Just the idea of medicating your pet can send both of you running for the hills. Mikkel Becker, CBCC-KA, KPA CTP, CDBC, CPDT-KA, CTC and Debbie Martin RVT, CPDT-KA, KPA CTP, VTS (Behavior) explain how you can make this stressful task rewarding and Fear Free for both you and your pet.
As the final piece of our pain management series, our experts each take a moment to let us know their most important pieces of information and expertise that they hope every veterinary professional can take to heart.
The management of patient pain can often fail when the onus is put onto the owner to properly medicate their pet. Our experts discuss best practices on managing pain at home with clients, particularly with feline patients who can often be difficult to manage. There is also a discussion of what acute pain does to the body of our patients.
One of the most overlooked tenets of Fear Free is the hospital environment and how it can affect your patients’ fear, anxiety, and stress. Our roundtable of experts discuss how you can create a welcoming environment for your patients, clients, and team members.
The roundtable of experts discuss how the implementation of Fear Free in hospitals can help reduce the stress of all members of the veterinary team and owners—and thus the FAS of the clients and patients. There is also a discussion on how to handle referral clients, especially those who may not be able to come back for repeated visits and how putting yourself in the place of the animal can help you to understand how to manage the hospital environment for them.
Blood draws are an essential part of practicing veterinary medicine, but they can be stressful for the professional, let alone the patient. Veterinary nurse/animal trainer Laura Ryder, CPDT-KA, KPA-CTP, shows you how you can get a canine blood draw done the Fear Free way.
Join a star-studded roundtable of Fear Free experts discussing the interaction of pain and fear, how the variability between specific patients and species can affect pain, and how management of fear can help to alleviate pain.
Managing Chronic Pain in Cats Following P3 Amputation
Cats’ paws and toes play a critical role in their lives. Sometimes, however, we see cats in our practices who have had their P3s amputated. These cats, no matter how carefully their surgeries were performed, are subjected to the same nervous system aberrations that occur in humans post-amputation, which can result in chronic maladaptive, neuropathic pain in up to 80% of patients.
In this session, Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP, will explore ways to “unwind” the peripheral and central sensitization that occurs in the wake of P3 amputation, both in the feet, and downstream from altered biomechanics.
Understanding Declaw Salvage Procedures
Until declaws are eliminated in the United States, you will most likely encounter declawed patients in your practice. With recent advancements in surgery, salvage procedures can help manage pain and improve limb function. Join one of the leading figures in declaw salvage surgery Nicole Martell-Moran, DVM, MPH, DABVP (Feline Practice), to learn about the procedures involved, how to find training, and how you can incorporate it into your practice.
The “fear center” and the “pain center” occupy adjacent areas of the brain. The thalamus is the area of the brain that registers pain, and on either side of the thalamus is the limbic system, which is responsible for emotions including fear, anxiety, and the sequelae of stress (FAS).
These two areas of the brain “talk” to each other and send signals back and forth. The thalamus sending signals to the limbic system is what causes your reaction to hitting your finger with a hammer. When this thalamic-limbic crosstalk happens in an animal in acute pain, the animal may lash out at the owner or veterinary staff.
So now consider an animal who is in pain and has been presented to you. If experiencing acute pain, the animal may lash out due to a combination of pain and FAS. If experiencing chronic pain, many of these pets act dull and disinterested. The owner may even comment that the pet just doesn’t socialize and lacks the energy and mobility that she used to demonstrate. Even worse is the animal who has chronic pain, say from osteoarthritis, and now has an acute injury on top of it. The distress in some of these animals is almost too much to bear.
It is easy for us to recognize and treat acute pain, but the diagnosis of chronic pain states can be difficult for a variety of reasons. It takes time to take a thorough history and perform a complete pain exam on dogs and cats. However, there are many resources available to make that task easier, including pet owner-friendly screening checklists for osteoarthritis (Cat, Dog) and expert tips for the OA exam (feline OA exam).
Even with successful diagnosis, the treatment of chronic pain can sometimes be difficult especially if your treatment is narrow in focus. But it is essential to make a timely diagnosis of chronic pain and provide effective analgesia to be successful in therapy. And it is also important that the owner understands your diagnosis, whether through education alone or with the help of radiographs and teaching tools (feline and canine chronic pain). The owner is an essential member of the pain treatment team, both in the evaluation of treatments over time but also in enlisting them in the day to day therapies that might be required.
My approach to the treatment of chronic pain in dogs, for example, is to build a pyramid of treatments, and on the base layer I start with an NSAID. The NSAID I use most commonly is Rimadyl® (carprofen), which I really like for its effects on both pain and inflammation. For many chronic OA cases, there are other factors that can influence the ability to manage both pain and disease progression, and they should all be looked at.
For example, consider the animal next. Is he overweight? One study showed that in an obese dog, losing only about 10 percent of body weight can significantly improve lameness1. In other words, weight loss for an overweight dog can amplify the pain relief achieved with an NSAID alone
What about exercise? Again, one human study showed that one-half hour of exercise 5 days a week for people with knee OA was the equivalent of – you guessed it: an NSAID! So now you have tripled your pain-relieving efforts by building a solid foundation of multi-modal therapies, upon which you can add other therapies as needed.
It is beyond the scope of this writing to discuss all possible treatments: medications, physical therapy, acupuncture, and so forth, but I encourage everyone to read or re-read the 2015 AAHA Pain Management Guidelines for a thorough review of all of the pain management options we have for both acute and chronic pain.
What does the future hold for us? The most exciting thing I have seen on the horizon is the introduction of anti-NGF monoclonal antibodies. NGF, or Nerve Growth Factor, is one of several major “players” in the transmission of pain via the nociceptors. The use of these monoclonal antibodies holds great promise to reduce the sensation of pain in our patients with osteoarthritis. More information about the action of anti-NGF monoclonal antibodies can be found at the New Science of OA Pain website.
IMPORTANT SAFETY INFORMATION FOR RIMADYL: As a class, NSAIDs may be associated with gastrointestinal, kidney and liver side effects. These are usually mild but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including Rimadyl. Use with other NSAIDs or corticosteroids should be avoided.
See full Prescribing Information at:
https://www2.zoetisus.com/content/_assets/docs/Petcare/rimadyl-prescribing-information.pdf
Reference:
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
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