Integrated Pain Management
Ethics and animal pain
For veterinary surgeons and animal owners or carers wanting the best for their companions and patients, the management of chronic pain is both a crucial area of awareness and an opportunity for compassionate action. It is quite clear to many people living and working with animals that they experience pain and fear pain in similar ways to human beings. That said, their mental processes are probably quite different to ours. In Chapter One of The Handbook of Veterinary Pain Management Bernard E. Rollin states: “Possibly, animal pain is worse than human pain because, lacking language and sophisticated reasoning skills and temporal concepts, animals cannot understand the reasons for and causes of pain and thus lack the ability to hope for and anticipate its cessation.” Ethically, it is effectively down to us to give our animal companions the benefit of the doubt where pain is concerned.
Chronic pain is pain that is experienced ongoingly but no longer has any physiological use for the body. In other words, the initial pain sensation that tells us that we have injured ourselves, and that we need to take some protective action, has changed into a more prolonged experience of pain that has become a large part of the problem itself.
Uncontrolled pain affects healing and resistance to disease and can be a cause of death in animals in the same way that it can in human beings. Chronic pain is therefore debilitating and associated with a great deal of emotional distress. The ethics of distress for animals in various situations is an area also of great importance, but beyond the scope of this article. As animal carers, I think we all have a responsibility to become more aware of the signs of chronic pain and the ways in which we can alleviate it.
How do I know what to look for?
Whether we live with the animals we care for or only see them occasionally, we need to get to know what is happy and healthy behaviour for them, so that we are best placed to notice when all is not well. The signs that tell us an animal is in pain are often not the obvious ones such as crying in distress, so we need to know what we are looking for. This can be particularly true for cats. Silence, inactivity, withdrawal, changes in posture, movement and facial expression, panting, trembling, restlessness, aggression and lack of grooming or appetite can all be indicators of pain in dogs and cats. This is a complex area, and the most effective way of increasing awareness is to know what is normal for your animal. If they stop doing something (such as climbing up or jumping) that has been usual for them, or they start doing something new (such as growling at the children), then they may be in pain.
Pain relief is far more effective if given early in the course of disease or injury. It is therefore even more essential for us to act quickly when we find an animal in pain. If you are in any doubt about your animal’s behaviour and whether they may be in pain then please contact your veterinary surgeon.
Options for pain relief
Traditionally in the veterinary profession, we have managed chronic pain with antiinflammatory and painkilling drugs. This area is constantly changing and even for cats there is now a range of options for the management of chronic pain. Your vet is best placed to discuss those options with you. Some animals are able to tolerate particular drugs less well for various reasons, especially as they age, and it is useful to have an integrated approach to pain management.
Many vets are now advocating integrated pain management, which basically means using a range of treatment options together to control pain. Many different strategies work together and can make the overall quality of life very much better for any animal in chronic pain. Examples of alternatives to drugs include diet and nutritional support, complementary therapies, physical therapies, exercise and movement, and behavioural therapies.
Complementary therapies that can help relieve chronic pain include acupuncture, herbal medicine, homeopathy and Reiki. Physical therapies include massage, hydrotherapy, physiotherapy, osteopathy and chiropractic. Touch and massage therapy at home can be a helpful additional support for animals with chronic pain. See the section on Tui Na for more information.
Electronic methods of pain management such as TENS can be used in animals, but because in most people the effects wear off immediately after treatment, they are probably of limited use. A technology known as Electronic Nerve Modulation (ENM), delivers a therapy known as “Deep TENS’, which appears to have a longer duration of action and is accepted by many animals. Ask your veterinary surgeon whether this may be appropriate for your animal.
Physical movement and exercise has an important role to play in the management of chronic pain. Animals often become inactive as a result of pain. This can worsen the problem, leading to weight gain and further loss of mobility and strength. Similarly, in certain situations, periods of rest will be important. Any exercise regime needs to be balanced, appropriate and consistent. For example, many ageing dogs with osteoarthritis will benefit from several very short walks a day on a soft grassy surface, rather than needing to walk all the way to the park on a hard pavement. Sometimes this will mean a ride in the car to a suitable and well-loved exercise place. Your vet will be able to advise you about the exercise appropriate for your animal’s pain management.
The ways in which we interact with our animals has a marked effect on their experience of pain. Mental stimulation including the use of appropriate play activity, toys, physical contact and attention, can all make a difference. The bond between owner and animal is strong, and the more informed and motivated you can be the better.
The best approach to pain management is usually a combination of several of these options. If you have any questions about pain in your dog or cat please contact your vet.