Pain Management

Our goal with pain management has been to recognize, prevent, minimize and improve provision of treatment or pain in our patients. A pain-management evaluation is made with each pet whenever warranted.

We use the following methods to prevent and, therefore, control pain in our patients:

• Oral analgesics such as Butorphanol and NSAID’s
• Injectable analgesics before, during, or after surgery
  • e.g. Rimadyl, Metacam, Robaxin, Ketamine, narcotics/opiates
• Transdermal analgesics
  • e.g. Fentanyl patches)
• Local and regional analgesics
  • e.g. Bupivacaine, Cetacaine, Lidocaine
• Adjunct agents
  • e.g. Valium, Acepromazine, Dexmedetomidine
• Environmental support: We provide warmth and comfort in a stress-free environment

 EVENTS/CIRCUMSTANCES ASSOCIATED WITH PAIN

• Any procedure that manipulates painful muscles or joints (e.g. radiographs);
• Any surgical procedure with incisions into muscles, skin/other tissues, or joints;
• Orthopedic surgery
• Dental procedures (even routine cleanings)
• Spaying and neutering

PAIN RANKING SCALE: 

• Severe/excruciating:
  • Neuropathic pain: Nerves/nerve roots, intervertebral disc disease;
  • Extensive/severe inflammatory processes: Encephalitis, meningitis, peritonitis, necrotizing pancreatitis or fasciitis, bone cancer.
• Moderate/severe:
  • Fractures
  • Neoplasia
  • Cornel ulceration/enucleation
  • Total ear canal ablation
  • Castration
  • Mechanical trauma (vehicular trauma)
  • Advanced osteoarthritis
  • Torsion of lung lobes or GI tract
• Moderate:
  • Umbilical/inguinal herniorrhaphy
  • Exploratory laparotomy
  • Urethral surgery
  • Digital amputation
  • Ovariohysterectomy (Spay)
  • Cruciate repair
  • MPL correction surgery
• Mild/moderate:
  • Cystitis
  • Cutaneous inflammation/hypersensitivity
  • Otitis externa/media
  • Conjunctivitis
  • Periodontitis
  • Superficial lacerations

RECOGNIZING (DEGREE OF) PAIN IN PETS

• Posture: Tail between legs, arched/hunched back, twisted body to protect pain site, dropped head, prolonged sitting position, tucked-up abdomen, lying flat/extended.
• Temperament: Aggressive, clawing, attacking/biting, escaping, uncooperative.
• Vocalization: Barking, howling, moaning, growling, whimpering.
• Locomotion: Reluctance to move, carrying one leg, lameness, non-ambulatory.
• Other: Panting, anorexia, lethargy, tachycardia, staring/chewing at site of pain.

PAIN MANAGEMENT

Medication dispensed, prescribed, or administered for pain management:

• NSAID’s: Block inflammatory cascade and pain firing for orthopedic problems.
  • Ketofen, Rimadyl, Deramaxx, Metacam, Previcox
• Narcotics: Act to provide analgesia.
  • Fentanyl, Hydromorphone, Butorphanol, Buprenorphine
• Muscle relaxers: Centrally acting muscle relaxant that, through muscle relaxation, decreases nociceptor firing.
  • Methocarbamol
• Centrally acting analgesics: uses Gaba pathway in central nervous system to prevent chronic, neurological pain.
  • Gabapentin

Ancillary methods for treating pain include massage, exercise, hydrotherapy, cold/warm compress application, bandaging, splinting/casting, padding cages, quiet environment.

SIDE EFFECTS

It is important to note that any pain relief might have side effects, especially the use of narcotics. At times narcotics can slow down the intestinal tract which may keep from going to the bathroom for a few days. Sometimes pets will act lethargic until the narcotics wear off which could be several days. Temporary loss of appetite is another side effect that is not uncommon.

STAFF TRAINING

In order to train our staff to identify causes of pain, pain levels, medications, and methods to control pain, we use an extensive in-hospital library regarding anesthesia and pain management, and doctor’s and pharmaceutical representatives’ presentations. This training is repeated as a time-sensitive review of all procedures performed and anticipated associated pain. Furthermore, oral instructions regarding triggers demonstrating the need to seek veterinary care.