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NSAIDs work…when used

Clients are more likely to comply with NSAID treatment when they understand its value to their pets.

There may not be a cure for pain. But, that doesn’t mean we have to live with it; nor should people’s pets have to do so. And, yet, an age-old challenge for your veterinarian customers is getting their clients to comply with non-steroidal anti-inflammatory drug (NSAID) treatment.

There is a lack of understanding among pet owners when it comes to managing their dogs’ osteoarthritis, says Jennifer Harrington, DVM, manager, veterinary technical solutions, Merial. “Sometimes, pet owners are more inclined to manage acute flare ups of pain, rather than address their dogs’ pain with a consistent use of pain medication, such as NSAIDs,” she says. “And, sometimes, pet owners don’t attribute certain symptoms, such as loss of muscle tone, easily tiring during walks or difficulty climbing stairs, to pain.” Rather, they believe these are typical signs of aging, she points out. And, while they might be such, they just as easily can signify osteoarthritis. 

Unless pet owners follow their veterinarian’s recommendation for pain management, however, and follow through with the appropriate treatment, it’s likely their pets will continue to suffer. Changing the cycle calls for an important discussion between veterinarians and their clients – something sales reps can help their customers initiate. 

 

Positive results

When veterinarians use their best judgment, the results of NSAID therapy are usually very positive, according to Kyle Malter, DVM, technical services veterinarian, Boehringer Ingelheim Vetmedica Inc. “I consider NSAIDs life-saving for many pets,” he says, noting they offer a safe way of addressing pain in dogs and cats, and can help alleviate chronic pain and inflammation in animals due to osteoarthritis, as well as post-surgical pain. “Quality of life and the ability to remain mobile are essential.” 

As NSAIDs become a growing standard of care, the industry is seeing a couple of trends. For one, more veterinarians look to use the lowest effective dose, particularly for dogs with osteoarthritis that require the drug for an extended period. “After a couple of weeks of therapy, if the dog is doing well, the veterinarian can gradually decrease the dose,” says Malter. In most cases, the patient responds very well, he adds. 

“The lower the dose you provide to the animal, you will minimize the chance of an adverse effect occurring,” he says. “Any pharmaceutical can cause a side effect.” NSAIDs are associated with vomiting, diarrhea or anorexia in dogs, and gastrointestinal and renal disease in cats. As a class of drugs, they are associated with a higher incidence of risk than other pharmaceuticals, including antibiotics, he notes. “But their benefits far outweigh their risk, which is still minimal,” he says.

In addition, NSAIDs are being prescribed as a cornerstone in multimodal therapy. Often, veterinarians prescribe an NSAID and then add a joint supplement, according to Malter. The benefits are apparent, he says. Opioids are also used in conjunction with NSAIDs, he adds. “The goal of multimodal therapy is to relieve pain in different ways to achieve a comprehensive effect,” he explains. 

 

Keeping the client in the loop

All veterinarians want their patients to receive the necessary treatment, Malter points out. Sometimes, it’s just a matter of getting clients to comply. When pet owners are educated about the efficacy of NSAIDs when they are administered according to the prescription, as well as the side effects to watch for, they may be more likely to follow through with the treatment, he explains. “Some dogs might require NSAIDs every day for years,” he says, noting that, with monitoring, this can be very safe. However, for clients, this means they must be in it for the long haul – remembering to give their pet its medicine and keeping an eye on how it is responding to the treatment. 

“The goal is to give the dog the lowest possible dose, for as long as it needs it,” Malter continues. “A dog won’t heal from hip dysplasia pain without an NSAID. In this case, the goal is not to take it off the drug, but to keep it on the lowest effective dose.” While veterinarians recognize the need for client compliance to ensure this goal is met, “this is an issue they would like to see improved,” says Malter. “Animals living in pain have a lower quality of life and, of course, lack of client compliance means lost revenue for the clinic.” There are several reasons why clients fail to follow through with their pet’s NSAIDs prescription, he continues: 

• They don’t identify their pet’s pain. Particularly when the animal starts to respond to the NSAID treatment, the owner might misinterpret this to mean it no longer requires it. 

• They can’t afford the cost of the prescription. Determining – and then prescribing – the lowest effective dose for the pet helps keep the cost down. 

• People have busy schedules. It’s easy for pet owners to forget to refill their pet’s prescription. 

The good news for pet owners is that NSAIDs today are more efficacious and convenient to use than they once were. “There definitely has been an evolution in NSAID products,” says Harrington. Whereas years ago veterinarians relied on products such as aspirin intended for human use, today’s solutions are FDA-approved and easy to administer, such as oncea- day flavored chewable tablets, she notes. The easier it is for pet owners to give their pets their medications, the more likely it is they will comply for the long-term, she adds. 

But, veterinarians can’t pass along the value of these products to their clients without some serious education. “Veterinarians should start a conversation with their clients about aging pets at annual checkups,” says Harrington. This may involve a discussion not only about NSAIDs, but exercise, proper nutrition and weight loss – all of which can help alleviate symptoms of osteoarthritis, she explains. In addition, Merial offers a client survey and an osteoarthritis pet owner brochure to educate them about osteoarthritis and pain management, she says. 

There are a few things distributor sales reps can do to help their veterinarian customers work more closely with clients to ensure greater compliance, notes Malter. For one, they should encourage their customers to give clients reminder calls when records indicate the patient’s prescription should be running low. If a pet owner still has some prescription left, this is an opportunity for the veterinarian to remind him or her that it doesn’t appear the prescription is being given regularly. “It’s important for veterinarians to engage and involve the pet owners,” he says.

Staying in touch with clients through reminder calls provides a good opportunity to ensure they are watching for potential side effects their pet may be experiencing, Malter continues. Most veterinarians remember to warn their clients to watch for side effects, he notes. At the same time, “it’s very important for distributor reps to understand what the side effects are and to remind their customers to educate the pet owners.” 

In addition to encouraging customers to engage clients through reminder calls, “one of the most impactful things sales reps can do is to remind their customers of rebate programs that are available,” says Malter. “There are some good programs offered by manufacturers, and it would help veterinarians if their distributor reps reminded them to use them to engage their clients.” 

When the pet owner purchases the medication and receives a check or credit that can be used at the clinic, “this connects the client to the clinic and solidifies the veterinarian-client relationship,” he points out, adding that it also discourages the client from purchasing a product online from a potentially illegitimate source. Not only that, “if a client is refilling a prescription online, and the veterinarian isn’t seeing the patient regularly, the veterinarian can’t offer the best quality of care.

“In the end, everyone benefits from client compliance,” says Malter. “Yes, it means greater revenue for the clinic, but it also means better care for the patient.”

 

Starting a discussion

By asking the right questions, distributor sales reps can begin a discussion about NSAIDs with their customers and determine how best to service them. For instance, reps should encourage veterinarians to focus on their patient demographics, says Harrington. “Reps should ask their veterinarian customers how they go about exploring their patients’ pain management needs with their clients,” she says. In addition, Malter recommends asking the following: 

• “Doctor, which NSAIDs do you currently use?” 

• “What do you like – and dislike – about the products you currently use? If you could improve one thing about your current NSAID products, what would that be?” 

• “What are you looking for in an NSAID?” 

• “Are you aware of some of the newer products currently available?” 

• “When prescribing NSAIDs, are you mindful of keeping patients on the lowest effective dose?” 

• “How do you work with clients to ensure they are compliant/follow through with your prescription?” 

Some veterinarians might object to trying a new NSAID, or they might feel that, because they already carry a couple of products, they don’t need to add one more. Distributor sales reps can respond by educating them on new NSAID formulations, says Malter, noting that today, in addition to the injectable NSAID administered at the initial visit to the veterinarian, NSAIDs come in the form of a pill or oral liquid. Most veterinarians will want to have different forms of the drug on hand to cater to different pet and client preferences, he points out. “Still, the most common objection [reps can anticipate] is that the veterinarian is familiar and more comfortable with an older product and is resistant to change,” he adds.

It’s the “common goal” of the veterinarian, the pet owner and the distributor sales rep to see that pets receive the best possible care, Malter continues. Working together to help ensure patients receive their full NSAID treatment helps make this possible.

 

Understanding the Basics:

Distributor sales reps don’t need to be scientists to understand the basic physiological processes that necessitate the use of NSAIDs. But, understanding a few basic terms and concepts, such as the following, will help make their job working with veterinarian customers easier: 

• Inflammation is a pathway, and several chemical compounds play a role along that pathway. 

• Prostaglandins, or a group of proteins, are chemical mediators, which send out a message throughout the body regarding what’s required to initiate the inflammation process. Prostaglandins don’t cause inflammation but control its severity and degree. 

• Prostaglandins are produced by enzymes, as they facilitate a change in compounds. In the case of inflammation, these enzymes are called cyclo-oxygenases (COX-1 or COX-2). 

Classes of analgesics include: 

• Opioids. A class of synthetic, narcotic drugs resembling naturally occurring opiates, which are used to manage acute pain.

• a2-adrenoreceptor agonists. A category of drugs used for producing analgesia and sedation. • Local anesthetics. A class of short-acting drugs that produce a loss of feeling or analgesia confined to one part of the body, without loss of consciousness. 

• Non-steroidal anti-inflammatory drugs (NSAIDs). A commonly prescribed class of medications with anti-inflammatory, analgesic and antifever properties used for managing acute, chronic and recurrent pain.

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