Owner advocacy makes the difference for pets in pain
By Dr. Narda Robinson
October 10, 2009
In the words of the philosopher and ethicist, Bernard E. Rollin, “both human and veterinary medicine can no longer ignore the moral and medical dimensions of felt pain.” But pain medicine in the veterinary profession is still a “touchy” subject.
On the one hand, more veterinarians are expressing interest in learning how to recognize and definitively treat pain; the International Veterinary Academy of Pain Management now offers certification in this field. And the lead author of the Association of Shelter Veterinarians’ guidelines for spay-neuter programs recently wrote, “[W]e acknowledge that analgesia [should] be provided to each animal independent of economic status of the program.”
On the other, however, some veterinarians still cling to the outdated notion either that animals don’t feel pain (ouch!) or they think that instituting pain control after surgery adds too much cost or takes too much time (although neither argument holds water). Some merely forget to think about it, having become desensitized or never truly appreciating how animals express pain, therefore ignoring how much pain they may cause with spays, neuters, and orthopedic surgeries or amputations, such as declaws.
Fortunately, more veterinary hospitals and animal shelters are agreeing that leaving animals in unmitigated pain is inexcusable. A wide variety of safe, inexpensive, and effective analgesic (pain relieving) options exist; treating pain successfully may include non-drug measures as well such as acupuncture, massage, and cold packs, in addition to medication.
At our Center for Comparative and Integrative Pain Medicine at Colorado State University, we welcome the evolution of veterinary medicine into a kinder, gentler profession in which practitioners no longer regard adequate pain management and the ethical treatment of animals as irrelevant to veterinary medicine.
Sometimes, though, the progress seems slow. It’s hard to change the minds of those who either don’t know or don’t care about treating pain. This is not unique to veterinary medicine; the same holds true in the human field. The difference, though, is that most humans can tell their doctor where they hurt.
Because the majority of non-humans cannot utilize the English language to inform us if, let alone where, they hurt, a vast amount of pain goes unrecognized. We may misinterpret a reluctance to go on walks as stubbornness instead of our dog telling us it hurts too much to go on a run today. When our older cat urinates outside of the litter box, could he be telling us the sides are two steep and his hips too painful to make it over time and again?
In order to alert the public to the cues their companions are giving about pain, my pain medicine colleagues and I developed a bookmark from our center that lists the Top Five Telltale Signs of Pain. We did this to empower people to detect pain in their own animals so that they can bring this to their veterinarians’ attention.
To get you started, then, here is our list on the “Top Five Telltale Signs of Pain,” based on our experience treating small animals in our pain practice at CSU:
1. Postural changes
- To begin with, look at your dog or cat. Is the back hunched up or sunken down? Back pain is a big problem in our four-legged friends. You might notice that midway down the back, just past the ribs, the back arches up. Press gently but firmly on either side of the spine, for several inches above and below this spot. Does he or she wince, look around at your hand, or sink down? Does the tissue feel ropy, or is there muscle atrophy (thinning) in the area? This is an especially common issue for geriatric animals; the disks between the vertebrae and the ligaments holding them in place deteriorate over time, and spinal cord compression, compromising neurologic function, could start to appear. Also check the lumbosacral junction, just ahead of the pelvis where the back ends and the sacrum begins. This is another common location for disk disease, arthritis, and nerve compression.
- Have you noticed that your dog walks with his head down? When was the last time he looked up to see what you were doing? If you hold a treat in front of him while he is sitting, does his neck only extend (bend backward) so far and then stop, causing him to follow the cookie with the eyes only? He could be having neck pain. If so, you may also find that the neck feels tense and thick. Have him eye the cookie as you bring it to the right and then the left, and notice if he turns more readily to one side than the other. Does he engage his body to turn to follow the morsel after a certain point? When it becomes too painful to turn the head by bending the neck, they will then use their body to complete the motion.
- Has your dog or cat become “rickety”? Do they walk with a stiff, painful-looking gait, reluctant to bend the limbs, neck, or back? Arthritis causes pain in our four-legged friends like it does in us, but be careful about assuming that everything that causes stiffness and soreness must be stemming from arthritis. Other problems can cause pain in older animals, including cancer and spinal cord injury. Treating pain appropriately first requires establishing a diagnosis. This may entail taking a radiograph (x-ray) but most certainly should include a neurologic and orthopedic examination by a veterinarian.
- Finally, look for other features of pain as well, such as asymmetry in gait (right versus left), indicating a painful limb. If the head bobs up and down when walking, your dog or cat could have a painful forelimb; the head drops down when the less painful limb strikes the ground. This takes the weight of the foot strike off of the hurting limb.
2. Activity changes
- All too often, a decline in activity becomes misinterpreted as “just getting old” or worse, “she’s a lazy couch potato”. Before counting couch-sitting as simply a life-style preference, think about times earlier in life when she may have bounded up and down stairs, begged for walks, and sought play with others of her species. Has that changed over the years? For cats, especially, no longer jumping on chairs or other objects can be a clear giveaway that he’s in pain.
3. Mood changes
- How do you feel when you hurt? Do you want to interact and be sociable, or do you withdraw? Does pain make you anxious, irritable? Do you become less affectionate, not able to reach out to others because you are lost in your own world, enveloped in your discomfort? Like you, your animal members of the family react emotionally to pain, stress, and other forms of discomfort. Be understanding and instead of retaliatory, and check with your vet not only about pain, but also about cognitive dysfunction and internal medical disorders.
4. New habits
- What else might have changed in the past year? Do you notice that your dog or cat keeps licking a certain area? Are they panting at night, unable to settle down? Does he cry or groan when shifting position? Has it become more difficult to keep him clean or brushed because he will not tolerate touch? All of these can point to pain.
5. Changes in Daily Habits
- Animals that hurt lose their appetite and cannot rest comfortably. They shift positions constantly and may find it difficult to adopt a suitable posture to urinate or defecate. Abnormalities in the activities of daily living such as eating, sleeping, pooping, and peeing show us that something isn’t right. Whether due to pain or some other cause, it’s worth looking into sooner rather than later, when the problem may no longer be treatable.
Identifying pain is merely the beginning. Treatment options include drugs (anti-inflammatories, anticonvulsants, opioids, etc.), interventional pain medicine procedures (e.g., nerve blocks, joint injections), herbs, supplements, lifestyle changes, and physical medicine modalities such as acupuncture, massage, heat, and cold.
A “multimodal” pain management approach institutes an array of options because when an animal has chronic pain, starting out with only one approach may be insufficient. Your animal will reap the benefits of a treatment plan tailored to the source and type of pain.
How will you know it’s working? Re-take the pain inventory described above a week or two after treatment begins. You should start seeing a difference.
Of course, if a vet prescribes NSAIDS for pain management, then there is information that is supposed to be given to the client along with the prescription:
http://www.petconnection.com/b.....-tell-you/
In a previous discussion here, it was revealed that all too often, vets just hand out the meds without the accompanying information.
Comment by The OTHER Pat — October 10, 2009 @ 1:40 pm
Here is the previous discussion referenced above:
http://www.petconnection.com/b.....erinarian/
Comment by The OTHER Pat — October 10, 2009 @ 1:41 pm
As the owner of two seniors and three about to be seniors, I appreciate the information you have given. I will print it off and keep it as a reference.
I’m also glad that the veterinary community as a whole is dealing with this. During my rescue experiences, I ran into a crusty old time vet who refused to give any pain meds (for anything) because the pain would keep the animal less active. I also dealt with a couple who didn’t believe the animals even felt pain!
Comment by catmom5 — October 10, 2009 @ 2:58 pm
It amazes me it’s taken this long for progress to be made in the companion animal field. I remember eight years ago having to demand from my vet analgesics for my dog’s spay post-op recovery. My current vet is probably a little more analgesic happy, but I’ll take that over a dismissive “they’ll be fine” statement.
I also work with farmed animals and we take the animals to a large, prestigious university teaching hospital. It is incredibly frustrating that, even with all the scientific evidence to the contrary (from researchers and professors at the school!), the vets still think cattle, goats, sheep pigs, chickens, turkeys, etc. shouldn’t be given post-op analgesics. We require the vets to provide the drugs to ease the animal’s pain. That’s a little ridiculous.
I’m happy progress has been made in the companion animal world, but there is still a lot of work to be done for farmed animals and avian species.
In any event, very useful information you have provided. It’s a good reminder to be vigilant with what the animal’s body and behavior are telling us.
Comment by Rinalia — October 10, 2009 @ 4:11 pm
I don’t take medication for every little ache or pain, and neither do I want my pets to.
Sometimes the medication causes more problem than the pain. I think NSAIDS are widely overprescribed and many times pet owners are not given any warning about possible side effects - which can include death.
I’ve been in rescue for 15 years now and we have spayed and neutered hundreds of dogs. I have not seen any evidence that they were in significant pain after surgery - most of them seemed perfectly normal the following day, and had to be restrained to keep them from being too active. Only one time in an older dog did I have a situation where I thought there could be a problem; the dog did not seem to be coming out of the anesthesia and in that case we made a return trip to the vet later that night. That was not really a pain problem either.
I think human medication is overprescribed too. I have a friend who just spent two weeks in a clinic in Chicago getting weaned off narcotics prescribed by her doctors for headaches. She had become addicted and was having withdrawal symptoms that caused her to be hospitalized.
I am not against pain medication in appropriate situations; I’m sure they have a place in treatment after major orthopedic surgery. I have given Rimadyl to older arthritic dogs and it has helped them keep mobility. But I don’t think drugs are necessary for minor temporary pain, in pets or people.
Comment by Mary — October 10, 2009 @ 4:11 pm
A spay is major abdominal surgery. It’s not MINOR. It’s agonizingly painful.
Animals hide their pain. Our casual observation that they “seem fine” is not always reliable. What is incontrovertible is that animals whose post-surgical pain is controlled have better outcomes than those whose pain is not. Humans,too.
Americans have a weird puritanical attitude that we, and by extension our pets, should just buck up and get on with it, and not do things that will make the pain go away. But there is nothing noble about suffering, and pain doesn’t just hurt, it harms. It supresses the immune system, retards tissue healing, and interferes with restful sleep.
Of course the benefits of many meds aren’t worth the risk, but that’s nothing unique to pain meds. There are plenty of very safe, well-tolerated pain medications. NSAIDs are only one class of pain drugs, and you can control pain without them.
I know we can’t escape the influence of our culture, but take a long, hard look at the science, Mary, and I think you’ll see that it doesn’t support your position.
By all means be skeptical about the drugs being prescribed for you and your pets, but don’t let that translate into a belief that it’s better to be in pain. Because the choice is not, “Suffer pain or take dangerous drugs.” There are plenty of options that enable us to have the best of both worlds in most cases.
Comment by Christie Keith — October 10, 2009 @ 4:37 pm
But I don’t think drugs are necessary for minor temporary pain, in pets or people.
Comment by Mary — October 10, 2009
“Common” is not the same as “minor.” What part of having your entire reproductive system sliced out sounds like “minor surgery” to you?
You may damn well believe that when I had my abdominal surgery I was on pre- and post-op pain control. Even with it, I hurt like screaming hell.
You may damn well believe that when McKenzie had her spay/gastropexy, she had pain control.
I recognize that it’s very necessary to do many spays without pain control in the interests of preventing even more suffering because of pets who will not find homes. I recognize, too, that it’s necessary to do spays assembly-line style or for rescues to bargain-hunt, for the same reason.
But as always, we need to base our decisions on the science so we know what trade-offs we’re making and can evaluate them accurately.
Comment by Gina Spadafori — October 10, 2009 @ 4:58 pm
I echo Gina and Christie. When Dot had her spay, OY. I was glad I did recognize it as major surgery up front. I was dealing with a 50lb 1.5yo Dal. We took it slow and it was a good 10 days before she was back to more of her old self. We are talking 2 layers of stitches here, with some muscle thrown in. How that can be minor . . . . ? She was very sensitive to the pain to the point she wouldn’t eat. Even after the 10 day point, I restricted her activity a bit. Didn’t really want her running out at full Dal speed knowing she was still healing on the inside.
Sure, I’ve seen lots of shelter and rescue dogs seemingly bounce back quick, but in my mind, that still doesn’t make it minor surgery and we always restricted activity for at least a few days. Now that I’m thinking about it, I don’t see how a spay is any more minor that the stone surgery a male Dal rescue went through. He was also slow for about 10 days, pain meds and all. He started lifting his leg a bit around day 7, iirc. But I’m betting most people would take his surgery more ‘seriously’ than a ‘routine spay’.
Comment by straybaby — October 10, 2009 @ 6:05 pm
I don’t care what species you are, there is nothing minor about having a surgeon slice open your abdomen and remove reproductive organs. Perhaps testicle removal is not so invasive, I wouldn’t know as I never had any, but I have had a cystic ovary removed, and it was no walk in the park even though my health insurance company deemed it only worthy of “day surgery”.
Earlier this week, one of my dogs had a major dental requiring tooth extraction of an incisor and 2 precarnasials. My vet sent him home with a pain med and an antibiotic, and you can be sure I have been giving him both as directed. Having had teeth extracted myself, I know first hand that’s no stroll on a velvet lawn either! The “inferior species” have as many nerve endings as we do, if not more. Why should they be kept in pain if it’s not necessary just because they are more stoic than we? I fail to see the point.
Comment by Anne T — October 10, 2009 @ 7:07 pm
I’d find testicle removal invasive.
Comment by Bob — October 10, 2009 @ 10:50 pm
A good article on this topic is the “AAHA/AAFP Pain Management Guidelines for Dogs and Cats” in the Journal of the American Animal Hospital Association [2007;43:235-248].
“Historically it was thought that animals did not feel pain or that they perceived pain differently than humans. As a corollary to this concept, it was suggested that pain following surgery or injury was beneficial to animals because it limited movement and thus prevented further injury…Untreated pain decreases quality of life in all patients, and prolongs recovery from surgery, injury, or illness.”
“As advocates for their patients, the veterinary team has the responsibility to recognize, assess, prevent, and treat pain. Pain should be thought of as the fourth vital sign — after temperature, pulse, and respiration — and integrated into all patient evaluation.”
The authors provide a list of frequently overlooked causes of pain; I think that it is common to forget that most illness have some degree of pain to them, whether it’s congestive heart failure, cancer, urine scald, dental or gum disease, eye disease, etc.
Also, my colleagues and I at the pain center have developed several pain scales to help those in our profession monitor and record how dogs, cats, and horses exhibit discomfort emotionally and physically. They are available at the IVAPM website in pdf form at: http://www.ivapm.org/siteSearc.....Search.pml ; they are the CSU acute pain scales.
The IVAPM website also has a free online video to watch called, “Is Your Pet in Pain”, to help educate the public on the detection of pain at http://www.ivapm.org/site/view.....inPain.pml .
I think our main challenges remain denial and misinformation. Animals naturally hide their pain; it’s when we aren’t watching them or nearby that they express pain most obviously, so it’s easy to think that it’s not a problem. But, research has shown that even one intensely painful episode early in life can alter the nervous system permanently. In the human pain medicine field, a condition called “chronic post-surgical pain” or CPSP is gaining appropriate recognition.
In the past, surgeons considered CPSP as “negligible” and “normal”. Thankfully, it is now recognized as an important clinical problem that can have serious economic consequences and significantly affect quality of life. It can happen not only after major surgery (amputation, hip replacement) but after minor surgical procedures as well.
I do recognize that not all veterinarians have gotten up to speed on the latest scientific and evidence-based reasons why pain control is important. That’s why I wrote this piece. We as caregivers need to speak out for the animals who depend on us, even if that means finding another veterinarian who will be better able to detect, treat, and even prevent pain. I agree, too, that too much pain medication can cause problems, which is why one needs to tailor approaches to the needs and sensitivities of an animal. One dose of an injectible, perioperative anti-inflammatory medication can go far in alleviating the pain from a spay or neuter, and is not that costly financially or time-wise to institute.
Not all pain needs drugs; providing a daily massage to a dog or cat with chronic back pain can sometimes alleviate a remarkable amount of pain and improve mobility, not to mention the benefits the provider gets out of this quality “together” time. Many of my animal patients insist on a daily massage once they experience the benefits! While it is not the same as a professional massage, there’s an amazing amount of benefit and soothing that we can provide to our own animals, at home.
Comment by Dr. Narda — October 10, 2009 @ 11:40 pm
Bob - LOL!
Comment by The OTHER Pat — October 11, 2009 @ 2:02 am
having neutered three cats in my life, this past one is the first time I’ve ever received anything for pain. I found it interesting, and useful. This cat is recovering better than the others did. Which is very nice to see.
Comment by Annette — October 11, 2009 @ 6:29 am
So last night I’m thinking as I’m trying to fall asleep (which is why I have such a hard time falling asleep many times!).
Why is it acceptable to NOT give pain med to shelter/rescue pets, pets reached through spay-neuter programs to poor communities, etc.?
The answer I came up with: The need for “quick-and-dirty” spay-neuters is like the need for “quick-and-dirty” emergency med on the battlefield or after a massive disaster.
It’s pain to prevent future pain and suffering. And of course, to save lives.
The analogy isn’t perfect. After all, if I had my burst appendix removed by a former combat medic using a sharp pocket knife dipping in boiling water on the third floor of a house isolated by massive floodwaters during an overwhelming natural disaster such as Katrina, it’s MY life that’s in need, and the gain outweighs the pain. Would I rather have that procedure done by a surgeon in an operating room with pain control … oh yeah oh yeah you bet. But it’s either this or die.
But in the case of shelter/rescue pets, feral cats, etc., we’re taking animals who are not personally in need of attention at that moment and subjecting them to levels of care that are not ideal in order to prevent suffering of future generations that will now not be born. Worth it? Still, I would say yes. Yes, BUT … can’t we give even those needy ferals a shot of pain med to ease them through the worst of it? Can’t that be factored into the cost as something that’s part of the “minimum care” standard we offer them?
It’s kinda hard to get your mind away from the “buts” and “what ifs” once you’re forced away from the “automatic” response we’ve all been conditioned to have, isn’t it? That it’s “good” to do inexpensive assembly-line spays without pain control — and that there’s no downside.
It’s just easier not to think at all, and respond as conditioned, which is why once they were tossed out here for refusing to engage in discussion, the people who went nuts when I questioned why declawing cats is considered “abhorrent mutilation” and an oviohysterectomy is considered “minor surgery” went somewhere else where they reassured each other of their conditioned responses by telling each other that I was a “cat-hating sadist” and a “whore for dog breeders.”
Of course, I’m neither. I don’t recommend declawing and my own cats have their claws, thank you. And almost all my pets are altered.
But I absolutely am a person who want you to show me the effing evidence before you sell me your dogma. As we all should be.
Comment by Gina Spadafori — October 11, 2009 @ 7:42 am
I’m baffled at the notion that cats/dogs don’t feel pain. How could they NOT? They’re mammals with advanced nervous systems. Not SHOWING pain is not the same as not FEELING pain.
Comment by EmilyS — October 11, 2009 @ 7:51 am
Good point, Annette; your experience is consistent with the evidence that indicates that patients do better after surgery when pain control has been addressed before the scalpel ever touches the skin and all the way through the recovery period.
Pretty much any animal (including the farm animals that Rinalia mentioned) recover more quickly and have fewer post-operative complications than animals left to recover on their own, dealing with untreated pain.
My friend who’s in private practice sees this all the time; clients call her when they’ve taken a newly adopted animal to a low cost spay/neuter clinic that hasn’t gotten on board yet with the whole “animals feel pain and need analgesia” concept. Inhalational anesthetics (gas anesthesia) don’t cut it; they may make the animal unconscious, but the painful stimuli from the procedure still enter the nervous system and wreak havoc. The inflammation that sets in after a procedure occurs well after the gas anesthetic has worn off.
The typical conversation goes this way:
Client: “My cat/dog/etc. just got spayed/neutered/declawed/cruciate repair/… and is now not eating/drinking/urinating/defecating/acting normally. I don’t know what to do; the vet said to give it a few days.”
My vet friend then recommends analgesia as long as other things check out okay (even only one-two doses of an anti-inflammatory often do the trick for the post-operative inflammation that is SO painful and not addressed with opioid medication).
There are many ways to confirm that at animal is having pain based on the signs and reactions to palpation that we compiled in our aforementioned CSU acute pain scales for dogs and cats.
Client calls back after analgesia: “S/he’s SO much better now! The pain medication made a world of difference!” For neuters, they can now sit or pee comfortably. For spays, they decide to eat and come out from hiding. For orthopedic surgeries such as cruciate repair, they’re not sitting around panting and whining.
There is a long road ahead with this, but I am so glad to see our vet students considering peri-operative and intra-operative analgesia (nerve blocks, epidurals, line blocks for incisions) when they are putting together anesthesia protocols. Most faculty are open to student input about pain meds, thankfully.
Most faculty, but not all, unfortunately, are willing to listen to student suggestions that a patient receive massage, acupuncture, laser therapy, etc. as an adjunctive to post-operative recovery. It’s not that there’s not scientific backing for each of those; the faculty members who resist just haven’t taken the time to learn about it, or instead may have heard someone give a pseudoscientific or energy-based explanation and were turned off, which I can understand.
The sad thing about this is that if clients are asked whether they would like their dog to receive a massage after surgery to comfort them and reduce pain, many would jump at the option. Same for other non-drug modalities or even medication in instances where non is usually given.
But clients are not likely given that option.
Rinalia, back to analgesia in animals used for food, research is showing that happy cows make more milk. Talking, singing, playing music for cows, giving them something comfortable to lay on rather than cement all make for better milk production. Given that it’s all about production for most of these creatures, if the ‘bottom line’ increases when animals are treated better, then there’s traction on this issue.
For farm animal sanctuaries, where the animals are NOT going to be used for food, staff still run into the “it’s too expensive” or “it’s unnecessary” mindset because it hasn’t in the past been convention to treat animals for pain, even for painful amputation and sterilization procedures, despite a willingness to pay from the sanctuary’s perspective. I don’t know the current prices, but from what I’ve heard, even pain control that costs under a dollar to institute is scoffed at by some operations.
Back to my earlier comment, I think denial is a biggie. If we admitted what these animals go through in terms of pain and suffering from the moment of their birth to when they face slaughter, a lot of the entire animal food production system/idea would need to be rethought.
Comment by Dr. Narda — October 11, 2009 @ 8:20 am
Gina, in response to your question,
“Why is it acceptable to NOT give pain med to shelter/rescue pets, pets reached through spay-neuter programs to poor communities, etc.?”,
it’s nice to see the Association of Shelter Veterinarians’ veterinary medical care guidelines for spay-neuter programs [Special Report in the Journal of the American Veterinary Medical Association, 2008;233(1):74-86] recommending:
“Analgesic agents are required for all patients undergoing neutering.”
Comment by Dr. Narda — October 11, 2009 @ 8:33 am
My vet pointed out another sign: when one of my dog’s knees bothers him (he’s got ‘loose’ knees), the opposite foot flattens out due to the compensatory weight shift. It’s the first sign he shows, too, so it’s been very useful.
EmilyS, I’ve long wondered about that myself. It’s not like the value of pain meds can’t be seen either - it’s really noticeable, how much faster animals whose pain has been controlled recover. Including me. I used to try and tough it out, and mostly what it got me was longer downtime.
Comment by Eucritta — October 11, 2009 @ 8:43 am
Eucritta,
The flattening of the opposite foot is a good thing to note. What we find as well is that when there are knee (or “stifle”, in veterinary terms) problems, the back suffers too because of the altered biomechanical loading/unweighting/shifting and the pain-spasm-pain arc that happens from nerve reflexes entering and exiting the spinal cord.
Next time your dog’s knee “goes out”, see if his back looks arched in the mid-section when he’s standing. You might also do the palpation exam today and find areas of tenderness or stiffness when you press firmly but gently on either side of the spine, just behind the ribs. This is a common concomitant to limb pain and frequently not detected without informed observation and myofascial palpation. We find back issues in nearly all of our geriatric, neurologic, and orthopedic patients.
Comment by Dr. Narda — October 11, 2009 @ 9:01 am
The idea that because an animal isn’t SHOWING its in pain, then it isn’t FEELING pain is completely ridiculous. There are billions of instances when humans, even those who complain long and loudly about a stubbed toe (which really, really hurts for 20 minutes), can and do suffer higher and longer levels of pain, and don’t make much, if any, fuss.
Moments after falling down steps and tearing a ligament and muscles in my foot, I was smiling and walking as if nothing hurt, because I didn’t want to upset my elderly neighbor (whose steps I’d fallen on). How many times do women who are suffering from unpleasant to excrutiating cramps, go to work and smile for the customer’s sake, because it’s not as easy to sell things to people when they don’t want to be around you because your grimacing and whimpering (women in retail, unite!). These are just two small examples, of the ability of people to ‘work through’ pain. Those who deny or brush off the pain an animal is in - after an obvious injury (such as major abdominal surgery, or ‘just a’ broken toe and anything in between), need to be reminded that pain is real and should be prevented or mitigated when possible. To purposely withhold analgesia (when it’s available) is actually cruel.
Mary said she didn’t think pain meds were necessary, especially for ‘minor’ things (and a spay isn’t minor!). I hope she realizes the cruelty of that statement - and her actions. Animals - both human and not - are better off when they aren’t in pain. Trying to train or interact with an animal in pain is difficult, and often pointless, as the animal can’t focus and is more inclined to resist and snap. How many animals get turned in to shelters/taken to vets and are put down because they are in pain and reacting badly to things? I’d hope Mary might rethink her position, at least for the animals she rescues, so they can have a better chance to enjoy their lives.
Comment by KateH — October 11, 2009 @ 9:10 am
I should also note, for safety’s sake, that anyone pressing (gently!!) on their dog’s back should only do so if there aren’t contraindications such as spinal instability or cancer.
Note as well that if your dog or cat are at all agressive or very painful, doing this could elicit a sudden response for the animal to let you know that that’s uncomfortable. I don’t want anyone to get bitten or scratched!!
Ideally, you should have your veterinarian do this, but since it’s all too often forgotten/omitted/never was included in a usual examination, my goal is to educate about how we do this.
I am always careful, however, and usually have someone restraining the head (holding them by the collar) if I suspect pain. A cat with chronic back pain may scratch. Being aware of this at the outset makes the examiner ready to withdraw the palpating hand suddenly. It’s also important to keep your face and eyes in the clear in case they do turn suddenly.
Ideally, what I like to do is incorporate my palpation exam in with my greeting of the animal. They think I’m just massaging/saying hi to them. While I’m doing that, too, I’m at the same time taking in information about how their body is doing and what muscles are tight or tender, and thinking about what that means for them medically and diagnostically.
Comment by Dr. Narda — October 11, 2009 @ 9:14 am
A neurophysiologic note on the toe stubbing: the more one stubs one’s toe, the more quickly and dramatically the nervous system responds.
Ultimately, until it might only take light pressure to make the toe hurt, due to the changes taking place within the nervous system (called “plasticity”) that convert simple, innocuous mechanical impulses such as light touch into pain stimuli. The chemicals and neural connections within the brain and spinal cord actually change to make pain impulses more likely to fire once something called “wind-up” sets in.
That’s why chronic pain gets so nasty. The nervous system may start to trigger pain impulses on its own, no longer requiring tissue damage or any other stimulation from the external environment.
Treating chronic pain effectively therefore takes a host of additional mechanisms into account and is decidedly more complex to adddress effectively, thereby reinforcing the need for pre-emptive, or preventive, analgesia, or at least early intervention and/or multimodal approaches.
Comment by Dr. Narda — October 11, 2009 @ 9:22 am
Dr Narda, my dog definitely has back pain when his knees bother him. He’s a dachshund cross, so we’ve all kept close eyes on his back. Fact is, his whole body is affected - I’ve found knots in his neck and shoulders, too.
Comment by Eucritta — October 11, 2009 @ 11:26 am
Kudos to you, Eucritta, for recognizing the extent of the myofascial restriction! Sounds to me like he’d love massage; that is, if he enjoys touch.
Comment by Dr. Narda — October 11, 2009 @ 4:00 pm
Dr Narda, my dog does enjoy massage. He also likes really thorough scritches, which I think sometimes relax him almost as well [g].
Comment by Eucritta — October 11, 2009 @ 6:13 pm
One argument I’ve often heard used against treating post-injury or post-op pain is that the animal (usually a dog) will “feel too good” (or some similar statement) and overdo or reinjure itself. Except perhaps in a puppy, I’m skeptical. Do you have a view on this?
We DO have to be our pets’ zealous advocates on this topic. I’ll never forget when years ago, my bulldog developed severe knee pain on a Saturday and the last vet left at our clinic (who did not know me or my dog) refused to see her or call in a pain med to hold us through the weekend. Unable to leave Lucie in that state, I took her to the nearest e-vet, but while they readily confirmed her extremely painful state, the only way to get a diagnosis would be emergency surgery, which the emergency doctor was reluctant to do. They kept her sedated and started antibiotics right after blood work came back.
Lucie ended up being hospitalized for almost a week, including having her knee opened, drained, old hardware removed, IV antibiotics, IV painkillers, and her recovery was touch and go. Vet#1 mercifully did not last long at our clinic.
Pain, after all, is also a symptom.
Comment by Susan — October 11, 2009 @ 7:47 pm
Using pain as a form of restraint is sadistic. It’s also unreliable. If a dog needs restraint, that’s why god invented crates and leashes and baby gates.
Comment by Christie Keith — October 11, 2009 @ 7:58 pm
Yes, I agree with Christie that there are reliable and compassionate means of limiting activity that don’t involve leaving animals in untreated pain. Using pain as a form of restraint may not be sadistic for some but in the veterinary clinic might turn ouyt to be more of a “that’s how it’s always been done” default approach that needs updating and reassessment based on facts and scientific evidence.
Purposely leaving pain untreated has potentially long-term negative consequences, including but not limited to the precipitation of chronic pain states as stated earlier. The physiologic costs of unmitigated pain include added stress on the cardiovascular and other organ systems.
Maladaptive behaviors may also result that bring into play additional sources of long-term suffering and difficulty living with others. Dogs and cats may suffer abuse because they are doing things that are unacceptable in the household not because they want to be “ornery” but because they are suffering in some way.
Then there’s the other matter, not yet addressed in this discussion, of saying that this or that animal is a “baby” when it comes to pain or that they are “just being over-dramatic” to get attention.
While each of us has our own associations with pain that are colored by our past experiences and resulting nervous system changes, there is also the genetic predisposition to being more or less tolerant to pain that must be considered. Some animals (and people) have a richer supply of pain receptors or pathways that send stronger pain signals.
For example, research has revealed a scientific reason why readheads have more pain susceptibility and exhibit resistance to local anesthetics, which accounts for their intense fear of dentists.
http://www.cnn.com/2009/HEALTH.....index.html
Could a genetic predisposition encoding a higher sensitivity to pain and emotional upset be why Northern breeds are so expressive about their feelings? Rather than brushing aside their whining and cries, might we accept that their experience of being left alone all day or their post-traumatic or post-operative pain experience is truly that much worse because of how their nervous systems are wired?
Comment by Dr. Narda — October 11, 2009 @ 9:17 pm
Using pain as a form of restraint is sadistic. It’s also unreliable. If a dog needs restraint, that’s why god invented crates and leashes and baby gates.
Comment by Christie Keith — October 11, 2009 @ 7:58 pm
Well said Christie. How would we feel if a doctor was to use this same reason for withholding pain relief from our child/parent ?
Comment by Alison — October 12, 2009 @ 1:05 am
“Dogs and cats may suffer abuse because they are doing things that are unacceptable in the household not because they want to be “ornery” but because they are suffering in some way.”
One of Suzanne Clothier’s favorite techniques in her workshop on “aggressive dogs” is point out to the owner some obvious (when looked for) sign of pain. If the dog snaps when the owner scratches her back, it might be because the dog is having hip pain (shown through limping). Rather than being aggressive, the dog is asking the owner, in the only way a dog has, to please not touch that spot.
Comment by EmilyS — October 12, 2009 @ 7:00 am
Interestingly, and specifically for newborns, there is an ongoing debate about pain management even for young humans.
Newborns, like our animals in a way, are unable to clearly report pain and as such it is up to others to recognize, assess, and manage these non-verbal patients’ pain.
Three decades ago, anesthetists considered newborns and infants too sensitive to gas anesthetics and opioid analgesics; as such, “newborns and infants were regularly denied adequate analgesia for painful procedures”; sometimes no analgesia was used at all [Mancuso T and Burns J. Ethical concerns in the management of pain in the neonate. Pediatric Anesthesia. 2009;19:953-957.]
There was also the widespread belief that newborns’ nervous systems weren’t developed enough to perceive pain. This belief system was shattered by later research that revealed that newborns demonstrated similar or even exaggerated physiologic and hormonal responses to pain compared to older children and adults. Research also indicated that prolonged or severe pain could worsen health status in neonates.
While there is ongoing debate about the relative safety of various analgesic and anesthetic agents on the developing nervous system, this article on “Ethical concerns in managing pain in the neonate” concludes that: “Until more definitive research closes gaps in our knowledge, it is both medically and ethically prudent to follow existing consensus guidelines on the prevention and management of pain in the newboard than emphasize ‘routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.”
Sounds to me like a good plan for our non-human friends as well.
Comment by Dr. Narda — October 12, 2009 @ 7:06 am
EmilyS,
Thanks for that info about Suzanne Clothier’s sensitivity to the connection between pain and aggression in dogs. I see this in cats as well. My equine veterinary colleagues who have taken my acupuncture course report that horses who have previously been hard for anyone to work with settle down once their back or neck pain is treated. Imagine having someone on your back with a poorly fitting saddle or pulling on the reins when your neck hurts.
Comment by Dr. Narda — October 12, 2009 @ 7:11 am
Thanks for your responses. I will be posting a link to this issue when I hear that “pain is good” argument repeated in the various forums I frequent.
Comment by Susan — October 12, 2009 @ 4:32 pm
Susan, while I’m sad hear that the outdated dogma persists in so many places, it’s good to know you’ll be on the lookout for “teachable moments”.
You might also direct those who persist with “pain is good” arguments to the American Animal Hospital Association (AAHA) standards page at
http://secure.aahanet.org/eweb.....eStandards .
Conscious and proactive attention to pain assessment, management, and training is obviously a characteristic they feel is important to include as they work to identify and accredit hospitals that deliver quality care for animals.
The AAHA Outline for Pain Management Protocol appears at
http://trends.aahanet.org/eweb.....otocol.pdf .
I fail to see anywhere on this document where it states that “pain is good” or “let them sit in their cage and whine; throw a towel over the door or put them in a back room so you don’t have to watch them suffer”.
Comment by Dr. Narda — October 12, 2009 @ 7:12 pm