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!
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 ♥