Pain Management
Does your dog or cat feel pain? Most pet owners would agree that their pets do indeed feel pain. After all, they limp, cry out, whine, mope, or otherwise change their behavior in ways that tell us there’s something wrong. Yet, as recently as 25 years ago, human medicine didn’t acknowledge that babies felt pain, and veterinary medicine took even longer to recognize that animals feel pain. Thankfully, the tide has turned and now modern medicine accepts not only that animals feel pain, but also that persistent or severe pain can actually harm the body. There are now very real medical reasons to treat pain that go beyond the mental and emotional capabilities of the patient being treated. At Harmony Veterinary Center, we take pain seriously and believe all patients deserve to have their pain managed using the best techniques available.
How do I know my pet if my pet is in pain?
Because animals are more stoic than humans, it can sometimes be hard to recognize their pain. After all, showing pain in the wild could cause them to lose their place in a pack or become prey for other animals, so they have learned to hide pain well. However, there are several things to look for when considering if your dog or cat is experiencing pain.
- An obvious injury or wound. While strictly speaking this is not a definite sign of pain, injuries that would cause us pain generally lead to pain in our pets since the same physiologic mechanisms of damage and pain response are present in animals.
- Limping or favoring a certain body part. Why do we limp? Because something hurts.
Make no mistake, a limping animal is generally feeling pain. - Crying out or whining. This is the sign of pain people most expect to see from their pets. But often, pets in severe pain get quiet. This is especially true for cats, who seem to turn inward to “hide” from the pain.
- Hiding. As above, pets may try to escape their pain by seeking out hiding places. A normally social pet may ignore the entire family, choosing to stay in one place.
- Behavior changes. Aggression, clinginess, loss of housetraining, changes in appetite, changes in sleeping patterns or locations, pacing, reluctance to lie down, and other behavior changes can indicate a pet is in pain.
- Abnormal licking, chewing, or scratching. Self-mutilation in one area may indicate pain in that area or pain in a remote area.
- Abnormal body posture. Stiffness, hunching up, laying to one side, holding an extremity out, abnormal tail posture, or abnormal head posture are all indicators of dysfunction but these can also be signs of pain.
The above list is not exhaustive. It is important to realize that each pet is an individual and just like people will experience pain it a unique way. However, if you see any of the above signs or you are concerned about your pet in any way, please call to discuss it with one of our veterinarians.
Good Pain vs. Bad Pain
So why did pain evolve in the first place? Pain allows us to recognize and respond to things that are harming us, such as a hot stove causing a burn or a sharp object we’re about to step on. Pain is an early warning system that allows us to react and change our behavior before serious injury occurs. So in this sense, pain is a good thing. In fact, the acute pain of an injury, such as a sprained ankle, keeps us from moving too much, thus allowing the area to rest and heal. However, pain becomes “bad” when it is chronic, outlasting the original injury, or severe. In these cases, the pain can lead to changes in blood pressure, elevations in cortisol levels, delayed healing, suppression of the immune system, and other serious effects.
How do we treat pain?
Today’s pain management isn’t just about giving a single drug to help relieve pain. Instead, it involves multi-modal pain management—using multiple techniques in combination to better alleviate pain. And there are many more ways to treat pain today then there were even 10 years ago.
Pharmaceuticals
Of course, the mainstay of pain management, both in the past and present, includes the use of pharmaceuticals. These drugs, while often vilified, are an important cornerstone in keeping good pain from becoming bad pain.
Non-Steroidal anti-inflammatory drugs (NSAIDS), such as Previcox, Deramax, Metacam, Zubrin, Carprofen and others, decrease inflammation that accompanies acute injury, surgery, or other trauma. A little inflammation can promote healing, but too much inflammation actually delays healing and creates more damage. Anti-inflammatories can stop this process, allowing faster healing and return to function with less pain. As with all drugs, and many non-drugs, these can have side effects, especially when used long term.
Pain relievers, such as Tramadol, Fentanyl, and morphine work to minimize the perception of pain and are critical in cases of moderate to severe pain, such as fractures, orthopedic surgery, back pain, and others. Without these drugs, good pain quickly progresses to bad, chronic pain, which is much more difficult to treat. Often the more potent drugs are given in a constant rate infusion, meaning the patient is in the hospital receiving the drug intravenously, such as after knee surgery. Once the patient is more stable, he or she can be switched to oral medications or skin patches for home management.
Muscle relaxers can be important, particularly in the cases of back pain or muscle injury. In these cases, muscles around the injured site spasm to protect the area, causing more pain (often outliving the pain of the original injury). Relieving the spasm can be as important as eliminating the original pain.
Gabapentin, similar to the drug Lyrica (used for fibromyalgia pain in humans), works specifically on nerve pain. However, it is also used in cases of chronic pain where the nervous system experiences something called wind-up. In this phenomenon, so much chronic pain sensation in the nervous system leads to the nervous system becoming hypersensitive to things that aren’t usually very painful. This means an even greater perception of pain for the patient. Gabapentin, Amantadine, and other drugs can inhibit this mechanism in the nervous system, ultimately allowing the pain to “wind down”.
Lidocaine is a topical numbing agent that can help relieve surface pain related to wounds and other skin irritations. Sometimes just numbing a painful area for a few hours can allow other pain therapies to work. Lidocaine is also injected along surgical incisions to help minimize the post-operative pain a patient might feel. In orthopedic procedures, lidocaine and other local anesthetics can be injected epidurally (around the spinal cord) to completely numb the surgical area for 12 to 18 hours.
Nutraceuticals and supplements
This category includes supplements and other nutritional support products. Many of these are designed to 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. These products are not regulated by the FDA or DEA and thus, there are minimal standards for truth in labeling, purity, quality, and the like. It is important to choose these products carefully, as random testing has shown some of the products have as little as 5% of the label-claimed amount of the active ingredients. However, these products can be of tremendous value in managing chronic pain patients. At Harmony Veterinary Center, we carry only products from reputable companies that hold themselves to quality standards and testing by the National Animal Supplement Council (NASC).
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. Please talk to one of our veterinarians prior to starting any herbal therapy for your pet.
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 to 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.
Stem Cells
These are not the embryonic stem cells at the center of such debate. This process actually involves taking a strip of fat from the abdomen or shoulder blade, and overnighting it to a lab in San Diego where it is processed to recover the patient’s own stem calls. The stem cells are returned two days later and are injected directly into affected arthritic joints. The cells then change into cartilage cells to help support the joint and relieve arthritis pain. Studies are currently underway investigating the use of these cells in healing tendon injuries and bone fractures.
Joint modifying compounds for dogs and cats
Many joint modifying compounds are available to provide some cartilage building blocks to damaged joints. While these don’t allow the formation of new cartilage, they can help the cartilage remaining in the joint to function better and relieve arthritis pain. Depending on the product used, it can be injected directly into the joint or can be injected under the skin by the owner.
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.
