The first stage of treatment is to treat any underlying dental disease. Teeth suffering from Resorptive Lesions or fractures are carefully extracted with minimal trauma and periodontal disease is treated.
Standard pain relief medications are often not very effective against Neuropathic Pain. However, it is sometimes necessary to use opiates in the immediate face of an episode, partly for their sedative effect. Similarly, as part of the initial first-aid, bandaging the feet and using Elizabethan collars may be required in the short-term to prevent the devastating effects of self-trauma.
Non-Licensed medications may have to be employed. Some of the anti-epileptic drugs such as Phenobarbitone, Carbamazepine Gabapentin, Pregabalin and Levetiracetam are used in man for Neuropathic pain and can have benefits for our patients. We have also used Amitriptyline (an anti-depressant) to good effect in some cases. When medications are used longer term, regular blood tests are required. In many cases doses can be reduced, or drugs withdrawn after some weeks. However, remission or recurrences of the condition are common. It is probably best to think of the condition as one that might be controlled - rather than cured.
It is important to address the social situation to minimise stress. The help of a behaviour specialist can be invaluable. In general terms we have found the Feline Facial Pheromone products to be very helpful. Cats should also have as stress free an environment as possible. If they are in a multi cat household, each cat needs access to its own food, water and litter space. Cats should have their own "safe zone" that they can feel secure in and have free "escape routes". They should be able to hide from the other cats, and to use the other natural destressors of distancing and climbing to heights. It is important to remember that windows may physically separate cats - but visual intimidation can still occur.
Unfortunately, sometimes treatment is not successful and a proportion of cats require euthanasia.