Pain Management
How do I know if my dog is in pain?
Pain is one of the most important factors in assessing a dogŐs quality of life. Humans and dogs have similar anatomy and neurophysiology, therefore dogs, just like people , absolutely feel and suffer from pain. Thankfully modern medicine has recognized this and has developed many modalities to minimize pain during surgical procedures. Veterinarians also have many drug protocols available to them to manage chronic pain. Since these medical advancements, dogs now live longer and more comfortable, active lives. The purpose of this article is to provide information so that owners can become advocates for their petŐs pain management.
The dictionary defines pain as physical suffering or discomfort caused by illness or injury; or a feeling of marked discomfort in a particular part of the body.
There are 2 main classifications of pain:
- acute pain which is short lived, lasting hours to days.
- chronic pain which lasts weeks to months or even years.
We tend to treat them differently since their cause is typically different. There are severe consequences to pain, these being distress, delayed healing, sleep disturbance, poor appetite, depression, altered social interaction, and ultimately a poor quality of life.
Dogs instinctively hide pain since they are naturally programmed for survival of the fittest. A weak dog in a pack is singled out and ultimately removed from the pack.
The clinical signs of pain in a dog are very subtle and we as humans have to rely on physical cues.
- Loss of normal behavior: Not greeting owners, sleeping in different places, avoidance of social interaction, hiding and change in normal routine.
- Expression of abnormal behavior: vocalizing, hunched posture, drooping head, limping, reluctance to move, decreased appetite, slow rising, restlessness and sometimes aggression.
- Reaction to touch: Tensing, flinching, vocalizing and aggression.
- Physiologic: increased heart rate, increased respiratory rate (panting), dilated pupils, increased body temperature.
Once we as humans have recognized that our dogs are suffering from pain, we need to diagnoses the cause. Veterinarians canŐt treat pain effectively unless we know why the pet is in pain. If we localize the cause we may be able to completely cure the problem and make that pain completely resolve. Sometimes this is simple; ie limping dog with a thorn in the foot - remove the thorn - pain is relieved. Unfortunately many problems are not so straight forward and require extensive diagnostic tests and more complicated repairs. Most illnesses do cause some degree of pain.
Think of ourselves when we have a simple cold. We have a headache and muscle aches. This also happens to dogs with respiratory infections. It is very common for humans to take anti-inflammatory drugs to relieve that type of discomfort but we rarely recognize this type of discomfort in our pets. Certainly pets with severe illnesses or trauma are in pain and this pain must be addressed. Some causes of pain cannot be fully resolved but the pain can then be managed long term so that these pets have a good quality of life; ie dog with hip or elbow dysplasia (abnormally formed joints). We canŐt completely cure this problem but we can do surgical procedures to improve the condition and then use drug protocols to control the discomfort.
Veterinarians have begun to create anesthesia protocols that attempt to treat the pain before we cause pain. We call this pre-emptive analgesia. This type of analgesia involves the use of controlled dosages of different drugs to control pain at each level of the nerve pathway. This involves the use of drugs that affect the pain receptors, local anesthetics that shut the nerve pathway to the spinal cord and then general anesthetics to sedate the brain so the brain does not recognize pain. We call this multi-modal therapy/anesthesia. These protocols are being embraced by some veterinarians and are not being used at all by other veterinarians. It is important for owners to ask questions to the veterinarian. How are you managing my dogŐs pain? Are you treating all components of my dogŐs pain? You want to hear your veterinarian speak to you about nerve blocks, multiple drug therapy, and you want your veterinarian to offer these services. All dogs that have had a surgical procedure performed should be going home with some sort of pain management medication.
There are many drugs available on the market for the treatment of both chronic and acute pain. There are different classes of drugs that work in different ways. This is important since all dogs donŐt have the same type of pain. Many dogs require more than one drug. As dogs age, their pain may change, it can get worse or change character.
Types of drugs:
- NSAIDS (non-steroidal anti-inflammatory). Drugs that inhibit the production of prostaglandins. Prostaglandins are chemical mediators that cause inflammation (swelling, pain, redness and heat). The most commonly used drugs in this class are Rimadyl, Deramaxx, Metacam, and Previcox. There are some common side effects that we must be careful with, which are gasto-intestinal upset, kidney disease and liver disease. All dogs treated with these drugs should have blood work performed before starting and the kidney and liver function tests should be monitored during the length of treatment. Dogs that are maintained on these drugs should have blood work performed at least every six months.
- Opioid drugs. Drugs that attach to certain pain receptors in the body. Each opioid drug differs a little in the type of receptor they attach to and the duration of action. These drugs are generally used for pure pain relief they do not have anti-inflammatory activity. The most commonly used drugs in this group are Morphine, Codeine, Fentanyl, Tramadol, Hydromorphone and Buprenorphine. The most common side effects of these drugs are sedation and nausea. Most of the time these drugs are used in anesthesia protocols or for acute pain management.
- Muscle relaxants. Drugs that act on the central nervous system or at the level of the muscle and act to relieve muscle spasms. Most commonly used are Methocarbamol (Robaxin), Xylazine, Diazepam (Valium), and all general gas anesthetics are potent muscle relaxants. The most common side effects are sedation.
- Local anesthetics. Drugs that numb local nerves in an area where it is injected. most common drugs are Lidocaine and Bupivicaine. The difference in these 2 drugs is their duration or activity. The most common side effect is stinging at the injection site.
- NMDA receptor antagonists. Drugs that prevent pain at the level of the spinal cord. They act on a specific receptor in a specific area of the spinal cord. The most common drugs are Ketamine and Amantidine. The most common side effect is agitation, confusion, and gastro-intestinal irritation.
- Seizure control drugs. Drugs that control pain by working on receptors in the brain. These drugs are generally used to treat neuropathic pain (nerve pain). the most commonly used in this group are Gabapentin and Phenobarbital. The most common side effect is sedation.
There are many classes of drugs used to treat pain in dogs. Every animal that is experiencing pain may have different components in the pain pathway being stimulated. If a dog is not responding to a specific drug other drugs may be added in to treat a different component of the pain. For example a dog with a herniated intervertebral disk has inflammation of the nerve and surrounding tissue, muscle spasms and distinct nerve pain that can be very severe. This dog would then be treated with a combination of medications (anti-inflammatory, muscle relaxant and a opioid drug) to fully resolve itŐs pain. One drug would not make this dog feel better. In anesthesia protocols, often more than one drug is used to both sedate the pet and to control all the components of that patientŐs surgical pain. Many times an owner is not aware of which drugs are being given to a pet.
Always ask the Veterinarian
- How are you medicating my dog for pain?
- Which drugs are you using?
- What are the side effects?
How long a pet needs to be treated really depends on the condition the pet is suffering from. Post surgical pain is limited; once the surgery site heals the pain is gone. Dental pain is typically short term in the sense that once the bad tooth is repaired or removed and all infection is treated the pain will be gone. Arthritis, some neurologic disorders, and some immune mediated diseases may cause pain for the lifetime of the pet. These pets may need pain management for their lifetime. Many drugs can be used in this fashion. If pets are to be maintained on drugs for long term blood work needs to be performed routinely (typically every 6 months) to ensure that organ damage is not occurring. If a pet has a reaction or a problem metabolizing a specific drug then the protocol changes and another mix of medication/supplements is attempted.
There are also some other modalities available to veterinarians and pet owners to help relieve pain.
- Physical therapy - which can involve the use of hot and cold therapy, electric stimulation of muscles or simply controlled exercise
- Acupuncture - which is done by a well trained veterinary acupuncturist
- Hydrotherapy - which is the use of underwater treadmills,or swimming. Both allow a dog to use full range of motion with less weight on the limbs.
- Massage Therapy - to help bring blood flow to damaged area of the body.
- Nutritional Supplements and Herbal Remedies that have been proven to help delay the progression of arthritis and also help the body heal.
The most important thing we can do for our pets that are suffering from a painful condition is to recognize that they are in pain. Everything that causes pain in a human causes pain in our pets. There are many safe and effective medications available to treat pain. There is no reason for a pet that is suffering from arthritis, dental disease, metabolic disorders, infections or any other condition, to have to suffer from pain. Be an advocate for your pet and arrange for a discussion with your veterinarian and ask how they can relieve your petŐs discomfort.
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Dr. Ellen Leonhardt
Animal General
East Norwich
(516) 624-7500
THIS SITE PROVIDES INFORMATION, NOT MEDICAL ADVICE
Information on this web site is provided for informational purposes only and is not intended as a substitute for the advice provided by your veterinarian or any information contained on or in any product label or packaging. You should not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. You should always speak with your veterinarian before giving any medication or nutritional, herbal or homeopathic supplement to your dog, or adopting any treatment for a health problem. For any products or services purchased from this web site, you should read carefully all product packaging and instructions.
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