Imagine my shock and dismay when one of you, a dear reader and knowledgeable cat owner, had no idea that pain medication was available for her felines. Perhaps that’s because pain control in veterinary medicine has come such a long way in the past five or ten years. I’m sure she’s not alone. How sad to think that patients might be going without the humane use of drugs due to the slow adoption of this indispensable innovation in veterinary medicine.
The sad reality is that pain drugs are not new to the profession. They have only now, however, begun to play a major role in how we treat our patients. It’s hard to believe, but veterinarians used to think that cats and dogs did not require the same kind of pain relief that humans do.
In fact, twenty-five years ago, human pediatric medicine was similarly inclined. Infants and children did not receive proper pain control after surgery or during painful procedures. I distinctly recall having my own fractured and dislocated arm set by a team of healthcare providers—with nary a pain drug in sight. I was eleven. I didn’t sleep for four nights afterwards. Yet I’m told I never once complained. In fact, after falling off that d--- horse they didn’t take me to the hospital for hours, assuming I’d let them know if I was in serious pain.
I’d like to think this experience served a purpose, making me more sensitive to the plight of the stoic pets we perform painful procedures on daily. My Bruticaine trauma, as I refer to it (invoking the veterinary term for anesthesia through brute force), served as a great reminder in vet school when, snug in my bed, I’d have to rouse myself for 2AM treatments: gotta give the pain meds was the mantra that replaced the one about the donuts.
Dogs and especially cats, like animals in the wild, will hide their pain so as not to reveal their weakness to a predator—and because they have no choice. They have to keep hunting, feeding their babies, and whatever else they have to do. They don’t have time to sit in a hospital room and whine like we humans do. And so they don’t tend to vocalize.
Recognizing this, we humans have to be extra-vigilant for signs of pain and, in most cases, assume pain is there, even when we can’t tell one way or the other. I can’t tell you how often a pet owner refuses drugs for the chronic pain of arthritis just because the dog isn’t whining. But he won’t whine!, I plead. Just humor me for a week. (I know most everyone eventually gets the picture when they tell me the dog is acting like a puppy just a few days later.)
Although most of the pain relieving drugs aren’t approved by the FDA for use on dogs and cats, we use them anyway. It’s legal for us to do so if no similar approved drug is in our arsenal. So we use direct-acting opiates like fentanyl (in a patch and as an injectable), butorphanol (pills and injectable), oxymorphone (injectable), buprenorphine (injectable), tramadol (pills), oxycodone (pills), hydrocodone (pills), etc. We also use tranquilizers and sedatives (acepromazine, valium, alprazolam, etc.) to reduce their awareness level, which aids in the stress-related wind-up of the pain mechanism.
Something I`ve recently become a big advocate for is the use of nerve blocks. This form of pain control is identical to the shots we get when a dentist does a root canal or when a woman gets an epidural before giving birth. However, we tend to use them when the animals are already sleeping. They help prevent the pain of a localized procedure from getting out of hand. The patients seem more comfortable and bite at their incisions less.
Pain is a funny thing. If you let it get started you’re in trouble. It’s always easier to prevent pain than it is to treat it after the fact. So nerve blocks on the belly before you make an incision or in the legs before a declaw can make a gigantic difference in how a pet feels later. (I would never do a declaw without at least three different pain meds.)
The most commonly used pain relievers in dogs and cats, however, are in the NSAID family. These aspirin-like drugs (like Rimadyl, Metacam, Previcox, etc.) have come a long way in the past ten years. Because they can be used relatively safely in dogs on a regular (even daily) basis, they have changed the way we manage chronic pain. Dogs with severe arthritis can now live one to five years longer than they otherwise might have—comfortably.
Cats can get these drugs, too, but their tolerance is not so great for the daily NSAIDs. We prefer to use patches or frequent oral dosing of opiates—neither of which is a great option for a lot of cats. What cat wants a pill shoved down its throat every four hours? And patches are pricey and hurt the skin over time. Hopefully we’ll have a good daily-dosed medicine for cats soon.
With the sophistication vet medicine has achieved in treating and preventing pain, there’s no excuse for failing to use a pain reliever for any painful procedure (except perhaps when to use a pain reliever might actually be more painful or traumatic, as when drawing blood, for example).
So now that you’re armed and educated, what will you say when your vet says pain control isn’t necessary for your cat’s spay? I’m sure you’re right, Doctor, but could you give it anyway?
In writing this I hope not to make my colleagues seem ignorant. They’re not. I have a tremendous respect for the skill, experience, and personal practice style of others. Some vets are just not used to all this pain control mumbo-jumbo. As I said, it’s a new thing and old ways of thinking are hard to let go of. But take it from a Bruticaine victim: pain meds are awesome.
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I'm not sure it was the rationale in pediatric medicine, but I know top veterinary surgeons used to believe -- and maybe still do -- that pain kept animals from being active and putting too much pressure on a newly-fixed area.
My own wonderful veterinary surgeon used to believe that, but now is as keen on pain meds as he is on surgery. (Well, almost!) He's also open to rehab and even complementary care. Guess you can teach an old dog new tricks!
Gina October 5th, 2006 09:56:00 AM
As a veterinary surgeon, this topic is a big item of interest (and frequent lecturing) for me. As everything I do in the course of my job hurts, I have become a big advocate of pain management in animals. It seems all of veterinary medicine is experiencing a large tidalwave of interest in the use of pain medications for our voiceless patients.
Amplifying on human experience you alluded to: only a few decades ago, pediatric heart surgeons were perfoming heart surgeries on children only a few days old for congenital heart defects using no pain medications. This was done under the belief that the medications would be more dangerous than the pain. At the time, the babies werre experiencing a mortalitiy of about 25%. One group came up with the crazy idea of providing drugs to blunt the pain, and guess what happened. Mortality rate dropped into the single digits. The conclusion? At least 20% of the children were dying of pain. That deserves repeating: death due to pain. Veterinary patients, and especialy cats, follow the same pattern. Criticaly ill animals in pain die of their pain. Traditionaly, in both human and veterinary medicine, pain was used as a tool to keep patients from having too much activity, or avoiding the (usualy very mild) side effects of the drugs. We are now recoggnizing that pain has more severe side-effects than the drugs.
I, too, experienced a major knee surgery as a teenager, and recived tylenol afterwards. Tylenol! I spent 4 days in a state of near catatonia because of the severity of the pain, and I think many of our patients do as well.
The good news is that the speed with which veterinarians are adopting good multimodal pain management strategies is accelerating, probably even faster than in the human field. Many different drugs, and drug combinations, are now available, and are being used aggressively.
I welcome this new trend, and find that it helps to puch it along from above and below. Veterinarians can take the lead, but the more clients ask for pain medications for their pets, the more in-tune the veterinarians get with this trend.
M
Marc October 5th, 2006 11:09:00 AM
This makes me concerned that I did not give pain medication to my animals when appropriate because they didn't show any sign of pain. My guilt is far reaching.
janet October 5th, 2006 11:55:00 AM
Hi Janet,
What happened in the past isn't your fault. Now take this new education provided to you and use it in the future. It won't help you to use shoulds about something you can't change now.
WIth continued advances in medical care for both people and animals the way pain is managed will continue to evolve.
Shannon
Shannon October 5th, 2006 02:47:00 PM
The fentanyl patch is an amazing pain medication especially for acute pain. My arthritic cat once injured his knee and then, as a result of adjusting his gait, strained his back. He was in terrible pain, crying... I took him to the emergency vet where they administered a fentanyl patch, and his pain relief was obvious. I feel quite fortunate that my vet is very vigilant about symptoms that could be painful, and administering pain medication without hesitation. I've learned alot from him.
karen April 28th, 2008 10:15:00 PM
I just had my cat I(Frosty) spayed on 12.11.08. Infact I had 2 cats done at same time (baby D was also done) I asked about pain medication over and over again as I neevr had female's spayed in past but knew thats an invasive surgery. I was told most dont need it . But i'll be honest it didnt sit well with me especially since I myself have had abdominal surgery in past and to boot I have been a pain clinic patient the past 5 yrs so I know pain well and live with it daily. After reading this this has made my belief's that much stronger that pets DO NEED pain management, after all why wouldnt they? My Frosty or Baby D wasnt given pain meds to bring home with them and althought baby D has done well (im sure she was in some pain ) Frosty has not!! She is clearly in pain , her bahavior tells the tale! She is going back to vet today. I thought maybe a few days she will be ok , after all she was eating and drinking and they told me that would be good . I wanted to believe the VET that they didnt need pain pills but it nagged at me . I didnt know I could say.. well i want them to come home with some anyhow ! After my conversation with the woman on phone today about bring frosty back in im not so sure I would of gotten any anyhow. I said to her.. This surgery is very invasive , How can you guys think any spayed cat would not be in pain? and why dont you guys send home some pain meds to prevent pain before it can get out of control? she said.. well we dont just send home pain meds most animals dont need it. I am rather disgusted at myself because my frosty has suffered over the past few days and of course it was a weekend! she has been quiet and resting but I still know she dont feel well. I should of walked out of that vet when they said they dont use pain meds. I encourage anyone who is going to have any surgery on thier animals NOT to use a vet that doesnt use pain meds!! Its animal Cruelty!!
Mary December 15th, 2008 12:53:54 PM
Nice article, very helpful. Thanks!!
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