Pain and distress
Click to access the 2015 AAHA/AAFP Pain Managment Guidelines for Dogs and Cats.
Identify, prevent, and minimize pain. Use pain assessment as the fourth vital sign, using scales such as the University of Melbourne Pain Scale or the Glasgow Composites Measures Pain Scale.59,60 Under-managed or intractable pain may become a criteria for euthanasia.
Identification of pain
Signs of acute or chronic pain vary and are described elsewhere. 16,56,61-65 Any behavioral change or change in vital signs may be an indication of pain. Signs of pain may be modified by factors such as demeanor (e.g., stoicism) or concurrent drugs. Involve, educate, and continually communicate with the client about recognizing and monitoring for signs of acute and chronic pain.66
Management of pain
Treatment options vary depending on the type of pain (e.g., acute or chronic). Single drugs or combinations of drugs may be used. To intervene at multiple sites of the nociceptive pathways, use multiple drugs.67 Control pain early in the course of chronic diseases. Chronic pain is best controlled by aggressive initiation of drugs and other modalities, followed by a tapering of the treatments to the minimum schedule or dosage that is still effective. Resources to help veterinarians keep current with new developments and recommendations for managing pain are becoming available, including the International Academy of Pain Management.
- Treatment modalities that may be applied for pain include oral, injectable, transdermal, or transmucosal drugs; physical therapy and massage; local and regional anesthesia; acupuncture; weight management where appropriate; and/or environmental modification such as a change in bedding, housing, access to the out-of-doors (e.g., ramp, lifting), etc.
- Drugs that may be utilized include NSAIDs, opioids, opiate derivatives, alpha-2 agonists, N-methyl-D-aspartate (NMDA) antagonists, anxiolytics and tricyclic antidepressants, anticonvulsants, bisphosphonates, and local anesthetics. Pain management should be integrated and complementary.68
Educate clients about possible adverse events and/or interactions of drugs. When appropriate, perform laboratory monitoring during drug therapy. Maintain and document communications with clients and reassess the animal frequently. Address anxiety on the part of the client regarding the pet’s pain, disability, and/or physical impairment.