Solving Pain Problems

Pain management products and services are essential to compassionate veterinary care.

This spring, a friend showed me a copy of the bill for neutering her dog. The overall cost made me look twice, but what really caught my eye was that nearly a third of the total was for pain management. It was proof of how important managing pain has become to the overall well-being of our pets.

It wasn’t long ago that animal health experts believed certain things about animal pain that we now know are completely false. The first research papers on canine pain were published in the 1950s, but until the early 1980s, it was considered “common knowledge” that animals didn’t feel pain like humans. Even into the 1990s, neonatal procedures were performed with no pain management, since neonates were “too young” to sense pain. Many veterinarians felt that some post-operative pain was beneficial in keeping an animal quiet following surgery. Treatment options were limited and since assessing pain in animals can be difficult, it was often overlooked because we didn’t know how to recognize it, or just attributed pain in senior pets to normal old age.

Thankfully, now we know better, and pain management is an essential component of compassionate veterinary care. The development of new products and nonpharmacologic treatments makes it an ever-evolving area of care and gives you plenty of opportunities to stay informed and discuss those expanding treatment options with your customers.

Flexibility in treatment plans

All pain is not created equal. The pain phenomenon is very complex, so the most effective treatment plan is often multi-modal pain management. With a wide assortment of supplements, pharmaceuticals, and nonpharmacologic treatments, veterinarians have great flexibility in developing patient-specific treatment plans. This can be particularly helpful to offset relying on a single drug that may have a risk of side effects.

When it comes to surgical procedures, the goals for pain management are always the same:  keeping the pet as comfortable as possible during surgery; minimizing tissue disruption to speed recovery, and creating a post-surgical plan that minimizes pain and is easy for pet owners to follow. This might include injectable pain medication pre- and post-surgery, using a CO2 laser when possible for soft tissue procedures, laser therapy after surgery to promote healing at the site, oral pain medications sent home with the pet, and clear instructions and follow-up with the pet owner.

Owners are often apprehensive about putting their animals through surgery, so a quick recovery is a benefit to both the patient and the practice. Purchase history can help you start a discussion of your clients’ surgical protocols. They may want to promote their pain management philosophy in client communications, on their website, and on social media with success stories and testimonials.

The diagnosis and treatment of acute pain often depend on whether the initial cause is known. A full physical exam, including heart and respiration rates and palpation, may not provide an accurate assessment of either very stressed or very stoic patients. Utilizing standardized pain scales and bloodwork to establish baseline data helps establish a treatment plan. Clinics with digital thermal imaging systems can identify areas eliciting pain with equipment that detects radiant energy emitted from the patient. The pattern of the emitted energy is converted to an infrared image showing areas of increased blood flow and inflammation.

Although many of the same products may be used to resolve short-term acute pain, chronic pain management should be proactive and include measures to slow the progression of persistent pain-related problems. Conditions like cancer, spinal problems, dental issues, or recurring skin or ear infections can all be a cause. Most common in pets is osteoarthritis (OA) which affects nearly 40% of dogs and at least 50% of cats. Early detection and intervention with effective multimodal therapies is the key to successful pain management over the long term. Completely eliminating chronic pain is usually impossible, but reducing it to a level where it is well-tolerated and doesn’t interfere with normal activities or reduce the pet’s quality of life is the goal.

The pet owner’s role

Pet owner involvement is critical in the proactive treatment of chronic pain. Veterinarians should inform customers about the high prevalence of OA and the signs and behaviors to watch for that indicate discomfort. Cats are experts at hiding pain which can make diagnoses difficult, especially if they’re stressed during clinic visits. My October 2021 column details the Feline Musculoskeletal Pain Screening Checklist, which is a simple survey for cat owners. Additionally, the Feline Grimace Scale scores facial actions of the ears, eyes, whiskers, muzzle, and head position to assess pain. Clients should be encouraged to take smartphone photos or videos of their pet at home to help their vet get a true picture of their normal behavior and movement.

A multi-modal strategy is often the most successful in managing chronic pain. This might involve much of the pain management toolbox, from pharmaceuticals to diet, supplements or nutraceuticals, and treatments like laser therapy, hydrotherapy, acupuncture, and massage.

Several nonsteroidal anti-inflammatory drugs (NSAIDS) are approved for long-term pain treatment in dogs by blocking prostaglandin receptors. These drugs have been associated with kidney, liver, and gastrointestinal toxicity, so regular bloodwork is recommended to check for adverse effects. Grapiprant is the first “piprant” NSAID that blocks the EP4 prostaglandin receptor without inhibiting the production of prostaglandins. Currently, no NSAID is approved for long-term use in cats in the U.S. Both meloxicam and robenacoxib are approved for long-term musculoskeletal pain in Europe, and recent studies have confirmed the efficacy of both for treating OA pain in cats.

Laser therapy is very effective for both acute and chronic pain conditions. In many cases, it can augment and sometimes even replace the use of NSAIDs or other drug therapy. It requires animals to come to the clinic for scheduled treatments, which allows owners to be a part of the process and allows the clinic staff to monitor the pet’s progress regularly.

Preventing or alleviating pain is a key component of successful treatment outcomes and client satisfaction. Helping your customers provide effective pain management for their patients enhances the veterinarian-client-pet relationship and strengthens their loyalty to you.

 

Photo credit: istockphoto.com/Photoboyko