Pain Management

43-pain-management-options2-300x229The best doctor in the world is a veterinarian. He can’t ask his patients what is the matter — he’s got to just know.

Will Rogers

It seems obvious to control pain after surgery, an injury, or during a painful illness like pancreatitis.  But in fact, the practice of pain management has not always been widespread in veterinary medicine.  The acknowledgement that our pets do indeed experience emotions like pain was not always a popular belief.  Even in human medicine, pain is often under-treated.  It is proven that untreated pain suppresses the immune system, delays healing, and prolongs recovery from surgery.  It is our greatest responsibility as the caretakers of our pets to alleviate suffering, and there are fortunately many options available to ensure that we are successful.

Pain can be articulated by people. However in pets, it must be observed and measured.  There are several pain scales that veterinarians can use to anticipate and measure pain.  Dogs and cats exhibit pain differently than people except in the case of acute, excruciating pain where vocalizing occurs.  Being pack animals, dogs tend to keep a low profile, staying away from others including human family members.  They may refuse food and be defensive, cowering and growling or snapping in anticipation of discomfort.  Cats will also hide and guard their wounds, and both dogs and cats may over-groom a tender area.  Pain is also measured by empirical methods, assuming that an animal would feel the equivalent of a human after experiencing surgery, trauma, or an illness.  Increased blood pressure, heart rate, and respiratory rate may also be used as indicators of pain.

Treatment for pain depends completely on the source and severity of discomfort.  Medications, physical therapy, alternative therapies such as acupuncture, and other palliative measures can all be used alone or in combination.  Multi-modal approaches to pain control tend to be the most effective.

For minor pain, heat and compression can give relief.  Cold increases the perception of pain.  Range of motion exercises can keep an arthritic animal limber and strong.  There are specialists in physical therapy that utilize tools like water treadmills to increase flexibility and avoid muscle wasting caused by chronic pain.

Medications that alleviate pain are called analgesics.  There are different categories of analgesics which have different mechanisms of action.  Drugs are used for moderate to severe forms of pain.  Non-steroidal anti-inflammatory drugs (NSAIDs) are useful for conditions like arthritis where pain relief is best achieved when inflammation in the joints is controlled.  Opiates are reserved for severe pain, like after major surgery.  They are usually not given long term because of the potential for side effects on the GI tract like constipation.  Opiate drugs come in oral, injectable, and transdermal forms.  Local anesthetics can be injected into the tissues around a surgical incision to completely numb the site.  Just as in humans, epidurals can be given by injecting an opiate directly into the spinal canal, completely blocking the nerve pathways for entire regions of the body.

Pain should be assumed, predicted, and preemptively controlled in our pets.  Because we can not tell an animal “this is going to hurt a bit”, even minor pain can affect their health and wellbeing significantly.