The management of pain in veterinary medicine has advanced greatly in the past few years. Dogs and cats perceive pain in the same way that we do, and recent studies have shown that the physiologic effects of pain can be dramatic in our patients. As a client at Aztec Animal Clinic, you will be offered the use of medication to alleviate or prevent pain in your pet. Understanding the types of pain that we see in pets, the signs of pain to watch for and the medications that are available to you for your pet are the goals of this article.
Types of Pain
Pain in the veterinary patient can be divided into two general catagories — acute and chronic pain — with a third category that combines the two: acute on chronic.
Acute Pain. This is the pain generated by a traumatic or medical event that happens suddenly in an otherwise pain-free patient. Examples of events that can cause acute pain are surgical procedures, automobile accidents and other traumatic accidents, and medical conditions such as inflammation of the pancreas.
Chronic Pain. Chronic pain is often caused by conditions such as arthritis or chronic intervertebral disc disease. This is a very common category of pain in our patients.
Acute on Chronic. Occasionally we will see patients that have experienced chronic pain with a sudden increase in the intensity of their discomfort. A dog with bone cancer that develops a sudden fracture, or a patient with a chronic knee injury followed by a full tear of a ligament are examples of such pain.
Is Your Pet in Pain?
Regardless of the type of pain experienced by our patients, it is our responsibility as veterinarians and pet owners to recognize and address this pain. Below are some of the typical signs of pain.
Symptoms of Acute Pain. Restlessness, panting, whining or crying, shifting of position, elevated heart rate, dilated pupils, and the refusal to eat or drink.
Symptoms of Chronic Pain. Decreased activity or exercise tolerance, difficulty getting up or down, panting, increased crankiness, decreased interaction with the family, whining or crying. It is important to know that some of our patients will exhibit no clear signs of pain, in spite of experiencing significant discomfort.
A Wide Variety of Treatments
There are many ways that we can address pain in our patients. The following is a summary of the more common medications and techniques used at Aztec Animal Clinic.
Opiates and Opiodes.These medications act on the central nervous system to block the perception of pain, and are often used before and after surgical procedures to prevent pain. When combined with an nonsteriodal antiinflammatory (see below), these drugs can offer significant reduction in pain seen in our surgical and trauma patients.
Steroidal antiinflammatories. Medications such as prednisone and Vetalog primarily act by decreasing inflammation that can lead to pain. We often use this type of drug in dogs and cats with severe back pain or injury.
Non-steroidal antiinflammatories (NSAID’s). Rimadyl, Etogesic, Metacam and aspirin are in this group. Deramaxx, while slightly different in function, can be included here. These medications work by blocking or addressing inflammation at the site of the injury, and by decreasing the perception of pain by the central nervous system. These drugs are useful in both acute and chronic pain, and are used extensively for our patients with chronic arthritic conditions.
Ice pack application. The use of cold or ice packs after a traumatic injury or surgery can have a significant effect on the degree of inflammation that develops. This is why we apply packs to patients after surgical procedures and recommend the use of cold packs when patients go home.
Summary
In general, it is better to block pain than to treat it. The use of preemptive medication (medication given before pain is induced) is far more effective than to use the same medication after the traumatic event. This is primarily important in our surgical patients. The use of multiple medications is often needed for adequate pain control in patients undergoing surgery or after a traumatic event. In many patients, we recommend the use of both an opiate and an antiinflammatory medication.
Finally, as veterinary care providers and pet owners we need to recognize our role in providing medication to relieve or reduce pain in our pets. The cat undergoing routine ovariohysterectomy (spay) and the old dog with arthritis both deserve our advocacy. Our patients cannot ask for pain medication before their surgery, nor can they stop at Walgreens for some Motrin on the way home from work. They depend on us to understand and acknowledge their discomfort, and to provide relief of pain when possible or appropriate.