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Pain Management / Palliative Care
Pain management in animals is now recognized as an integral aspect of veterinary practice that offers many advantages to patients. Anyone who has experienced a painful episode is well aware of the discomfort involved. If not addressed appropriately, pain is not only similarly uncomfortable in our animal patients, but may also lead to delayed healing and exaggerated stress in already sick or injured patients. Untreated pain potentially results in further injury, illness, and severe behavioral changes typical of human depression and dysfunction. Major advancements within our profession over the last decade have enabled us to respect pain not only as a serious side effect of many medical and surgical procedures, but also as a significant disease in and of itself! With pain relief or analgesia, significantly fewer adversities such as inflammation, sepsis, cardiac dysrhythmias, pulmonary disease, clotting dysfunctions, and gastrointestinal issues arise from both acute and chronic illness. Pain relief is therefore a prudent means of healing all of our animal patients, comparable to antibiotics which treat bacterial infections and surgical techniques which correct developmental or traumatic problems!
Palliative and supportive care, also known as symptomatic treatment are important aspects of providing pain relief and part of the global welfare of your pet, our patient. We utilize a spectrum of different tools and techniques, both complementary and mainstream, and many medications/administration options to treat common daily gastrointestinal, urinary, dermatologic, mucosal, mobility issues such that quality of life is maintained for both recovering and terminal patients. Patients with multiple medical issues, cancer, degenerative disease, neurologic and orthopedic debilitation and even post surgical recovery will often require care/support which routine medicine and surgery cannot offer. When care matters just as much as "cure", our palliative care service can assist both owner and pet. Hospice care is also provided by our staff for those patients who cannot leave home or who need benefit of end of life support and palliation.
The veterinary pain specialist often holds advanced training in medicine, surgery, neurology, pain diagnosis and treatment, physical therapy and rehabilitation, and possibly a complementary therapy such as acupuncture or chiropractic. This clinician will conduct an in-depth history, thorough physical examination, and a complete review of medical records and your description of the animal's problem. For this reason, it is very helpful to collect your pet's blood work (both recent and past), vaccination status, radiographs or other imaging data and have this available for your visit. Often, supplemental diagnostic studies, such as detailed questionnaires concerning your pet's daily schedule, function, and surroundings, imaging (ultrasound, CT, MRI, radiographs, fluoroscopy), function testing (force plate or lameness scoring), and local anesthetic tests help to pinpoint sources of pain and underlying problems.
What types of problems are seen on the pain management service:
. Degenerative or immune mediated (joint or neuro) diseases (e.g., osteoarthritis)
. Post surgical orthopedic problems (Post cruciate lameness or dysfunction)
. Neurologic impairments (disc protrusion or extrusion, nerve entrapments, embolic events)
. Chronic musculoskeletal laxity secondary to medical disease (Cushings tendon or ligamentous strains)
. Oncologic gastrointestinal, radiation, surgical side effects
. Traumatic recovery illness (post HBC orthopedic and soft tissue dysfunction or impairment)
. Dermatologic diseases (hotspot, ulcerative, diffuse dermatolgic, otic, mucosal or burn pain)
. Intensive care cardiac and pulmonary disease patients (post pneumonia recovery patients)
. Postoperative or postchemotherapy gastrointestinal disease (nausea, vomiting, constipation)
. End stage or hospice therapy
What are the diagnostic tests which might be useful in determining why my animal is painful?:
CBC/Chemistry/serology
. Joint and mass cytology/histopathology
. Ultrasound
. Radiology
. Magnetic Resonance Imaging
. Computed Tomography
. Flouroscopy
. Scintigraphy
. Thermography
. Force Plate Analysis
. Videography
. Local and regional blockade
. Vital parameter and behavioral pain assessment or scoring
What can be done? What are some of the treatments that might be suggested to help my pet?:
Palliative medications: Antinausea and anti-diarrheal drugs, medications for bowel and bladder control, antibiotics and anti-inflammatories, as well as dermatologic topical and systemic therapies are amongst the many medications used to symptomatically treat patients. Pain relievers are often used side by side with these medications in an effort to improve quality of life and the focus on primary disease or surgery.
Pain relievers: Prescription of pain relieving medications including narcotics, anti-anxiety drugs, anti-inflammatories, certain anti-depressants and nerve modulating drugs. Careful titration of dose and form are required to balance these medications with medications your pet may currently be receiving. Many of these medications can be formulated into unique means of administration including topical agents, lotions, sprays, liquids and patches.
Injection treatments: local anesthetics with or without anti-inflammatories, chondroprotectants, and nerve modulating agents, can be injected around nerves, into muscles, or into joints with the use of aided imaging like fluoroscopy and CT. These may act to reduce swelling, irritation, spasms or abnormal nerve transmissions that cause or amplify the pain. Local and regional blockades similar to those utilized perisurgically can be performed in an effort to provide longer lasting pain relief.
Radiofrequency or neuroablative treatments: obliteration of nerves which create or add to terminal pain can be performed with the use of radiofrequency which utilizes heat to cause limited nerve damage. In certain terminal pain patients, injections of phenolic or glycerol solutions may add to permanent nerve destruction.
Infusion therapies: Systemic or localized (Bier block) intravenous injections of local anesthetics or biphosphonate type compounds greatly enhance pain relief for many oncology or large tissue trauma patients.
Extracorporeal shock wave therapy: Use of high energy sound waves, transmitted to localized body parts stimulates growth of endothelial (blood vessel) cells and tissue growth factors conducive to healing.
Laser therapy: Class III and IV lasers, commonly known as "cold lasers" have been used in Europe and Canada for decades by physiotherapists for both soft tissue pain relief and rehabilitative purposes.
Physical therapy techniques:
. Massage assists with influencing/disorienting incoming pain signals and increasing venous and lymph flow to reduce pain, swelling, and inflammation.
. Range of motion exercises can be both passive (performed by the therapist or owner) or active (performed by the animal) to aide in increased tissue perfusion, joint mobility, tissue laxity and improved healing. Heat or ice therapies often assist range of motion therapies.
. Therapeutic exercises are often involved in later stages of post traumatic and surgical pain to strengthen tissues and improve quality of movement. Unique tricks and exercises, involving simple constructs such as pylons, exercise balls, and even everyday household furnishings! can accelerate an animal's ability to heal.
. Therapeutic ultrasound is the use of sound therapy to reduce inflammation and increase tissue laxity, relieve pain. Musculoskeletal injuries benefit the most from this modality which must be done following the acute phase of injury.
. Whirlpool and underwater treadmill therapies utilize buoyancy as a key mediator in relieving pain and returning function to badly damaged orthopedic and soft tissue injury. Underwater treadmill work is also useful for strengthening and conditioning athletic and service animals.
. Electrical stimulation in the form of TENS (transcutaneous electrical stimulation) and NMES (neuromuscular electrical stimulation) can be helpful for both pain and increasing function in contracted or severely damaged tissues.
Complementary therapies including chiropractic and acupuncture can be utilized for chronic forms of pain, stress, gastrointestinal or neurologic disease. Many disease modifying agents including relaxants, herbs, antioxidants, chondroprotectants, and supplements can also be employed to help resolve the primary condition and the pain.
Behavioral therapies such as clicker training, feedback, positive reinforcement and reorientation can be extremely helpful in modifying a veterinary patient's attitude and mental stimulation regarding illness.
We encourage your questions on how any of the above can help improve your pet's quality of life. Consultations with us can be arranged via a phone call to our main desk.
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