Great Gains in Pain

 

Dear Dr. Dog: My older dog has developed arthritis and I’m worried that he is hurting, even though he doesn’t complain. What is the best approach to pain management in dogs?

 

Pain management in veterinary medicine is a relatively new concept that has come a long ways in the past 20 years. 

An old paradigm thought alleviation of pain in animals would mask the symptoms of an underlying disease, and so was not helpful. Some veterinarians thought it “better” to allow pain to act as a check on active behavior in sick animals. For instance, without post-operative pain treatment, an animal would be more likely to stay still and quiet during the healing process. Thankfully, this notion has fallen out of favor and we now understand that pain exerts very negative effects on an individual’s ability to heal.

One definition of pain that appeals to me (from a veterinary surgical text) is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”  Basically, then, pain is a message to the body that damage has occurred, whether it is by temperature change, chemical stimulus, or mechanical trauma. 

Pain is experienced differently by different animals and can be hard to recognize. Some individual dogs and cats are very stoic and tolerate a large amount of pain without obvious expression. This is an understandable instinctual response, since in the wild, weak or injured members of a pack or pride can be simply left behind, or actively ostracized and even killed. 

When Kenna, my eleven-year-old Labrador Retriever, first developed arthritis, she exhibited her difficulty in jumping onto my bed with only a quiet whine and by taking a bit longer to make the jump. I hear from clients quite commonly that their old arthritic dogs don’t cry at all. For some dogs, signs of pain may include less activity around the house or yard, general crankiness, decreased appetite, or excessive panting. 

When pain stimulus can be anticipated (such as in surgery or chronic diseases like arthritis or cancer), management is much more effective when started early or even before pain has occurred in the body. This is termed “pre-emptive analgesia” and is an important component in veterinary surgical procedures. Another important concept is that multiple pain medications from different categories can be used simultaneously, as demonstrated in Kenna’s treatment plan described below.

The most common types of pain medication are local anesthesia (often used in dental procedures or small skin surgeries), narcotics (opioids) that act on spinal cord and brain receptors, NSAIDs (non-steroidal anti-inflammatory drugs) that block tissue production of inflammatory chemicals that cause pain, corticosteroids that act similarly to NSAIDs but often have more side effects, and alternative/complementary methods. This latter category includes “nutraceutical” products such as joint supplements, essential fatty acids (the omega 3 and 6 oils), and anti-oxidants, as well as chiropractic and acupuncture modalities.

Kenna takes a chewable tablet daily that contains glucosamine, chondroitin sulfate, and avocado oil – this helps keep her mild aches from arthritis in check most of the time. When she overdoes it with running or swimming, I give her a veterinary NSAID for a couple of days. Dogs with moderate to severe arthritis may need the nutraceuticals and NSAIDs daily for continual help during the cold weather months, or even year-round.

NSAIDs deserve a bit more attention here, since their use is fairly popular in veterinary medicine. Currently, at least eight NSAIDs have received FDA approval for use in dogs, and two for cats. Remember that not all human drugs are safe to use for dogs and cats – most notably, ibuprofen and Tylenol can cause significant liver and kidney damage, and can even be fatal. It is important to check with your veterinarian before giving your dog these drugs!  

Even approved veterinary drugs may cause gastro-intestinal problems in dogs and cats. If your pet is taking one and develops signs of nausea, not eating, vomiting, or diarrhea, contact your vet right away. Most veterinarians recommend regular blood work checks (every 6-12 months) for pets who use these drugs chronically, to keep an eye on the animal’s overall health.

Alternative (or complementary) modalities are becoming more accepted and popular in veterinary medicine. One such treatment is acupuncture, an age-old medicinal technique developed in China. It is unclear how acupuncture works to relieve pain; one theory is that it stimulates an internal release of endorphins (natural opioids). There are rigorous certification programs for licensed veterinarians who wish to pursue disciplines such as acupuncture and chiropractic medicine, and I recommend consulting a certified practitioner when seeking this type of treatment. 

Today, we can protect our dogs and cats from suffering by utilizing the proper blend of drug and complementary therapies. If your pet is limping, whining, or licking an area constantly – or if you observe other unusual behavior that could signal injury or illness – see your veterinarian as soon as possible to diagnose the problem and set up an appropriate program of pain relief. 

Veterinarian Mona Miller lives in Lafayette and practices at Four Seasons Animal Hospital there. Her special interests are preventative health care, internal medicine, and avian/exotic medicine. She can be reached at 925-938-7700 or MonaSDVM@aol.com.

 

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