Owner engagement in chronic pain

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: Owners often need help to understand the difference between acute and chronic pain; that often we cannot cure the problem; and that the main priority is to reduce the patient’s suffering (which may include side effects and restricted access to resources). Suffering is assessed by changes in individual behaviour and chronic pain is a chronic stressor. We cannot teach our patients not to feel stressed by the sensation of pain and owners must understand that the treatment of chronic pain necessarily involves more veterinary input because of this. A dynamic approach will usually begin with pharmacological analgesia, but may be followed with more physical treatments to help reduce the amount of medicine required and to maintain the animal’s strength and mobility. The clinician should stay open to discussing any approach and be prepared to explore other avenues if the owner requests them. Medicines often a carry a negative association for many clients and the clinician should be clear in explaining expected outcomes; possible side effects; monitoring; and frequency of review. Getting the owners involved in weight control; physiotherapy exercises; comfort; improved core territory; and replacement of lost resources will help with compliance by giving them a sense of control over their pet’s pain.

: Chronic pain can seem like trial and error sometimes. Having a firm understanding of the pet’s pain and a baseline pain score is essential for judging the efficacy of any future therapies. The identification of pain behaviours is recommended. When asked what they want for their pet, most owners will reply that pain reduction and maintenance of quality of life is their goal. I do ask this directly to owners so we can establish common ground and start to manage expectations. However, when asked to rate quality of life as a direct question in the Canine Brief Pain Inventory owner response can vary according on the message they wish to convey to you. We will discuss this point in the session. Questioning across health domains associated with quality of life can give us vital information and this is the basis of the Vetmetrica scoring system. I adapt the pain/HRQL scoring system I use according to the owner – which can help with the spectrum of pain presentations – another point for discussion. Writing down treatment goals and pain behaviours helps owners recall the consultation and draws focus to each aspect of management. Highlighting the importance of each intervention is valuable to the owners understanding.

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