International Veterinary Academy
of Pain Management
"Just because our
pets will tolerate pain quietly,
doesn't mean they should have to"It seems strange
to think that even just a few years ago most practices did not
focus on managing pain in our
veterinary patients. We're not talking acute, intense pain that is
universally recognizable. Veterinarians have always tried
hard to help those pets. We're talking about the kind of
pain that the pet doesn't complain about like a person would.
This more subtle pain is what has escaped our treatments.
That may initially seem cruel but there were good reasons for
it. First, there were not very many pain medications to
choose from. Those that were available either didn't last
very long or if they did last a while, carried the potential for
some seriously unpleasant side effects. Second, it is
difficult to objectively assess pain in animals because they
often "suffer in silence". Consider post-operative
animals: Are they vocalizing (i.e. whining, barking, whimpering,
howling) because they are scared and confused, or are they painful?
What about those that don't vocalize? Are they painful
too? Keep in mind that this isn't a problem just in
veterinary hospitals; it is also a problem at home.
Owners are often unaware that their arthritic pet is painful
because pets rarely vocalize in pain. Another good
example is dental disease. Pets will continue to eat
despite what must often be constant discomfort. Third, if
we can't objectively know (in most circumstances) when a pet is
painful, how then can we measure a pet's response to pain
treatment to know if it even worked! Fourth, most
veterinarians received little training in pain management in
veterinary school and there were few controlled studies to learn
from on this topic.
The good news:
What a difference just a few years can make. There are now
books on pet pain management, numerous peer-reviewed studies,
lectures at every conference, articles in all the profession's
magazines, on-line discussions, and many safer drug options.
The veterinary community is undergoing an exciting renaissance
in our perception and understanding of animal pain. As
doctors and nurses we are learning to be even more empathetic
and more aware of the degree of pain that comes with diagnostic
and treatment procedures. We are learning to treat pain
aggressively and treat early. Importantly, we are passing this
knowledge onto pet owners. However, this isn't easy.
It takes considerable time to keep up with the flood of
published studies, learn when and how to use these medications
most effectively, and to train ourselves and support staff in
pain management techniques.
Recent work in
this field has taught us several broad concepts. The first
is the importance of "pre-emptive analgesia". This is when
we give the patient analgesic agents (i.e. pain
medications) PRIOR to the onset of pain
(i.e. prior to surgery). This serves to block stimulation
of pain receptors and the "wind-up phenomenon", both of which
can lead to more intense post-operative pain. The "wind-up
phenomenon" is when nerve fibers start to overreact to even mild
discomfort making the sensation of pain much worse. The
second is the importance of "multimodal analgesia". Here
we use multiple drugs that act to prevent/treat pain in
different ways to provide better, overall analgesia. The
third is probably the most important: if it would be painful
to a person, assume it is painful for the animal and act to
prevent/treat pain accordingly.
It is important
for you to know that Merrimack Veterinary Hospital strongly
believes in compassionate, quality medical care for our
patients. We take pain prevention/treatment very seriously
and will work hard to keep your pet as comfortable as possible.
Thus, all surgical and dental patients will receive pre-emptive
and multimodal pain management. Additionally, analgesics
may be prescribed for use at home post-operatively. We
also encourage owners to treat painful disease conditions such
as arthritis and dental disease early and aggressively.
While we are
working hard at this, remember that you know your pet best.
Communicate with us if you think your pet is uncomfortable so we
can work with you to make modifications to their treatment plan.
Our goal is to help you keep your pet as comfortable as possible
for as long as possible.
