herniation of the cerebellum through the occipital hole (Chiari-like Malformation or CM) and cavity formation in the spinal cord (Syringomyelia or SM). Both conditions are usually treated with gabapentin, an anti-epileptic drug that is also used as an analgesic for nerve pain. Associate professor and veterinary neurologist Dr Paul Mandigers, veterinary neurology specialist in training Dr Marta Plonek and veterinary medicine student Ramona ter Maat assessed whether the drug amitriptyline works better, and it seems that it does.
Mandigers saw that in humans, amitriptyline is a first-choice treatment. Since he sees many Pomeranians in his veterinary practice, he immediately saw opportunities to collect and analyse data. He explains, ‘The effectiveness of amitriptyline and gabapentin has never been properly studied. Both drugs have been used ‘off label’ in dogs for years but no decent study had been conducted. We wanted to at least make a start on that. And we now have strong signals that amitriptyline works better. That may be a reason to prescribe that first.’
Comparing 90 Pomeranians
90 owners whose Pomeranian was diagnosed with CM or SM were given the choice of starting treatment with gabapentin or amitriptyline, including the arguments. Clinical symptoms were then monitored and whether the dog benefited from the chosen drug. If desirable, it was possible to switch to the other drug, if the dog could benefit from it.
Thus, data were collected from dogs that had been treated exclusively with gabapentin or with amitriptyline and from dogs that had switched to the other drug. This led to a study showing that both drugs could be relieving and that amitriptyline might be a first-choice drug, as it is for human patients.