“Pain” is a feeling formed in the brain from chemical processes in the body. It begins as a stimulus somewhere in the body. The stimulus can be physical, temperature, chemical or inflammatory damage to tissues. The stimulus causes chemical and nerve changes that travel to the brain. Here the brain processes it and forms the perception of pain. perception that the brain creates from input called “nociception” (pronounced no-si-sep-tion). This is the physiology term to describe the chemical processes that are at work in the body that receive a stimulus, modify it, and transfer it to the brain for interpretation and reaction. The stimulus can be physical, temperature, chemical or inflammatory damage to tissues. The brain processes this nociceptive input, mixes it with other data, and creates the perception we call pain. Everyone’s pain perception and reaction to it may be different.
Not all pain is bad—pain lets us know that something may be harming our bodies that we need to stop. But “pathologic pain” is a type of pain that is no longer serving this helpful purpose. Most of the pain issues we are likely to encounter with our pets in the medical situation are examples of pathologic pain.
Pain can be caused by many things:
- physical trauma, such as falling down or being hit by something
- internal organ problems, such as intestinal upset or kidney blockage
- surgical procedures, such as abdominal surgery or bone surgery
- brain or spine problems, such as a slipped disc, pinched nerve or headache
- degenerative changes, such as arthritis and joint damage
Reactions to pain vary for each individual. Symptoms can be very subtle in animals or they may hid all signs of pain until their condition is very painful. Common pain behaviors are:
- favoring a limb
- growling and/or purring (cats)
- not grooming (cats)
- not moving from one spot or hiding (cats)
- squintingg (cats)
- crying and/or whiningg (dogs)
- glassy-eyed, vacant lookk (dogs)
- hunched up body (cats and dogs)
- restlessness, unable to get comfortable, and changing positions a lot (dogs)
- shaking and trembling (dogs)
- hiding (cats and dogs)
- irritable or aggressive (cats and dogs)
- no appetite (cats and dogs)
- protecting the hurting body part (cats and dogs)
During and right after a painful injury or other illness, the body responds in several ways; the heart and breathing rate go up, muscles tense, endorphins (natural pain killers) are released internally. But after awhile, other stress hormones are released as the pain continues. This can lead to systemic effects on many body systems, including:This is when the down side of pain starts to outweigh the earlier benefits. The bad effects of pain include:
● no eating or drinking
● poor intestinal function, poor nutrient uptake
● increased risk of infection or delayed wound healing
● poor hygiene and ability to move around
● inability to sleep
● irritable or aggressive behavior, preventing nursing care or therapy
Pain and its effects can slow recovery and prolong illness if it is not treated appropriately. Any one or all of these complications may be present and may risk the recovery of your pet. Sometimes it means your pet does not recover; sometimes it means treatment is more prolonged, This can lead to chronic issues that may require more intensive, and invasive treatments. It may also make some treatments , ineffective or more costly. Painful illnesses in a pet’s life may make future illness or injuries more difficult to treat. Your pet may have a bad memory of veterinary care he/she received, and be fearful or aggressive the next time they need treatment. Therefore, pain should not be viewed as a “good” treatment to prevent pets from being too active and all illnesses and injury that cause pain should be appropriately treated.
Not all pain is created equal. Some is short-lived (like an injection), some is manageable w/ accommodation (like limping to relieve a sore ankle), and some is incredibly severe (like a broken back that makes a pet bite their owner when being helped). If pain goes away quickly and is minor enough, the negative impact is slight. As the duration and/or severity of pain rises, all of the negative impacts start to add up, and pets need our help.
There are several places in the pain pathway where we can intervene and help pets experience the least amount of pain based on their illness or injury. Pets are often given several treatments to “hit” pain at all these different spots in the pain pathway. This is referred to as multimodal analgesia. Below are several ways in which your pets pain may be treatedThere are several stages in a pet’s medical experience when we can address pain; each stage is an opportunity for providing treatment or “analgesia” (i.e. pain relief) and having a plan for each stage allows us to keep each treatment to a minimum (less risk, less cost).
- Medications – There are several types of medications that can be used and these can address different spots on the pain pathway. Ideally, a medication is given before the painful stimulus so that the pet never experiences pain. This is only possible for planned painful procedures like surgery. For other pain, your veterinarian will use a combination of injectable, oral, and even topical medications to help decrease pain.
- General anesthesia We use anesthesia to make a pet unconscious. This stops the brain from perceiving aany pain. This is helpful for surgery, but also for painful conditions where other medications aren’t effectively treating pain.
- Immobilization – Your pet does not understand that when they move, it can cause more injury. For injuries like fractures or wounds, a bandage, splint, or cast can stop your pet from moving the area and causing more pain. We can also give oral sedatives to help keep the pet calm. This will keep their activity level low and can also decrease anxiety which can be a factor in pain.
- Local therapies – Several different treatments can be used locally at the surgery or injury site to help decrease pain and inflammation. These include cold and warm compresses, massage, range of motion exercises, ultrasound, and laser therapy.
- Rehabilitation – Rehabilitation can be used for both new and chronic pain. A rehabilitation specialist will use exercises, medications, and other therapies to help pets recover from an injury and help prevent new injuries from occurring.
Pain management is a complex subject and we are learning new ways to manage pain. Different veterinarians will prescribe different medications or use different techniques based on their expertise, experience and/or knowledge. A pain management plan must be tailored to your pet, their medical condition, and their pain; charges for these services will vary from patient to patient.
A pain management plan must also be supervised to allow for modifications as your pet’s response unfolds; the time-frame may be over minutes, hours, or weeks depending on the medical condition and pain being treated. All of the different treatments for pain also have unique side effects that you and your veterinarian should discuss and monitor. This could involve frequent exams, tests, or changes in the dosing of the medication. Using any of these options without proper follow up can results in severe complications to your pet.
There are a variety of tools available to monitor your pet’s response to therapy. There are standardized tools to give an objective score to an animals pain. These tools look at your pet’s behavior and gives a numerical score that can be tracked or used to determine if the pain management protocol should be adjusted. The two most commonly used in veterinary medicine are the Glascow Composite Pain Scale and the Colorado Acute Pain Scale.
The veterinary profession is sufficiently advanced to recognize and successfully manage pain in our patients. We have medications, techniques and experience that can be customized to the species and the medical condition; current standard of care allows for the vast majority of patients to be made comfortable the majority of the time. Pet owners should feel empowered to be part of the medical decision-making regarding this, and other, aspects of their pet’s medical care. From the common spay procedure to the complex trauma case, reserve the time for these pain management discussions with your primary care veterinarian or your veterinary surgeon.