Pain management

Drug free management: Owners must understand that medical analgesia is often vital to reduce suffering, especially at the start of the treatment of chronic pain. We cannot, by explaining that chronic and acute pain are distinguishable by the threat they pose to survival, teach our animal patients to be to be unafraid of their pain. We therefore need to reduce both the sensation and the emotion of pain and this process sometimes needs medication. Where the pain field has become exaggerated and expanded, physical therapies may be contraindicated until that field has been reduced. Rather than ‘drug free’ (which tends to give ‘drug use’ a negative sense), the physical therapies should be thought of as integrated; relatively safe; and relatively free of side effects. Their use may reduce the use of medicines; may positively contribute to the animal’s health and mobility; and, often, indirectly contribute to owner compliance because the therapist can continue to educate and to build on the plan. Physical therapies include but are not limited to: acupuncture; physiotherapy and hydrotherapy; laser; manipulation; and myotherapies of various kinds. This lecture will briefly describe the most common therapies, their indications, advantages and possible drawbacks.

Foundations of drug therapy – building the plan and an overview of NSAIDs: Medical treatments provide the cornerstone of most pain management plans, but how effective are they in addressing chronic pain? Osteoarthritis is a major cause of chronic pain and it is an excellent example of the need to properly understand how pain is being generated before attempting to resolve it. Management involves controlling the local disease, a source of nociceptive stimulation, while at the same time separately addressing non-nociceptive mechanisms, neuropathy and central processing. NSAIDs have been used widely and successfully to address pain in OA. We almost know too much about these drugs and our knowledge restricts our use and client acceptance due to risk of toxicity. However, there are other limitations in managing chronic pain using NSAIDs. The use of unlicensed medications to treat chronic pain about has increased greatly. But are they safe or effective? Properties do not easily translate between species as we found in the past with NSAIDs and more recently with tramadol. Medical agents are important tools in building a management plan but due consideration must be given to therapeutic targets, effectiveness, duration of use, practicality and common sense.