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Pet Pain Patrol - Please Participate!

10/05/2009

When choosing a veterinary practice for your pet, or deciding where to have a surgery or procedure performed, one of the most important parameters to evaluate is the practice's philosophy regarding pain control. In the olden days of veterinary medicine, many patients received little to no pain control after a surgery or injury. These days, many (but not all) veterinarians are vigilant about providing pain relief to the animals in their care. You need to ensure that the practice you use is up-to-date on both their pain control philosophy and the actual methods employed.

Failure to provide adequate pain control to animals is not only inhumane, it can also be severely detrimental to the animal's health and recovery. For example, pain has been shown to slow wound healing, increase rate of infection, cause shock and decreased circulation, and prolong hospital stays. 

Veterinarians must be proactive about recognizing pain in their patients. Pain is often underestimated in animals for a variety of reasons; for example, cats and older animals generally do not vocalize when in pain. It is essential to assume pain is present following a procedure or injury that would be likely to cause pain, and also to recognize more subtle signs of pain in veterinary patients. Cats are notorious for hiding significant pain. A cat in discomfort will often sit quietly in a hunched position, while a cat with proper pain control will have a more relaxed body position, move about, interact, and groom. If a dog or cat sleeps soundly with dreaming, this is a good sign of adequate pain control. Aggression is often a sign of pain in animals.

One very useful parameter veterinarians can use to evaluate for pain is the heart rate. An animal in pain may be lying quietly yet with an elevated heart rate. A good veterinary practice will assess the patient's heart rate at regular intervals, using a rapid rate as a clue that additional pain relief may be needed.

There are various medications available to provide pain control for pets. Some of the most commonly used options include narcotic medications, given as an injection, pill, liquid, or skin patch, and non-steroidal anti-inflammatory medications (NSAIDs), which may be supplied as an injection, pill, or liquid.

In some situations, NSAIDs should not be used due to the likelihood of significant side effects such as kidney failure and/or gastrointestinal ulceration. NSAIDs are contraindicated in animals with liver or kidney disease, gastrointestinal symptoms such as vomiting or diarrhea, and in patients who are dehydrated or having signs of shock, such as low blood pressure or low body temperature. Screening blood work to evaluate liver and kidney function is essential prior to administration of NSAIDs.

Use of NSAIDs in cats is controversial, with Metacam being a particularly well-known example. The manufacturer's instructions for oral Metacam state that this drug should not be used in cats, and indeed multiple reports exist of significant and even fatal consequences of oral Metacam use in cats. Regarding injectable Metacam, the manufacturer's instructions state that cats should only receive one injection of Metacam, and there are reports of even one injection leading to consequences such as kidney failure. Failure to follow the manufacturer's package insert directions is a risky business not only for the patient's welfare but legally as well.

One option for pain control in cats at home is buprenorphine (Buprenex), a liquid narcotic that can be given under the cat's tongue and will absorb from the oral mucosa. Because a very small volume is needed (around 0.1 cc in most cats) and because it does not need to be swallowed, it is easy to administer and this drug is nicely effective for many types of pain in cats.

Another relatively new development for pain control in both humans and animals is skin patches that release medication over several days. Skin patches containing the narcotic fentanyl can be used in both dogs and cats; care must be taken that the patch is not ingested by the animal. Below is a dog wearing a fentanyl patch.

Pain patch on dog small.jpeg 

And here is a close-up of the patch:

Fentanyl patch close up small.jpeg

As a pet owner, please be proactive in ensuring that your pet always receives safe and adequate pain control. Animals cannot tell us when they are suffering, or ask for help, so we must be vigilant in our efforts to protect them. Don't be afraid to ask about pain control for your pet, or to investigate the safety of any drug given to your companion.

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