Veterinary Hospital in Laguna Niguel
www.MonarchVet.com
In the April 2009 issue of Aliso Viejo News I published the first part of this two part series on pain management in pets. In that article I focused on how you can know your pet is feeling pain.
Anyone wishing to obtain a copy of that article from that issue please contact me through our website and I will email you a copy. This article will summarize the many different options available to provide relief for the pain that our beloved pets encounter.
First and foremost, your pet should be properly examined by a veterinarian and correctly diagnosed if you perceive that the pet is painful. The top priority is then to address any specific diagnosis with targeted therapy to correct the underlying condition or disease process that is at the root of the pain.
If that cannot be done, or only partially done, then the pain treatment becomes what we call “palliative”, or simply trying to make the pet as comfortable as possible for as long as possible.
This may be the situation in some cancer patient or severe, long-standing osteoarthritis. But—again—it is essential to have a correct diagnosis by a competent veterinarian before any treatment is prescribed or initiated.
Many times I have see folks do something on their own, such as give over the counter pain medications, with tragic results.
NEVER give your pet ANY human medications or homeopathic medications without at least a phone call to your veterinarian. Play it safe. Medications such as Tylenol and Advil or Aleve can kill your pet.
There are very specific occasions when a veterinarian prescribes chiropractic manipulation or acupuncture, but those should never be initiated without a veterinarian’s directive. In fact, it is illegal for a chiropractor to treat a pet without a veterinarian’s prescription.
The use of class IV lasers is another alternative treatment for certain conditions that can be very effective in selected cases.
Once a diagnosis has been made, or at least we know the cause of the pain, then a veterinarian has many options to alleviate that pain and make the pet more comfortable. In cases of osteoarthritis and hip dysplasia or elbow dysplasia, weight reduction is often recommended, and helps tremendously.
In specific cases, hydrotherapy (whirlpool bath) and physical therapy (especially after surgery or traumatic injuries) can speed recovery and alleviate pain. Deep tissue massage and passive flexion and extension during recovery from fractures and spinal injuries or muscle injuries are very helpful, but as the clinician directs and teaches you how to do it.
Special diets are available in selected cases such as osteoarthritis, such as Hill’s j/d diet, which has been shown to slow down the destruction of joint cartilage and preserve the joint integrity. Glucosamines, essential fatty acids, MSM, and chondroitin are all “nutroceuticals” that help maintain joint integrity. So is an injection called Adequan.
In the case of osteoarthritis of a chronic nature, there is a cutting edge option that has become available in the last 2 years—adult stem cell therapy, also known as regenerative cell therapy (www.Vet-Stem.com )
Recently, some surgeons are combining this with surgery with good results, such as elbow dysplasia cases. The stem cells are harvested from fat tissue in the pet, purified and processed, then injected intravenously and into the joints.
Some of the results have been near miraculous. There is much promise that adult stem cell therapy will be used in many other aspects of veterinary medicine in the near future, including kidney and heart disease and diseases of the bone marrow. Though not inexpensive, is has become as very viable option to keep pets mobile and enjoying life.
I know that pain management in hospitalized patients has changed dramatically over the years as well, as more local anesthetics are used during surgeries and dentals that last for hours during the initial recoveries. Local and regional nerve blocks in addition to systemic pain medications at the time of procedures are resulting in much smoother recoveries.
More recently we are seeing epidurals being used in some orthopedic procedures and it so nice to see these pets wake up essentially pain free. Diligent use of all modalities available to us is very rewarding as we see pets recover. However, the primary focus of this article is to address the pain your pet may have at home.
The prescription medications we veterinarians prescribe fall into two primary categories: opioids (narcotics) and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), and a product known as gabapentin. The opioids work best for soft tissue pain and also are often used when any pain is severe.
They also sedate the pet to a degree. The NSAIDs are best for long term orthopedic pain, are the most commonly prescribed, but are not be used without ascertaining good kidney and liver function, and require ongoing periodic blood tests to make sure they are being tolerated. It is a standard recommendation to give gastrointestinal protectants such as Pepcid™ or Prilosec™ when giving NSAIDS as they have the potential to cause severe gastrointestinal ulcerations and bleeding. Some of the newer “Cox 2” NSAIDS only require once daily administration and offer pain relief far better than something like aspirin, and with less danger of stomach ulceration or bleeding.
Follow your doctor’s advice carefully with these meds. The NSAID use in cats is controversial, and is used with prudent caution.
The bottom line: Be alert to observe your beloved pets carefully and sense it they are in any pain or discomfort, and then consult your veterinarian and follow the doctor’s advice carefully. Just know that today’s technology offers many options.
Dr. Glenn Craft
