Gabapentin and Amantadine for Chronic Pain: Is Your Dose Right? - Tamara Grubb, DVM, PhD, DACVAA

Oct 12, 2026

Uploaded by adawds

Gabapentin and amantadine are evaluated for dosing to manage chronic pain, with clear distinction between acute protective pain and chronic maladaptive pain. The text explains why chronic pain is often harder to treat, linking persistent pain to factors such as osteoarthritis, cancer, and mixed inflammatory and neuropathic mechanisms. It summarizes anti-inflammatory limitations, the need for multimodal analgesia, and neuropathic features including peripheral/central sensitization and opioid receptor down-regulation.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages10

Reading Time4 min

AccessFree to download

Pain management

Acute pain vs chronic pain

Chronic pain components

Inflammatory pain

Neuropathic pain

PEER REVIEWED [shutterstock.com/everydoghasastory](shutterstock.com/everydoghasastory) FEATURES CONTINUING EDUCATION PAIN MANAGEMENT Gabapentin and Amantadine for Chronic Pain: Is Your Dose Right? Tamara Grubb, DVM, PhD, DACVAA Associate Professor, Anesthesia and Analgesia Washington State University, College of Veterinary Medicine Pullman, Washington Pain is not always a bad thing, and all pain is not the same. Acute (protective) pain differs from chronic (maladaptive) pain in terms of function and treatment. This article describes the types of pain, the reasons why chronic pain can be difficult to treat, and the use of gabapentin and amantadine for treatment of chronic pain. ACUTE PAIN Acute pain in response to tissue damage is often called protective pain because it causes the patient to withdraw tissue that is being damaged to protect it from further injury (e.g., a dog withdrawing a paw after it steps on something sharp) or to become less active to protect tissue that is already damaged but healing (e.g., a cat sleeping frequently after abdominal surgery) . A commonly used definition of acute pain reflects its normal role in tissue protection and healing: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”1 Protective pain (also called adaptive or nociceptive pain) is normal anda necessary adaptation for survival, but even protective pain causes adverse effects, and pain that exceeds the level needed for protection should be treated. Untreated or undertreated pain can cause myriad adverse effects, including but not limited to insomnia, anorexia, immunosuppression, cachexia, delayed wound healing, increased pain sensation, hypertension, and behavior changes that can lead to changes in the human–animal bond.2 Hence, we administer analgesic drugs to patients with acute pain, not to eliminate the protective portion but to control the pain beyond that needed for protection (i.e., the pain that negatively affects normal physiologic processes and healing) . This latter type of pain decreases quality of life without providing any adaptive protective mechanismsand is thus called maladaptive pain. It serves no protective purpose but can cause the painmediated adverse effects previously mentioned. CHRONIC PAIN Chronic pain falls largely into the maladaptive pain category. This pain is often not protective because chronic pain is generally not caused by conditions that require rest for tissue healing, even if an acute injury that might have healed actually started the pain process. A common definition of chronic pain reflects SENIOR PATIENTS DEALING WITH CHRONIC PAIN The most common cause of chronic maladaptive pain is osteoarthritis, or degenerative joint disease. [todaysveterinarypractice.com](todaysveterinarypractice.com) NOVEMBER/DECEMBER 2018 25 PEER REVIEWED its lack of a role in tissue protection and healing:“pain that has persisted beyond the normal tissue healing time … pain without apparent biological value.”1 As with acute pain, chronic pain can cause the pain-mediated adverse effects previously mentioned and thus requires analgesic treatment. Components of Chronic Pain The most common cause of chronic maladaptive pain in mammals is osteoarthritis, or degenerative joint disease, and the second most common cause is cancer. The overall sensation of pain from any cause is multifactorial, and pain from either osteoarthritis or cancer generally has both inflammatory (which can be protective if not excessive) and neuropathic (which is always maladaptive) components.3 Inflammatory Pain Inflammatory pain is a very common component of most pain syndromes, making the inclusion of anti-inflammatory drugs (e.g., nonsteroidal antiinflammatory drugs [NSAIDs] or piprants [grapiprant]) an integral component of chronic pain therapy for all patients, unless use of these drugs is contraindicated (e.g., gastrointestinal ulceration, renal dysfunct

FAQs

How does the document distinguish acute pain from chronic pain?

Acute pain is protective and linked to tissue damage and healing, while chronic pain is maladaptive and persists beyond normal healing time without a clear biological value.

What are the most common causes of chronic maladaptive pain discussed?

Osteoarthritis (degenerative joint disease) is identified as the most common cause, with cancer as the second most common cause.

Why might anti-inflammatory drugs alone be insufficient for chronic pain?

Anti-inflammatory drugs may not fully control moderate-to-severe or longstanding pain because pain can also originate from other sources such as neuropathic mechanisms.

Oct 12, 2026

Uploaded by adawds