Pain Management Techniques

Our Pets Feel Pain Like We Do
Pain management in veterinary medicine has often been only a minor concern in the overall care for our companion animals. The perception for far too long has been that they “don’t feel pain” like people or that certain elective procedures were “minor” or likely to cause only minimal discomfort. What research and observations over the years have come to prove is that our patients do perceive pain much the same as humans, but it is our poor means of evaluating pain that has led us to mistakenly believe that they “tolerate” pain better than we do.

Unmanaged Pain Can Slow Recovery Our companion animals have instinctive behaviors that cause them to hide their pain from outward observation (think about nature – the strong survive and the weak or injured become lunch) so we must think proactively when it comes to pain management. To put it simply, if a surgical event would be painful for a human, then we should expect a similar level of pain to occur in our patients too. Our goal is to prevent pain when possible and if we can’t prevent it, then we should take steps to minimize its effects on our patients. Research has shown that unmanaged pain is a significant impediment to a speedy recovery for any surgical event.

Dr. Cox and Stacey with Zeus getting some meds on board before surgery.

Don’t confuse anesthesia with pain control. Anesthetic drugs are used to induce a state of unconsciousness where the brain is unable to sense the pain signals that the body is sending it. Most anesthetic drugs do very little for managing pain after they wear off and the patient wakes up. The surgical event, while not sensed by the patient under anesthesia, still causes biochemical changes to occur in the body in response to injury. It is those biochemical changes and the transmission of signals to the brain that elicits a painful sensation once recovered from anesthesia.

New Strategies To Help Your Pet
In an effort to provide the highest level of pain relief for our surgical patients, we have adopted a variety of new strategies for the administration of pain-relieving drugs. We are taking a more active role in preventing pain by administering drugs before the surgical procedure, during surgery, and post-operative all in an effort to minimize the transmission of pain, perception of pain, and the biochemical changes that cause painful sensations in the post-operative recovery period. While not all procedures may need all of the techniques we have at our disposal, we will employ whatever means necessary to preempt and treat pain on an individual basis.

Pain Management Before The Surgical Procedure
We routinely use non-steroidal anti-inflammatory drugs (NSAIDs) to block the cascade of inflammatory events that occur due to surgical procedures. If we can minimize the biochemical changes associated with tissue trauma, we will minimize the ongoing sensation of pain post-operative. We will also use morphine derivatives to act directly on the central nervous system’s pain pathways, providing pain relief by reducing the body’s ability to perceive pain. These morphine derivatives provide a sedative effect and make the transition to anesthesia a much less stressful event. Prior to surgery (but usually after anesthesia is induced) local anesthetic nerve blocks are often used to prevent the transmission of pain from the surgical site to the brain. This local anesthetic will provide a “numb” sensation at the surgical site so during recovery there is less perceived pain.

Pain Management During Surgery
We can also administer analgesics such as morphine derivatives, local anesthetics and dissociative anesthetics during anesthetic episodes via a technique called constant rate infusion (CRI). This advanced technique involves mixing these drugs into intravenous fluids and infusing them slowly during the surgical procedure. This is advantageous because it keeps a steady-state level of pain relievers in the system during surgery, reducing the amounts of anesthetic drugs required to maintain the desired level of unconsciousness as well as reducing the nervous system’s ability to transmit pain signals to the brain and spinal cord. This has the added benefit of reducing the painful sensations felt upon recovery from anesthesia and reducing patient stress during this transition period.

Post-Op Pain Management
During the immediate post-operative phase, the CRI technique can be continued for as long as necessary to provide pain relief and to make recovery from anesthesia as smooth as possible. We assess each patient’s need for additional analgesics using a standardized observation protocol and address the need for additional pain control techniques. We can administer additional injections of morphine derivatives, sedatives and local anesthetics as needed to assure the most comfortable recovery possible for our surgical patients. When it is time to release our patients back to their families, we will dispense medications that can be safely administered orally for continued pain relief at home.

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