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Feline orofacial pain syndrome
PAG E 6
A D VA N C E S
in 12% of cases that they were euthanized for humane reasons. Sensitization of trigeminal nerve endings as a consequence of oral disease or tooth eruption appeared to be an important factor in the etiology, based on finding 63% of cases with a history of oral lesions and at least 16% experiencing their first sign of discomfort during eruption of permanent teeth. FOPS signs could also be directly linked to a situation causing anxiety in 20% of cats. FOPS was resistant to traditional analgesics, but in some cases, successful management was achieved by use of anticonvulsants with an analgesic effect.
Author Conclusion
FELINE OROFACIAL PAIN SYNDROME Background Feline orofacial pain syndrome (FOPS) is a condition first recognized in the early 1990s and characterized by signs of acute oral discomfort and mutilation. Most reports have been in Burmese cats. Signs at presentation are usually exaggerated licking and chewing movements and pawing at the mouth. Advanced cases may have mutilation of tongue, lips, and buccal mucosa. No neurological abnormalities are evident in affected cats, including no apparent motor or sensory trigeminal deficits. Discomfort is episodic and confined to 1 side of the oral cavity and lips. The discomfort is triggered, in many cases, by mouth movements. The cat remains alert and can be distracted from licking, chewing, and pawing at the mouth, although with considerable difficulty in some cases. Some cats have anorexia. Diagnosis is by elimination of other causes of oral pain or trigeminal nerve dysfunction. Earlier studies have suggested oral lesions and environmental stress may initiate the condition. The disease could then become a neuropathic pain disorder, analogous to trigeminal neuralgia or glossodynia in humans. Anti-epileptic drugs appear to alleviate the discomfort from their allodynic rather than anti-convulsant effect.
Objectives To better describe FOPS and to determine what management regimes were more likely to be effective.
Case Reports Among 113 cats with FOPS, 100 were Burmese. The disease was severe enough
Phenobarbital (dose rate 2 to 3 mg/kg, twice daily) is a reasonable first choice for treatment of FOPS and can be given by the oral or intramuscular route. Periodic monitoring of liver function and drug serum concentrations is recommended.
Inclusions Four figures, 2 tables, 60 references.
Editor Annotation Feline orofacial pain syndrome is rarely reported but, when present, is potentially incapacitating. A predisposition to Burmese cats is reported; however, it is not breed specific. Although there are flaws in this study, it does present very important information. When faced with a patient with oral pain without an obvious cause, the first consideration should be a full oral examination, including dental radiographs followed by treatment of any found pathology. If the pain does not subside, opioids may be the next step in treatment. If pain still continues, anticonvulsants, such as phenobarbital, may be considered. (ML) Rusbridge C, Heath S, Gunn-Moore DA, et al. Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases. J Feline Med Surg 2010;12:498-508.
A D VA N C E S
in 12% of cases that they were euthanized for humane reasons. Sensitization of trigeminal nerve endings as a consequence of oral disease or tooth eruption appeared to be an important factor in the etiology, based on finding 63% of cases with a history of oral lesions and at least 16% experiencing their first sign of discomfort during eruption of permanent teeth. FOPS signs could also be directly linked to a situation causing anxiety in 20% of cats. FOPS was resistant to traditional analgesics, but in some cases, successful management was achieved by use of anticonvulsants with an analgesic effect.
Author Conclusion
FELINE OROFACIAL PAIN SYNDROME Background Feline orofacial pain syndrome (FOPS) is a condition first recognized in the early 1990s and characterized by signs of acute oral discomfort and mutilation. Most reports have been in Burmese cats. Signs at presentation are usually exaggerated licking and chewing movements and pawing at the mouth. Advanced cases may have mutilation of tongue, lips, and buccal mucosa. No neurological abnormalities are evident in affected cats, including no apparent motor or sensory trigeminal deficits. Discomfort is episodic and confined to 1 side of the oral cavity and lips. The discomfort is triggered, in many cases, by mouth movements. The cat remains alert and can be distracted from licking, chewing, and pawing at the mouth, although with considerable difficulty in some cases. Some cats have anorexia. Diagnosis is by elimination of other causes of oral pain or trigeminal nerve dysfunction. Earlier studies have suggested oral lesions and environmental stress may initiate the condition. The disease could then become a neuropathic pain disorder, analogous to trigeminal neuralgia or glossodynia in humans. Anti-epileptic drugs appear to alleviate the discomfort from their allodynic rather than anti-convulsant effect.
Objectives To better describe FOPS and to determine what management regimes were more likely to be effective.
Case Reports Among 113 cats with FOPS, 100 were Burmese. The disease was severe enough
Phenobarbital (dose rate 2 to 3 mg/kg, twice daily) is a reasonable first choice for treatment of FOPS and can be given by the oral or intramuscular route. Periodic monitoring of liver function and drug serum concentrations is recommended.
Inclusions Four figures, 2 tables, 60 references.
Editor Annotation Feline orofacial pain syndrome is rarely reported but, when present, is potentially incapacitating. A predisposition to Burmese cats is reported; however, it is not breed specific. Although there are flaws in this study, it does present very important information. When faced with a patient with oral pain without an obvious cause, the first consideration should be a full oral examination, including dental radiographs followed by treatment of any found pathology. If the pain does not subside, opioids may be the next step in treatment. If pain still continues, anticonvulsants, such as phenobarbital, may be considered. (ML) Rusbridge C, Heath S, Gunn-Moore DA, et al. Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases. J Feline Med Surg 2010;12:498-508.