The following is the sixth in a Wicked Local series of articles contributed by specialist veterinarians at Angell Animal Medical Center.
For many of us, our pets are not just companion animals but bona fide members of our family, whose wellbeing we regard as a top priority. That’s why the notion that a beloved animal can be suffering from chronic pain, without the ability to tell us what’s wrong, is so disturbing. The reality is that dogs, cats and other pets suffer greatly from pain—whether it’s pain associated with injury, surgery or illness—and identifying and treating the pain is key to their quality of life.
|Acupuncture and other pain medicine treatments help 18-year-old Sweet Pea remain mobile and comfortable in old age. (Pictured here with acupuncture needles in place).
Pain behaviors are different in every species, and can be specific to each individual. Additionally, dogs and cats go to great lengths to hide their pain as part of their evolutionary past—when demonstrating that they were in pain could make them vulnerable to attack from other animals. People expect animals to cry or vocalize when in pain, but they usually only do this with severe acute pain, like breaking a bone. Pets are generally quiet and stoic when in pain.
In order to diagnose pain in patients who cannot “tell” us what they’re feeling, today’s veterinary specialists have to resort to indirect methods of pain assessment. These methods rely on noting changes in functional movements (i.e. “my dog can’t jump on the bed any more”). And sometimes we have to assume pain is present when we diagnose a disease and treat for the expected level of pain.
The response to treatment may be the best evidence that pain exists. If, for instance, combination drug and movement therapy enables a dog to jump up on the bed after months of being unwilling to do so, we can often conclude that he was experiencing pain that limited his movement.
The next frontier of animal pain assessment is the development of a validated pain scoring system, like we have for humans. Such systems are now in development and will no doubt add significantly to veterinarians’ ability to identify and treat pain.
Treating Various Kinds of Pain
|Dr. Moses administers acupuncture to Sweet Pea.|
Today we have sophisticated strategies to relieve both chronic and acute pain using a variety of methods, including multiple types of drug therapy, nerve blocks and other forms of local anesthesia for surgical and cancer pain, as well as acupuncture, trigger point therapy, physical therapy and lifestyle changes.
These multi-pronged treatment programs are often hugely beneficial in reducing pets’ pain.
For example, one of my patients is a nine-year-old golden retriever who has severe elbow arthritis. When I met her, she did not run or play and was very lame on one leg. She has been treated with a combination of medication and acupuncture over the course of the last year. Within one month of treatment she resumed a favorite activity: running down the hall in her condo building. Moreover, she now swims and runs on the beach several times a week without limping.
Another of my patients is a middle-aged orange tabby cat who had been hit by a car and required two surgeries. His initial treatment protocol called for full physical therapy (including using an underwater treadmill). But after two months it was clear he needed additional treatment beyond just physical therapy. We used a combination of two different medications and acupuncture and, within a few weeks, he had resumed jumping up on a chair and onto the bed. He’s now completely mobile and has been off all medication for two years.
|Older kitty "Agent K" receives acupuncture to alleviate pain.|
In addition to the above scenarios, I see a number of patients suffering from pain caused by cancer. Cancer pain is completely different, and the source of the pain changes as the cancer progresses and different treatments are employed. This is where palliative care, the same model used for human patients, can be very helpful. Even as the patient is receiving therapy for their disease, we can employ specific techniques to improve comfort, appetite and relive pain, which significantly improves quality of life. Palliative care is a way to focus on the “whole patient,” and not just their disease.
When it’s Time to Say Goodbye
Because of the nature of the work done by the Pain Medicine Service, particularly when working with very sick and traumatically injured patients, end of life discussions are routine. Perhaps the most important work done in the realm of palliative care is to see animal patients through to the end of their lives and help their owners prepare for this sad reality. Pet owners should know that even toward the end of their lives, it is possible to maximize their animal’s comfort and support the family so they can provide care at home.
When I work with people whose pets are nearing the end, we frequently reassess pain and how much nursing care is required to keep the animals comfortable. We also recognize that being a caregiver for a dying pet is very hard and we try to provide support for that experience. For many of my patients, multiple visits are spent talking about how to decide when the end is near and when they should consider euthanasia. Having a good relationship with a trusted veterinarian is the best way I know to get the help and support needed when pet owners are considering euthanasia.
|This 13-year-old bulldog visits Dr. Moses weekly for pain relief treatments.|
I always tell people that grief over losing a beloved companion can be shockingly hard. Psychologists who study grief see this process as the same as the loss of any other close family member. People who have lost their pets must give themselves the same kind of room to grieve as they would if a member of their human family died.
Diagnosing and treating pain has come a very long way in the past few years, which has significantly benefited the lives of animals (and the people who love them). I continue to encourage owners of pets who may be suffering from pain to seek out qualified veterinary advice to determine what can be done to ensure their beloved animals live as comfortable as possible, for as long as possible.
About the Author
Lisa Moses, VMD, DACVIM, CVMA, Certified in Veterinary Medical Acupuncture
Dr. Moses leads the Pain Medicine Service at Angell. Dr. Moses is board certified in internal medicine and was a senior clinician in Angell's Emergency and Critical Care service for 12 years. She has received advanced training in both human and veterinary pain medicine. This combination of training and experience enables Dr. Moses to manage complex cases requiring simultaneous treatment of multiple medical problems. As a result of the training, the Pain Medicine Service is modeled after pain clinics created at human hospitals. Dr. Moses has also been trained and certified in veterinary medical acupuncture. She is an elected member of the International Veterinary Academy of Pain Management Board of Directors and lectures at many national conferences.
Under her direction, the Pain Management Service provides advanced assessment of both chronic and acute pain and manages treatments accordingly. This includes multiple types of drug therapy, nerve blocks and other forms of local anesthesia for surgical and cancer pain, acupuncture and trigger point therapy and recommendations for physical therapy and lifestyle changes.
To contact Dr. Moses at Angell’s Pain Medicine Service, call 617-541-5140 or email firstname.lastname@example.org.