WHAT IS PET PAIN MANAGEMENT?
Before we can talk about pet pain management, we have to discuss what pain is. Pain is a neurological component of injury or disease to any part of the mammalian body. Pain lets us and our pets know that something is wrong. If there were no pain, it would be very difficult to diagnose fractures or other illnesses that cause disease in dogs and cats. Pain is a clinical sign but pain is something no animal should have to bear; particularly with the advancements in veterinary medicine. To tolerate pain and do nothing about it in a dog or cat is blatantly inhumane.
Pain can be acute or chronic. The pain associated with a broken bone is acute or just happened quickly. An abscessed tooth or other dental issue left untreated can lead to chronic or long bouts of pain. Pain can also be referred. A classic example of this is a dog with a slipped L4-5 lumbar disk. The actual pain is at the level of the spinal roots and column yet that pain radiates or is referred to other parts of the body. Just touching a dogs underside can make it cry out in pain. This is referred pain. Pain has a threshold. Simply put, if a dog or cat is suffering from bone fracture pain, pinching them with a forceps is not going to phase them because of the high threshold of pain reached in the bone fracture. In other words, pain is relative and is exhibited differently in all individuals.
Pet pain management is the control of any type of pain produced by any medical, surgical or trauma related incident. To do this right, as a veterinarian, requires not only the technical chops needed to understand and treat pain but feeling EMPATHY for the patient. It is this latter trait that shows a veterinarian’s humanity and compassion time after time after time.
THE EFFECTS OF PAIN ON AN INDIVIDUAL
To be in constant pain is like having the life sucked out of you. It wears you down. It is a component of inflammation and long term inflammation is known to be bad for a dog or cats body. Prolonged pain decreases survival chances and also retards surgical and medical healing times. Pain will decrease an animal’s appetite and desire for fluids. Many surgical and medical diseases need a strong appetite to help with any recovery effort. Without pain relief and or control, this is excessively prolonged. There is a mental manifestation to pain, even in dogs and cats. Pets are depressed and do not feel like doing the things in the past that gave them pleasure; like taking a long walk with a family member.
Pet pain management involves treating an animal for pain that is appropriate for the level of pain felt by the patient. Treating the pain of a torn dewclaw in a dog or cat would be different from treating pain associated with a bone fracture. The latter, the feelings of pain are much more intense. Different types of diseases or trauma issues get treated differently plus each individual feels pain differently. Effective pet pain management must be tailored to the individual; not the size of the individual or medical problem faced.
TREATMENT OF PAIN
Pain management can be accomplished in a myriad of ways. After a fracture is reduced, the patient receives a hard or soft cast. This cast prevents movement of the bone fragments which decreases the chance of intense pain caused by the motion of broken bones. Much pain indirectly can be controlled by not touching a body part or allowing it to move. A dog may cry out in pain from an ear infection after the owner strokes its ears but once the person realizes something is wrong, they stop the activity and the pain ceases in intensity. Another twist on this thinking is cage rest. It prevents an animal from hurting itself worse and facilitates healing by keeping it confined.
Pain can also be alleviated by the use of heat during surgery. Heating pads keep the patient warm but also the warmth acts to relax the dogs musculature hence decreasing pain. Veterinary acupuncture is another method of pain control prescribed by veterinarians educated in the field. Properly done, this can help alleviate much pain seen in dogs and cats.
PHARMACEUTICAL MANAGEMENT OF PAIN
This is perhaps the most common type of pet pain management in dogs and cats. Analgesics are pain killers that alleviate different types of pain. Understanding the species you are dealing with is crucial. Cats can not take: aspirin, Tylenol® or Rimadyl® for management of pain. These drugs can be lethal to cats. The big problem today is that there are very few safe pain killers for cats. In large part this is due to the absence of a liver enzyme known as gluconyl transferase. It is present in humans and dogs and facilitates the breakdown of drugs into harmless breakdown products. Not so in the cat! Cats can be given butorphanol by injection; even though it has to be given frequently. It can be sent home with the patient in a liquid base for pain management.
Anti-inflammatory drugs play a big part in pet pain management usually seen on a day to day basis in most practices. In dogs, Rimadyl® is commonly given to an animal by injection prior to a surgical procedure and the same thing sent home in an oral form. Reducing inflammation, reduces pain. It was mentioned earlier in this article that pain is a manifestation of inflammation. Rimadyl® is a non-steroidal anti-inflammatory but corticosteroids are used frequently in veterinary medicine to indirectly alleviate pain via decreasing inflammation. To those wondering why I have not brought up Valium® here’s why. Valium® is not an analgesic but a muscle relaxant. It does not control pain effectively but it very effective at slowing down seizure activity.
In the presence of uncontrollable pain, nothing beats the opiates. Opiates are those drugs that fall under the following names: Morphine, Demerol® plus Hydrocodone and its Tylenol® derivatives such as Vicodin® and Percoset®. Opiates are considered controlled substances by the FDA and their use is highly regulated in domestic pets and humans in the United States. They should only be used when other forms of pain control are inadequate. The use of any opiate in cats is risky business! Lacking that liver enzyme mentioned above can produce an excitability factor in cats given any opiate. I have never prescribed them in cats as I did not want to take a chance.