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Evaluating and Addressing PainWritten on February 20, 2014 by Staff Veterinarian
Where Does it Hurt?
Many owners take for granted that their pet’s pain is being relieved by medications or procedures. Don’t be afraid to ask your veterinarian if this TRULY is the case. It is extremely difficult for all of us, medical professionals and owners alike, to tell if an animal is in pain, and to scientifically prove they hurt. If you are seeing something that suggests your pet is in pain, please address this with your veterinarian. You play a key role in recognizing your pet’s pain, so we can treat it.
Relieving pain not only enhances the quality of your pet’s life, it also aids in the process of healing, reducing the potential for further injury, illness and behavioral changes.
Diagnostic tests and equipment used to determine where pain or disability arises include:
- Joint and mass cytology/histopathology
- Magnetic Resonance Imaging (MRI)
- Computed Tomography (CT)
- Force platform analysis or force plate analysis
- Gait analysis
- Home video
- Local and regional blockade
- Vital parameter and behavioral pain assessment or scoring
Once the source of the pain has been identified, the problem can be medically or surgically remedied. Along the way there are many options available to ease the pain that accompanies the primary intervention.
The modalities (some new, some routine) we use to treat painful conditions include:
Prescription of pain relieving medications including narcotics (hydro and oxycodone), anti-anxiety drugs (clomipramine, midazolam, alprazolam), anti-inflammatories (aspirin and Tylenol like drugs), certain anti-depressants and nerve modulating drugs is now routine care for most patients. However, new drugs are discovered every day to treat pain and additions to the many classes of pain relievers continue to flood the human and veterinary market. The efficacy of many of these formulations, supplements and drugs needs to be carefully considered and is individual to each patient. Careful titration of dose and form are required to balance these new medications with other medications your pet may currently be receiving.
Many of these medications can be formulated into unique forms to ease administration. Options include capsules, topical agents, lotions, sprays, liquids and patches. Talk to your doctor if administering your pet’s medications is harder than it should be. A veterinary compounding pharmacy can ease the process.
A combination of local anesthetics (novocaine-like drugs) with or without anti inflammatories, chondroprotectants, stem cell and other growth factors,and nerve modulating agents, can be injected around nerves, into muscles, or into joints. Non-painful electrical location, ultrasound, and even imaging like fluoroscopy and CT are used to ensure accuracy at the injection site. These drug combinations placed very close to major nerves and nerve roots reduce swelling, irritation, spasms or abnormal nerve transmissions that cause or amplify the pain. They are modified local and regional blockades similar to those utilized perisurgically (like an epidural for a C-section) but they are performed in an effort to provide longer lasting pain relief in cases of severe or intractable pain (such as that from traumas, cancers or chronic inflammations).
These “nerve blocks” not only reduce pain, but can also reduce inflammation, spasms and swelling, all without the interruption of movement or coordination. Intraarticular or peri-and intra-joint injections reduce inflammation, promote healing, and encourage rehabilitation, especially for those animals affected with a chronic musculoskeletal disease such as arthritis.
Intravenous Analgesic Therapy
Systemic intravenous injections of certain drugs (bisphosphonates, ketamine, lidocaine) may greatly enhance pain relief for many oncology or large tissue trauma patients.
Administration of an intravenous analgesic therapy would take place over the course of a day at the hospital. The patient receives an intravenous catheter and a slow deliberate infusion of pain relievers over the course of several hours. Following this procedure, their pain is often reduced for days or weeks. The most common of these “infusion therapies” is that of pamidronate delivered to patients with bone tumors every 2-4 weeks. Chronic but regular delivery of these agents has added months to years of quality life to many patients with invasive bone tumors and osteoporosis.
Radio Frequency or Neuroablative Treatments
This is the actual obliteration of nerves which create or add to terminal pain. The procedure is performed with the use of radio frequency which utilizes pinpoint microscopic heat to cause limited nerve damage. In certain terminal pain patients, injections of phenolic or glycerol solutions may add to permanent nerve destruction. The nerves which are obliterated typically are sensory branches of spinal nerves which innervate, or feed, into a painful area. Motor function (movement, coordination, bodily function) is often unaffected by this procedure, but imaging (fluoroscopy, CT or ultrasound) is required to be sure placement of substances or positioning of needles is accurate.
This treatment is often reserved for end stage or palliative care of oncology patients, but is very effective in pain control where major organ systems or body areas are involved.
Extracorporeal Shockwave Therapy
This is the use of high energy sound waves, ironically called “shockwaves” transmitted to localized body parts especially connective tissues, to stimulate growth of endothelial (blood vessel) cells and release of tissue factors conducive to healing.
This procedure is performed most commonly for non healing fractures, tendons and ligaments. It has also been used postoperatively for immediate surgical healing after cruciate ligament repair, and for burns/soft tissue wounds such as decubitus and ulcers. Sedation of the small animal patient is often required but the procedure is very rapid, taking only one to two minutes.
Analgesia or pain relief with this therapy has two phases, one immediate, and one which occurs within days of the procedure, lasting for weeks to months.
Class III and IV lasers, commonly known as “cold lasers” are utilized as low level light therapy to deliver deep heat to connective tissues, inflamed tissues and even non healing tissues. Their ability to improve blood and lymphatic flow, increase tissue energy levels, and cause pain relief through endogenous analgesics, (opioid and other neurotransmitter release) is unparalleled by a non invasive means in the small animal world presently.
Their primary use is to treat osteoarthritis, post traumatic strains and sprains, wounds, and even post surgical inflammation.
Physical Therapy Techniques
- Massage assists by 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 items 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.
Chiropractic and acupuncture can be utilized for chronic forms of pain, stress, gastrointestinal, or neurologic disease.
Acupuncture involves the insertion of needles at specific sites along the body contour. Effects range from instant pain relief, to reduced inflammation, through increased elasticity, improved blood flow, to disease modification (reduced thyroid hormone production for hyperthyroid patients).
Chiropractic treatments involve the manipulation or mobilization of joints, and surrounding tissues to provide similar outcomes as acupuncture without the use of needles.
With both of these techniques, complementary homeopathic disease modifying agents including relaxants, herbs, antioxidants, chondroprotectants, and supplements can be employed to support the body during illness and reduce the pain.
Capital District Veterinary Referral HospitalLatham, NY 12110
IVG MetroWestNatick, MA 01760
Massachusetts Veterinary Referral HospitalWoburn, MA 01801
Port City Veterinary Referral HospitalPortsmouth, NH 03801
SAVESLebanon, NH 03766