Document type: article published in Veterinary Practice News
Author: Kim Campbell Thornton
Preview: (...) For too long, the chronic pain of osteoarthritis or other diseases was simply accepted as a normal part of aging, especially for pets. Now, more is known about pain pathways and more options are available for managing pain multimodally, even over long periods. The one sticking point can be talking to clients about pet pain and demonstrating a pet's slowdown is pain-related, not simply an artifact of aging for which nothing can be done. Three veterinarians who target pain in their practices share tips on how to help clients recognize pain and get patients the help they need to improve their quality of life.
Make pain exams routine
Screening pets for pain should be part of every physical exam throughout the animal's life, says Robin Downing, hospital director of The Downing Center for Animal Pain Management in Windsor. The more you put your hands on normal pets, the more readily you will recognize abnormal responses to palpation. (...)
Ask what clients are seeing
(...) A diagnosis of chronic pain due to osteoarthritis-which is highly prevalent in dogs and cats-can come as a surprise to clients, says Tamara Grubb. Dr. Grubb uses the exam as an opportunity to show clients what pain looks like and evidence for the diagnosis of pain, including how behavior changes can be indicative of pain. A study published in February 2020 reviewed 100 dog cases and strongly suggested the potential role of pain in problem behavior. The veterinary behavior experts involved found, conservatively, around a third of referred cases involved some form of painful condition, and in some instances, the figure was nearly 80 percent. "Musculoskeletal but also painful gastrointestinal and dermatological conditions are commonly recognized as significant to the animal's problem behavior," they wrote. (...) Videos available online can help to demonstrate normal mobility versus that of an animal in pain. One for cats6 might show a normal cat jumping onto a table while a painful cat first jumps onto a chair and then onto the table. (...)
Ways to manage pain
Current pain management goes far beyond NSAIDs and includes anti-nerve growth factor (NGF) injections; grapiprant, which works at a different part of the pain pathway than other NSAIDs,7 potentially causing fewer adverse side effects; and new injectable compounds8,9 to treat the joint directly with long-lasting effects by targeting inflammation and pain or protecting and supporting the joint through biomaterials such as collagen and elastin. (...) A retrospective study10 of 240 dogs looked at using gabapentin for chronic pain. "It is the first peer-reviewed paper in the veterinary literature that articulates effective doses of gabapentin in dogs with chronic pain. The balance we need to achieve is the balance between comfort and sedation, and sedation is the only relevant side effect. If we get sedation, we've gone a little too far in the dose, so we back it off, Downing says." (...) Finally, pain management is always multimodal, Downing says. Do not just throw an NSAID at it and call it a day. Collaborate with the client to create a personalized pain plan appropriate for each patient, including follow-up visits and an ongoing dialog with the client. If particular patients exceed your ability to get them comfortable, do not hesitate to consult or refer to a pain specialist.
