Pain Management in Dogs

Today I attended an all day lecture on anesthesia and pain management by veterinary anesthesiologist Dr. William Tranquilli.  First, how awesome is that name??  Second, I will tell you a little bit about why pain management is so very important to me.  And finally, I will focus on what Dr. Tranquilli said about pain and pain management – he is the expert after all, and then I would love it if you would share your experiences with your own pets and pain control!


My Obsession with Patient Comfort

Since I started my career as a veterinarian, pain management has been one of my passions.  The attitude of the veterinary profession has moved from “pets don’t feel pain” (WITW?) to “pain is useful to keep pets quiet and from hurting themselves” to the predominant attitude today, which I think is most accurate:  Pets feel pain. We as their loving families and veterinary teams have the ability and responsibility to keep pets restrained when needed and the ability and responsibility to control their pain.

I had a teacher in veterinary school (a surgical specialist!) tell me that a black Lab puppy with a surgically repaired femur should not receive pain medication because he needed to rest.  Thankfully, even then, that attitude was on the way out, and every vet in their right mind, then and now, would restrict that puppy’s activity while also controlling his pain.

The tools we have to control pain have only gotten safer and better over the years, to the point where most pets can be kept mostly comfortable most of the time.  I LOVE that.

Clinically, I have most often dealt with pain of my patients in three areas:  surgical pain, trauma and osteoarthritis.  Pets also deal with pain related to intervertebral disk disease (which causes back and neck pain – we will talk about that more next week), dental disease, cancer and other conditions.

Dr. Tranquilli and Pain Management

Here are some seemingly random thoughts from Dr. Tranquilli’s lecture today.  I have found that when very, very smart people seem to be saying random things, there tends to be much wisdom found in what they are saying!  So I will try to just present to you what he shared, and hope that you are encouraged that specialists such as Dr. Tranquilli invest their lives in pain management, and veterinary general practitioners obsess about learning everything we can possibly learn about pain management because we love your pets so.

Very Important Things Shared by Dr. Tranquilli…

Pain does serve a purpose:  ”Thank God we have this system in our bodies ready to protect us from tissue damage.”

“Veterinarians treat pain more than human general practitioners.”

Appropriately balance the risks of medication with the need to alleviate pain.  ”As veterinarians, we need to advocate for our patient’s reality in the moment at all times.”  Think of the pet and what he or she would want above all else.

Pets, like people, have a very wide variety of tolerance levels to pain.  Every patient’s pain management plan should be tailored to his or her unique situation.  However, it is better to treat all pain aggressively, knowing some of the pets with the highest pain tolerance may not have needed as much pain control than to undertreat pain and have more sensitive patients remain painful.  When in doubt, treat as if all of your patients are crybabies.

Perioperative treatment of pain (before, during and after surgery) it the best way to handle surgical pain, and it significantly decreases the incidence of chronic postoperative pain.  When this was discovered in the 1980′s, it was a “game changer.”  Dr. Tranquilli cited studies that have shown this to be true in humans who have undergone surgical treatment of knee conditions.

Conditions similar to human fibromyalgia probably exist in dogs.

People often wake up from propofol (an injectable general anesthetic used in human and veterinary medicine) happy, horny and clear-headed.  Pets seem to wake up from propofol happy…and clear-headed, which is a huge plus over many other anesthetic agents, which can leave patients groggy, crabby and with awful headaches.

Dogs who are probably suffering from depression will often show improvement of chronic pain conditions when put on selective serotonin re-uptake inhibitor antidepressant medications, which increase the amount of serotonin in the bloodstream.  This has also been seen in humans, in which cases it is more straight forward to diagnose depression and monitor pain levels.  This is probably due at least in part to the fact that serotonin most likely has an analgesic (anti-pain) effect.

Very exciting things are on the horizon in chronic pain control and osteoarthritis management.

Inflammation at appropriate levels aids in healing.  Excessive inflammation is painful and impedes healing and should be intercepted.

Thank Goodness for Experts!

Dr. Tranquilli is super excited about the physiology of pain control and how medications interact with every body system, but much of the lecture on the cellular/physiology level was over my head.  So instead of showing you the super-genius diagrams with the tiny lettering and arrows everywhere, I will say that as a veterinarian dealing with anesthesia and pain control on a daily basis, I want to know three things:

1)  My patient will survive this procedure/condition.
2)  He or she will be as pain-free as possible.
3)  I will not lose blood or body parts.

It was very fun for me to hear Dr. Tranquilli’s stories of medications from “the old days” and treating exotic patients and unexpected effects of new drugs as they have come onto the market.  I also love to see experts in their field passionate about what they do, and today was no exception.  However, in Real Life, I want anesthesia and pain control to be as boring and straight-forward as possible!

Beyond Medicine…

The focus of today’s lecture was medication, but pain control, of course, also encompasses a much wider array of prevention and management.  So please share your experiences with pain control in general, as well as non-drug pain management modalities you have found helpful…physical therapy, chiropractic, nutraceuticals, acupuncture, T-touch, environmental manipulations (such as carts, ramps, supportive bedding…) and any other concepts or aids that have helped your pets with pain control.

May your pets all be happy, healthy and pain-free 







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17 comments

  • December 12, 2011 7:10 amPosted 2 years ago
    genjiscorner

    Pain management is always on my mind, with 4 senior dogs in the house. We tried acupuncture in conjuncture with pain meds for our 14 year old gal we recently lost.

    Reply
    • December 12, 2011 10:07 amPosted 2 years ago
      Shawn Finch, DVM

      Wow, 4 senior dogs is a house-full! I bet you have all sorts of pain-related issues come up! I am sorry to hear about your 14 year old. I hope the combination of pain meds and acupunture were able to keep her comfortable.

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    December 12, 2011 3:39 pmPosted 2 years ago
    Cindy D.

    I have a 3 and a half year old rescue dog who is probably a border collie/heeler/? mix. She has hip displasia and one of her knees is “blown.” She is on three legs a good deal of the time but rarely exhibits any overt pain symptoms. I give her 50mg of vetprofen usually once a day. She regulates her own activity level to a large degree. The first exray round (about a year ago) showed serious damage and a need for surgery. My financial and health issues did not allow for that. Now that I am recovering from my own hip replacement, I’m trying to mentally and financially gear up for Darcy’s hip surgery. I’m scared about her post-surgical pain and recovery. On her left side she’ll probably need her femoral head removed and then later go back in a do her knee surgery. It seems like a lot to put her through. But, I know how much pain I was in before my surgery. I am just not sure what to do about this situation. If I give her the high end dose of the NAISD, I’m afraid it will damage her liver and I’ll lose her to that. I feel caught between a rock and a hard place. She is a wonderful addition to my life and I want what is best for her.

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      December 13, 2011 6:51 pmPosted 2 years ago
      Anonymous

      Do you have a university with a veterinary program near you? It is a lot less expensive going through them and the vets at MU have been outstanding, caring and knowledgeable. You might check it out. Saved me $2000-$3000.

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    December 12, 2011 5:38 pmPosted 2 years ago
    Shawn Finch, DVM

    Sounds like you are on the right track! And that you both have been through so much! Yeah, don’t you hate that balance? I would rather take some risks and have a pet comfortable, than take no risks and have them in pain, but it is a difficult balance to reach sometimes. I will be anxious to hear that you are both well!

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    December 12, 2011 9:36 pmPosted 2 years ago
    Anythings Pawsable

    Where are you located? What State?

    Reply
    • December 12, 2011 9:47 pmPosted 2 years ago
      Shawn Finch, DVM (Author)

      Nebraska! :)

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    December 13, 2011 4:24 amPosted 2 years ago
    Cherry

    I’d just like to say, that I wish all dogs had a kind, intelligent, caring ‘Mum’ that Cindy D. obviously is! Brilliant article, thoroughly enjoyed it, but gosh…I wish I could find a vet to treat me!

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    December 13, 2011 8:44 amPosted 2 years ago
    Shawn Finch, DVM

    Thank you Cherry! And I agree-Cindy D. Darcy is blessed to have you. Cherry, I hope you find your vet soon!

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    December 13, 2011 6:32 pmPosted 2 years ago
    Kristin Turner

    Thank you for the article. My 10 month old puppy George, is 1 month post-op bilateral MPL with tibial transposition. In the last few days he has developed swelling and inflammation around his knees and he is really grouchy (totally the opposite of his normal sweet self) and trembling in pain :( Found out he is rejecting the pins, but we need to try to keep them in a couple of weeks longer since the bone isn’t healed yet :( The vet hesitated when I asked him for an anti-inflammatory and stronger pain med. He said George is far enough out to not need them, but I insisted because of the new symptoms and obvious pain(he doesn’t want to put any weight on either leg). I didn’t see any reason George should have to suffer simply because the timeline says he shouldn’t need pain control. I sat in the waiting room with George for hours until they finally agreed to give me some meds for him.
    He is now happy and resting comfortably in my lap. Counting down the days until we can have the pins removed!

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      December 13, 2011 6:41 pmPosted 2 years ago
      Shawn Finch, DVM

      Aw, poor George! I am SO glad you were such a strong advocate for him.

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    December 13, 2011 6:50 pmPosted 2 years ago
    Cindy D.

    I abhor people or animal “doctors” who act as though they know it all. They will be the ones to determine if the dog or the person is in pain. How dare they! I suffered for two years before I got an accurate diagnosis of avascular necrosis for myself and I’ve changed vets several times if I don’t think they take me seriously about my dogs’ issues. I have a Ph.D. so I am very familiar with the “I’m the expert” attitude and it stinks no matter what the profession. For those of us who know our animals or ourselves I think the medical profession should listen carefully to what we tell them. We can make their jobs easier and ourselves healthier and happier if we cooperate. We must advocate for ourselves and our animals to get the best care possible. It wasn’t very long ago that the medical profession thought little boys did not need pain meds when they were circumcised. What nonsense.

    Thanks for your good work, Dr. Finch. You are a credit to your profession.

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    January 3, 2012 5:13 pmPosted 2 years ago
    Minneh

    My now two-year-old rottweiler/chocolate lab/shepherd mix was diagnosed with hip dysplasia a year after I adopted him. He also has a sensitive stomach. He takes glucosamine and chondroitin supplements that he takes daily for his hip and a probiotic for digestion, and I’ve learned to keep anti-inflammatories, pumpkin, yogurt, gas-be-gone, and pepto bismol in the house at all times, as well as avoiding any rawhide, corn, and soy food and treats, and minimizing the amount of wheat, beef, and certain types of fish he eats. My coworkers at the Petsmart I work at often joke that I’m obsessed with and spoil my dog, and they’re right; I’m obsessed with keeping him healthy, happy, and as pain-free as possible.

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      January 14, 2012 10:08 pmPosted 2 years ago
      Anonymous

      have you heard of vetstem cell therapy? Google vet stem dna cell therapy. Its doing exstrordinairy things for hip disp. and arthritis.

      Reply
      • January 15, 2012 7:56 pmPosted 2 years ago
        Shawn Finch, DVMFINCH

        Yes, I have heard great and encouraging things about stem cell therapy!

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    January 24, 2012 4:44 pmPosted 2 years ago
    evelyn

    I have 6yo rottie named sally. She’s really a sweetheart. Sally already had surgery twice because of gland mamary cancer. The first biopsy say that it is mixed mammary complex carcinoma which is malignant. The biopsy of second surgery said it is mammary epitneliosly, intralasio kista mamary. The 1st surgery is around august 2011 and 2nd is at november 2011. Now the scars from surgery is completely recovered and there is seemed no swelling gland anymore. She is healthy, love to ride and play at the park, and eat normal. But about a month ago, i discovered she had limp and now her right back foot like stiff and hanging not touch if she walk. I really worried because vet have different diagnose artritis , tromboembolism…today vet give her aspirin and tomorrow piroxicam (pain killer) but vet say only for a week. I can see sally is in pain and feel uncomfortable. She eat not as much as usuall too…im afraid if she will get sick. I read your article and your passion toward pain manGement is so good and helpfull…also people shared stories about pain management for their loving pet. Do you have suggestion for sally if you dont mind and i just wondered how we can search the caused of the pain….thanks so much..

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    December 10, 2013 11:50 amPosted 10 months ago
    Anonymous

    My big dog was limping badly and went to the vet to find out the bad news, it was a torn acl ccl knee tendon and was told by my vet that the only solution was tplo surgery or tta surgery or tightrope surgery. I called numerous vets in the area, all said surgery only. I researched online to find alternatives to surgery and learned that a dog knee brace does basically the same as surgery for a torn CCL or ACL. Support the knee from the outside without painful complications from surgery. Online there are several companies that made dog knee braces. I ended up trying several, as each one seemed to have fitting problems. The braces all worked to a point after finally figuring out how to make it fit but had to keep readjusting as the braces kept slipping down or the brace used a donut foam tube shaped strap wrapped too tightly on the hock to hold the brace up. I tried the posh dog knee brace which had an added lower extension to prevent slipping and an improved sleeving system that also helped with the slipping problem. And the straps worked better too. I have used it for several months and am very happy to see that it actually works, my dog is healing without any complications that can happen from surgery. Fortunately I didn’t listen to my vet or the other vets and took time to look out for my dog and found an alternative. I use the dog knee brace with conservative management and supplements like glucosamine, flax seed, and salmon oil. I hate to see other dogs go thru unnecessary surgery when there is a safer way. The healing takes several months whether you go with surgery or a brace. But the brace doesn’t have horrible side effects like infections, bone cancer, corrosion of the implant, amputation of the leg or even worse I read. I would tell anyone try a brace. Surgery is not guaranteed and if it goes badly your dog will suffer in pain. Go the safer softer way and try a brace instead.

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