Multimodal Pain Control
Medicine sees two types of pain: adaptive and non-adaptive. Short term pain (like stubbing your toe or breaking your arm) are considered adaptive. The pain was caused by an action taken by you (smashing your toe into the coffee table) and the pain tells us that for the safety of our toes we should take a greater effort to not slam them into furniture going forward. This type of pain is generally short-lived and can usually be addressed with NSAIDs (Non Steroidal Anti Inflammatories – almost all over the counter medications fall into this category) and mild opioids (think Tylenol 3).
Most of the pain that we feel when we are young and healthy falls under this category. However, as we grow older we can encounter a different type of pain.
As we grow older (and our pets too) we are more likely to begin facing long-term chronic pain. This pain is usually the result of wear and tear on joints which causes osteoarthritis. This type of pain is non-adaptive. It serves no purpose. It also tends to grow worse out of proportion with the actual injury. This is because for unknown reasons, chronic pain triggers the body to create more pain receptors to the area(s) involved. Chronic pain becomes a never ending downward, mal-adaptive cycle that spirals out of control.
The only way to combat this type of pain is to ‘get in front of it’. Remember, chronic pain creates more pain pathways, so the only way to combat this action is to stop the pain in the first place and keep it stopped. This is hard enough in people who tend to wait for pain to return to take pain medications. It is far harder in dogs and cats.
First we often miss a lot of the first signs of pain in our pets. Pets grow older, maybe fatter, and probably lazier. How do we parse out getting slower due to natural changes and those associated with pain? The easiest way to tell if your pet hurts is to look at their normal behaviors, an older dog may not run as far or fast, but she’ll still run, your frisbee dog will still want to play, but if he stops jumping, if he can’t ‘mark his territory’ any longer, if he’ slow to sit, or she can no longer get on the couch, these are all changes caused by pain, not age.
But even after we discover pain in our pets the battle has only started. There are several factors that play into an owner’s unwillingness to give medications when a pet is merely ‘stiff’ or before they seem to be actively painful. The most obvious is safety – no medication comes without risks, and those risks are not small. Second is cost, canine and feline NSAIDs are almost all still under patent, and they can be prohibitively expensive, especially in larger dogs. Third, is a very legitimate reticence to giving medications too often or when not needed.
But, we know from research into neural pathways that we must address chronic pain before it returns. This is the only key to breaking or hindering the downward pain cycle.
So, we have followed the lead of human pain specialists in advocating for a multimodal pain control regimen. What this provides for our patients is:
Less reliance on NSAIDs
Slowing or stopping the pain cycle
Prolonging patient comfort and life
Saving clients money on medications
So, what does a multimodal pain control regimen look like? What does it use and how does it work?
Multimodal pain control usually starts with a thorough assessment of your pet’s pain and a full geriatric work up.
The most common form of multimodal pain control is a mixture of NSAIDs and opioid-like medications. These two medications work in conjunction against different pain receptors in the body.
Opiods control pain by blocking the opiod receptors in the brain. Opiods are metabolized differently in pets, and many of the traditional human opiods are not effective in pets. Tramadol is an opoid-like medication that works well with pets, and in conjunction with NSAIDs, is very effective at pain management.
NSAIDs are almost always going to be the cornerstone to a multimodal approach to pain control because of their high effectiveness against pain and their anti-inflammatory properties. Most chronic pain arises from inflammation (often caused by osteoarthritis). Combatting this inflammation has to be a part of a good pain control plan. When NSAIDs are used, we employ specific protocols to ensure safety with chronic use. When monitored closely, NSAIDs are very safe.
In addition to opioids and NSAIDs we can discuss diet (fewer pounds to carry means an easier work load on the joints), acupuncture, body work (a mixture of chiropractic and massage), class IV laser (which helps combat inflammation), essential fatty acids (combats inflammation), glucosamine (may help with cartilage repair and conservation), Adequan injections (helps with joint function for joint- related pain), Gabapentin ( eases neuropathic pain), and Amantadine ( very effective when combined with other pain relievers).
Lastly, we offer stem-cell therapy which has proven highly effective in combating pain and inflammation. The stem cells are harvested directly from your own pet and pose no risk of rejection. Click here for an in-depth discussion of stem-cell therapy.
Using a multimodal pain control regimen takes time and a concerted team effort with your veterinarian. We will have to constantly assess the efficacy of the various methods and make changes where necessary. What works for one pet will not necessarily work for another, and what works for your pet now may not work as well in a year. Combating chronic pain is a challenge, but we have had great successes through the years using multimodal pain control..
Treating chronic pain is one of the great challenges faced by both human and animal medicine. Both humans and animals are living longer, which means that they are spending greater fractions of their lives with chronic pain caused by wear and tear to joints and old injuries. We are always searching for better avenues to help our senior pets live longer, healthier lives, and we feel that being pain free is a huge component of this effort.
Utilizing multimodal pain control allows for specifically tailored treatments that fit the individual patient, as well as the owners comfort level and budget. It allows us to help young dogs with poor joints live normal lives for an extended period of time, and allows old pets to resume many of their normal activities and have an extended quality of life.
