Alleviating pain is a professional obligation and a key contributor to successful case outcomes and enhancement of the veterinarian–client–patient relationship.
Recognition and proper management of chronic pain can be as life-saving as any other medical intervention in veterinary medicine.
Pain management treatment should focus on the underlying cause of pain (nociceptive, inflammatory, or pathological) rather than strictly on its duration.
Appropriate pain management requires a continuum of care that begins with a case-specific pain assessment and treatment plan, including anticipation of pain, early intervention, and evaluation of the treatment response on an individual-patient basis.
In addition to pharmacologic treatment of pain, there is a strong role for nonpharmacologic modalities of pain management as part of a balanced, individualized treatment plan.
The most accurate method for evaluating pain in animals is observation of behavior, including deviation from normal behaviors and development of new behaviors, utilizing a validated pain-scoring tool for dogs and cats.
Every veterinary health care team member should be able to recognize pain-associated behaviors in patients and know how to respond appropriately.
Pain assessment should be a routine component of every physical exam.
Pain-scoring tools should be routinely used to assess acute and chronic pain.
To target multiple pain pathways, effective pain management involves a balanced or multimodal strategy using several classes of pain-modifying medications.
Opioids are the most effective drug class for managing acute pain.
Because the majority of painful conditions have an inflammatory component, nonsteroidal anti-inflammatory drugs are a mainstay for managing chronic pain and for perioperative use.
Pharmacologic intervention can usually be enhanced by various nonpharmacologic approaches, including weight optimization, physical rehabilitation, environmental modifications, and proper-patient handling techniques.
Although degenerative joint disease, including osteoarthritis, disproportionately affects older patients, its onset often begins at an early age in dogs and cats.
Early intervention can delay the onset and severity of degenerative joint disease and should involve the caregiver as part of the treatment strategy.
In cases involving hospice and palliative care, it is important to offer explanations of probable outcomes and to provide end-of-life choices designed to relieve the pet’s pain and suffering.
Pain management in clinical practice is a team effort, with the pet owner functioning as an integral part of the team.
All veterinary health care team members should have a defined role in the practice’s approach to providing compassionate care to its patients.
Proper handling of older patients at home and during veterinary visits is an important component to minimizing discomfort of degenerative joint disease and other chronic pain conditions.
Each pain management plan should include patient-specific instructions, given verbally and in writing to the pet owner, including the prevention and recognition of adverse drug effects.