A new reference for pain management in dogs and cats has just been published and while it is aimed at veterinary practitioners, it provides a lot of good information to owners as well. It is called Guidelines for Recognition, Assessment and Treatment of Pain and was produced by the World Small Animal Association’s Global Pain Council.
As the document states:
Pain is a complex multi-dimensional experience involving sensory and affective (emotional) components. In other words, ‘pain is not just about how it feels, but how it makes you feel’, and it is those unpleasant feelings that cause the suffering we associate with pain.
These new guidelines go into great detail about how to recognize, assess, and manage pain associated with many conditions in dogs and cats. The protocols and techniques that are presented should be extremely helpful to veterinarians looking to improve their ability to manage pain in their patients, but here’s what I think will be of most interest to owners:
1. The pictures and descriptions of painful cats and dogs in comparison to what comfortable patients look like. Refer to these when you’re wondering if your pet might be hurting.
2. The table entitled Perceived Level of Pain Associated with Various Conditions. Look up your pet’s health concern. If your cat has been diagnosed with an aortic saddle thrombus (clot blocking blood flow to the hind legs) or your dog has bone cancer and you don’t think he or she is in much pain, think again. Both conditions are categorized as “severe-to-excruciating.”
3. Specific pain management protocols. If you worry that your dog or cat’s pain is not well controlled, look up your pet’s condition and you’ll find options for analgesia. Talk to your veterinarian about any that have not yet been tried. Don’t overlook the non-drug options like physical rehabilitation, acupuncture, diet, nutritional supplements, medical massage, and surgery.
4. The section entitled Common Pain Misconceptions. Specifically,
- ‘Opioids cause respiratory depression in dogs and cats.’ False. This misconception has arisen from the fact that humans are very sensitive to the respiratory depressant effects of opioids. However, this is not the case in dogs and cats and opioids have a wide safety margin in healthy patients. In sick animals, opioid drugs should be titrated to effect to minimize the risk of respiratory compromise. For this to occur, the patient must be markedly mentally depressed.
- ‘Non-steroidal anti-inflammatory drugs are toxic in dogs and cats.’ False. As most pain is associated with inflammation, NSAIDs are the mainstay of analgesia for both acute and chronic pain in dogs and cats and are widely and safely used in many animals around the world. The analgesic benefits far outweigh the potential risks. However, it is essential that the individual patient is screened for potential risk factors prior to administration and is monitored during treatment. Many of the NSAIDs licensed for use in humans have a narrow safety margin in animals and should be used with caution. Where approved drugs are available, they should be used preferentially.
- ‘If I alleviate pain, the animal will move and disrupt its suture line/fracture repair.’ False. The use of pain to control movement following surgery is unethical. Where activity needs to be controlled, other means should be adopted (e.g., cage confinement, controlled leash walking, etc.).
- ‘Newborn and infant animals don’t feel pain.’ False. Animals of all ages feel pain.
- ‘Analgesics mask signs of patient deterioration.’ False. Appropriate pain relief eliminates pain as a potential cause for signs of patient deterioration (e.g., tachycardia).
- ‘Anaesthetics are analgesics and therefore prevent pain.’ False. The majority of anaesthetics (inhalant, propofol, barbiturates) block conscious perception of pain but are not analgesic as nociception is still occurring during the unconscious state. The pain generated during the anaesthetic state will be experienced upon awakening.
To quote the Guidelines for Recognition, Assessment and Treatment of Pain, “Pain is an illness, experienced by all mammals, and can be recognized and effectively managed in most cases.”
Let’s all vow to do a better job recognizing and treating pain in our animal companions.
Dr. Jennifer Coates
Image: Kachalkina Veronika / Shutterstock