Veterinary Talk by Dr. Jim Humphries

Pain management in both dogs and cats

Ever since I was in veterinary medical school, I have wondered about how animals perceive pain, how we know the signs of their pain, and what we can do about it. That was more than 45 years ago, and while we are better at identifying pain, we are not as good at the application of the tools we have to combat pain.While progress has been made, mostly in post-operative pain, we still need to focus on those pets who have moderate to severe chronic pain, and therapies and medications that can reduce that pain to tolerable levels.It is true that many dogs and cats will hide their pain as a survival mechanism. Think of birds as an example. If they show signs of disease, they will be eaten by predators! So, there is a deep need for animals to pretend it doesnít hurt when it does. Because animals canít tell us the details of their pain, as veterinarians, we must be extraordinarily sensitive and perceptive when we see the signs of acute and then long-term pain.Because acute pain is common, we typically use first line treatments; the animal will recover, and we move on. However, it is with chronic pain where we see an almost different disease. The brain chemistries begin to change, and the nervous system becomes more protective; it can even trigger a pain response, when none exists. These wider changes begin to impact every aspect of life, like physical activity, interactions, even appetite. This is the same ìCycle of Painî seen in people with chronic pain conditions.Eventually, your pet friend begins to lose the desire to walk, play and even eat normally. The next step in this downward spiral is debilitation, fear and faster loss of function.What must happen at this point is proper intervention, and that often involves physical therapies, and medical therapies. Knowing this, here are the steps you must take when your dog or cat begins to show pain:Identifying pain: (there are many symptoms, but here are some to watch for)

  • Whining, whimpering, groaning
  • Licking or biting at the area that hurts
  • Withdrawal from normal activities
  • Decreased appetite
  • Lagging on walks or stopping altogether while on walks
  • More time sleeping
  • Reluctance to move and restlessness, not wanting to be held
  • Tough time getting up or laying down
  • Change in facial expressions, flattened ears, vacant stare
  • Panting (often a consistent sign)
  • Limping, not wanting to be picked up, hiding
  • Growls, hisses, bites, yelping
  • Sudden change in personality
  • Acts out of character
  • Pins ears back
  • Hunched stance, may lay on their side
The best example of chronic pain and the most common cause of pain in dogs and cats, is arthritis. Acute pain comes from an injury or after a surgery. No matter what the cause, we must treat it using drugs from several categories, and therapies that help the pet move better.Arthritic pain is common in older dogs. Anyone who has witnessed an older dog struggle to rise or be unable to stand after lying down can imagine the discomfort these dogs must endure.Treating the pain:Your veterinarian should make you a custom treatment plan that we refer to as ìMulti-Modalî pain control. This simply means we use drugs that are anti-inflammatory and perhaps some that directly block pain signals and pathways, and then weíll use various modalities of physical therapy, like cold, or heat, or ìmovementorî restricted movement. It all depends on the cause and stage of the pain.One of our best tools is the nonsteroidal anti-inflammatory drugs (NSAIDs). Just as in human medicine, there are many of these drugs and they must be used properly. Similar tools are the cortisone steroids such as prednisone and dexamethasone. They are potent anti-inflammatory medications and can have a profound impact on treating pain. You may also be prescribed gabapentin that works differently than either of these two but can be remarkably effective.Finally, there are the opioids. Because of over prescription and misuse, everyone in medicine is especially sensitive about prescribing these. However, if your pet needs them, we have formulas specifically for dogs and cats that will help tremendously.Considering all these types of medications, you can see why a ìMulti-Modalî approach is best. This allows all the types or modes of effectiveness to work without relying on one drug to carry the full treatment burden. This approach is now the most common way pain is treated.Untreated pain is something no person or pet should endure. Watch for the signs that mean your pet is hurting, then collaborate with your veterinarian to get the right combination of modern medications to help relieve the awful effects of pain.
Dr. Jim Humphries is a veterinarian and the medical director for a national hospice and end-of-life practice. He also serves as an adjunct professor at the College of Veterinary Medicine at Texas A&M University. He lives in Falcon with his wife, horses, and Great Danes. https://www.HomeWithDignity.com

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