Using Integrative Therapies to Treat Pain

Using Integrative Therapies to Treat Pain 

Pain has as many manifestations as there are injuries, conditions, and individuals. In recent years, veterinarians have made great progress in understanding how pets feel pain and the best ways to manage that pain. Many dogs instinctively hide their pain as a survival mechanism, which, in the past, led well-meaning experts to presume that dogs did not feel pain the same way humans do. Similarly, cats are much less likely to show outward signs of pain, especially when they are suffering from chronic (long-term) pain. We now know that both dogs and cats have a nervous system very similar to humans, and we know better how to recognize and manage their pain, using a combination of both integrative and traditional approaches.

Pain is generally defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” However, pain is very subjective and difficult to measure. Because dogs and cats instinctively hide their pain to prevent potential predators from targeting them when they are injured, pain assessment can be challenging. The outward demonstrations of pain vary widely from pet to pet. It is important to recognize that just because a pet does not cry, limp, or show other obvious signs of pain, that does not mean it is not in pain. A good general rule is that if it would hurt you, it would hurt a dog or cat.

Recognizing Symptoms

Although the signs may be subtle, most pets experiencing pain alter their behavior in some way. A dog may be reluctant to climb stairs, jump into the car, show decreased activity, or resist being handled or picked up. A cat may decline to jump, avoiding the windowsill or the back of the sofa. They may still be able to get to their favorite resting spots, but take several small jumps to get there, for example from a chair to a table to a windowsill.  Other signs of pain include (but are not limited to):

• whimpering or vocalizing
• becoming quiet, withdrawn, and anti-social
• showing uncharacteristic aggressiveness when approached, touched or handled (an attempt to protect themselves from further pain)
• holding the ears flat against the head
• increased licking of a painful/sensitive area
• decreased appetite
• reluctance to walk, run, climb stairs, jump, or play
• stiffness or limping
• lagging behind on walks or stopping altogether while on walks
• changes in personality
• increased panting and/or restlessness
• resisting handling or being picked up
• withdrawal from family activity/anti-social
• decreased grooming and unkempt haircoat (mats, dander, or greasy fur) OR increased grooming in specific areas

Treatment Options

If your cat or dog is undergoing a surgical or dental procedure, do not be afraid to ask what pain management will be provided. Most of these procedures require some postoperative pain management, though the duration of treatment will vary with the procedure. Generally, your pet will receive pain-relief medications before, during, and after the surgery or a dental procedure.

Common veterinary pain-relief medications include both Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), which interfere with the body’s production of inflammatory molecules that trigger pain and swelling, and opioids, a more severe class of pain-relief medications that includes includes morphine, codeine, fentanyl, buprenorphine, and hydromorphone. There are also new applications of existing medications, such as gabapentin, tramadol, maropitant citrate and other cortisone-like drugs that offer additional pain relief options for pets. 

Beyond medication, there are a number of integrative therapies that can work well either alone or in tandem with pharmaceuticals to help the body heal and decrease pain. They include:

• Nutraceuticals and supplements. This category includes supplements and other nutritional support products, many of which support a specific tissue type, like joint tissue, allowing it to function better and relieve pain. Glucosamine, chondroitin sulfate, MSM, green-lipped muscle, circumin, cetyl myristoleate, and countless others can be used to help mitigate joint damage and pain in arthritis patients.
• Herbs. Herbs are similar to supplements in that they are not regulated by the DEA, and just like supplements and nutraceuticals, there are as many claims out there as there are products, without testing or evidence to back them up. When considering herbs, it is important to ask the questions: is it safe, is it effective, and is it worth considering for my pet? There are many herbs, such as boswellia, feverfew, cordyceps, and others that have been shown to be effective for pain without a lot of side effects. It is important to note that while herbs are natural, that doesn’t always mean safe. Herbs can have their own side effects and can also interact with other herbs, supplements, or pharmaceuticals.
  
• Homeopathy/Homotoxicology. These therapies involve using very small amounts of certain plants, enzymes, and minerals to affect change in the body. While this field is as much an art as a science, new research shows the role it can play in pain management. One study compared the Homotoxicology remedy Zeel to the pharmaceutical Rimadyl in treating arthritis pain in dogs. The Zeel group showed as much improvement as the Rimadyl group (although the effects took a little bit longer). And the Zeel group had no side effects, while the Rimadyl group had a 27% rate of ill effects. Combining Zeel with a non-steroidal anti-inflammatory can allow immediate pain relief short term, with long term management using the Zeel alone.
• Acupuncture. While this technique may look a little odd to our western minds, there is actually a lot of science behind acupuncture. Inserting thin needles into certain locations in the body has been shown to cause endorphin release (the body’s natural morphine), cortisol release, other hormonal changes, changes in blood flow, and improved healing. This is a great technique to use for arthritis and other chronic pain.
• Therapeutic Laser. The therapeutic laser emits a low energy light wave that penetrates tissue and creates changes at the cellular level. These changes ultimately speed healing. This is a non-invasive tool to use in wound healing, arthritis and nerve pain. Because it is essentially hands off, it works especially well on cats.
• Massage Therapy. Often, the initial pain of an injury or disease is compounded by compensatory muscle spasm—the muscles around the injured area tighten and spasm in an attempt to protect the area. However, the muscle spasm also closes off blood flow to the area, shutting off the input of vital nutrients and ultimately delaying healing. This muscle spasm can outlast the original pain and can be more severe. Massage therapy is a great way to relieve this muscle spasm and return blood flow to injured areas, allowing them to heal. Patients frequently improve with just massage therapy, and most really enjoy it as well.
• Rehabilitation Therapy. Rehabilitation includes a variety of techniques, from stretching to swimming therapy, that allow return of movement to injured areas. This alone can help alleviate pain. Techniques such as ice and heat therapy can take away acute pain, while ultrasound can break up scar tissue and the underwater treadmill can strengthen weakened muscles.
• VOM/Chiropractic. VOM, or Veterinary Orthopedic Manipulation, is a variant of chiropractic where a tool called an activator is used to cause tiny micro-adjustments in muscle, bone, and nerves along the spine. This technique is designed to help with pain secondary to nerve issues, muscle spasm, and minor injuries. Chiropractic uses larger manipulations to actually adjust vertebrae that are out of alignment. As in people, the misaligned vertebrae can create muscle and postural problems that cause pain.
• Medical Qigong. Medical Qigong is an excellent adjunct to western medicine. Therapy consists of a series of energetic treatments by a trained practitioner to regulate the patient’s qi (vital energy). The aim of a qigong treatment is to correct the bio-energetic imbalances, or blockages, in the patient’s system so as to strengthen and regulate internal organs, the nervous and immune systems, ease emotions or anxiety, and relieve pain.

Untreated pain is something that no pet should experience. By closely observing your dog or cat for subtle signs of pain and working with your veterinarian, you can help your dog enjoy a pain-free life. In particular, please talk to one of our veterinarians prior to starting any herbal therapy for your pet.