Pain definition, recognition and management!

What is Pain?

Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage" (Weiner's Pain Management, 7th edition).  It seems obvious what pain is for humans.  Pain in companion animals can be as obvious as in people, however it also can be very challenging to recognize in some individual pets.  We have found significant differences in the way pain or discomfort may be demonstrated comparing cats and dogs and between individuals within cat and dog breeds as well.  It would be wonderful and very helpful if we could communicate more clearly with pets.  It is tremendously important to look (observe your pets' behavior), listen, touch gently and be empathetic to better understand companion animals with regard to pain. The secret to better recognition of pain is better observation and improved understanding of species and individual differences.  The signs of pain may be very subtle and important.

This patient created this huge swelling from facial rubbing for two days.  He suffered from abscessed (infected) root tips.

Recognizing pain is not always as easy as photos displayed above! 

The recognition of pain can be simple or very difficult.  The effort is very worthwhile
regardless!

Research has demonstrated that chronic pain can be detrimental to the patient.  
Chronic pain can create a "stress response" associated with elevations of cortisol,
an internal chemical.  The stress response can reduce the patient's immune response,
contributing to infection, slower healing or the inability to heal.  Chronic pain
is unfortunate because the pain response can remain long after the injury has healed.
Excellent Observation of your pet is key to recognition of potential pain;

A multimodal approach (multiple methods) to treatment is best
Pain management is unquestionably a topic of great interest in veterinary medicine today. The concept of pain management encompasses pain prevention, minimization of nauseous stimulation and treatment. My veterinary team is responsible for the management of our patient's comfort and we find these efforts very rewarding.

Preemptive analgesia (preventing pain) is a function of balanced anesthesia. Pre-anesthesia medications and the route of administration are selected based on the patient's age, health status and temperament. These premedications provide sedation, analgesia (pain relief) and patient safety. The opiates drugs (hydromorphone and morphine) and low dosages of alpha 2 adrenergics (medetomidine or Domitor) are very useful premedications for preemptive analgesia (minimizing or avoiding pain).

Maintenance analgesia can be part of balanced anesthesia or independent of anesthesia. Continuous infusions of analgesics (pain medications), also called chronic rate infusions (CRI's), are extremely effective tools of pain management. Opiate drugs are the primary CRI's employed, however ketamine and lidocaine have also been very effective. Combination CRI's have shown to be optimally effective. Morphine, lidocaine with ketamine (MLK) and fentanyl, lidocaine with ketamine (FLK) are extremely effective and versatile in pain management. The medications are carefully dosed for each patient and infused precisely using intravenous pumps and infusion syringes. With appropriate training and experience, these techniques have become fundamental procedures for pain management.

The uses of local or regional "nerve blocks" have proven to be excellent adjunct procedures for analgesia as well as balanced anesthesia.  Again training and experience are required to ensure that these procedures are performed safely. Knowledge of appropriate dose calculations and technique are imperative.

Nonsteroidal anti-inflammatory medications {NSAID's (Deramax, Metacam, Rimadyl and others)} have additionally been useful for mild pain management. Their uses in combination with opiate drugs have been particularly effective in pain management protocols. It is always very important to address the patient's hydration status as well as kidney and liver function prior to using NSAID's.

I have found transdermal fentanyl (casts or dogs) and transmucosal buprenorphine (cats) particularly useful for pain management.

Hydrotherapy, massage therapy, spinal manipulation and veterinary acupuncture are all modalities to help manage pain.Where does the veterinary team start?

Continuing education is the essential first step in understanding the pathways of pain recognition and management. I joined the International Academy of Veterinary Pain Management (IVPAM) near the organization's inception and have enrolled my technicians as members annually. This organization has an active meeting schedule and courses for continuing education.

Pain management has become very rewarding professionally for me. The benefits in patient safety and comfort as well as client satisfaction are clear.

Pain Management is important!

Pain is a useful warning signal in the early period (acute) following injury or surgery. Longer periods (chronic) of pain can be very harmful. Recent research has shown that balanced anesthesia with appropriate analgesia can minimize and even prevent pain. This minimization and prevention of acute pain can eliminate chronic pain all together. Chronic pain is un-necessary, harmful and at times avoidable. I believe that chronic pain is a shame, and and I never want to be to blame for it. I promise to take a proactive approach to pain management with your pets!

Dr. Kressin continues his education.

As a veterinary dental specialist, Dr. Kressin has had training beyond veterinary school training in anesthesia and pain management.  Advances in veterinary anesthesiology and analgesia are continually improving.

Dr. Kressin uses the Veterinary Anaesthesia and Analgesia journal as a resource in his practice.  The pain management position of the American College of Veterinary Anesthesiologists are also a source of guidance.

Hannah caring for "Buster"

Dog Dental Care

Cat Dental Care

Home