When Sophie, a nine-year-old shepherd/collie, developed a tumor, Karen Daiter’s first priority was to relieve the shepherd/discomfort. collie’s “She was a very playful, good-natured dog,” Daiter says. “But she left, and I didn’t want her to feel bad about it.”
“We feel it when our pets in pain,” Steve Dale, Sophie’s upstairs neighbor and daytime caregiver, says. “It’s not just frustrating because you can’t do anything to help them; it’s also your responsibility.”
Pain is a distressing sensory or emotional experience that exists only in the mind of the individual who is experiencing it. People have long assumed that because animals cannot express their pain, they do not feel it as deeply as humans do. Despite the fact that general anesthesia keeps pets immobile and oblivious to pain during surgery, pets have historically been under-treated for pain.
Dr. William Tranquilli, clinical medicine professor at the University of Illinois, says, “We’ve never really trained veterinarians to think about disease-related pain.” The Companion Animal Pain Management Consortium is working to change this. Dr. Tranquilli, Dr. Charles Short of the University of Tennessee’s Center for the Management of Animal Pain, Dr. James Gaynor of Colorado State, and Pfizer Animal Health, a pharmaceutical company headquartered in New York (www.pfizer.com/ah/index.html), are leading the charge.
Owners who do not want their pets to suffer are driving advancements. Veterinarians and pet owners now recognize that pets, like humans, feel pain; they just express it differently.
Nerve endings become sensitive to chemicals released by damaged tissue. The nervous system’s response to pain travels up the spinal cord to the cortex of the brain, where pain is registered and a protective reflex is triggered. This “learned avoidance” teaches pets to avoid future hazards such as candle flames. In order for an injury to heal, a pet may protect or rest it.
Not all pain is severe, unexpected, or requires the use of strong analgesics. Dr. Tranquilli defines discomfort management as “long-acting steroid products used to reduce skin inflammation.” Antibiotics can also help with a sore throat, and a heat lamp can help with chronic joint pain in older pets. According to Dr. Shawn Messonnier, a holistic veterinarian and author who practices near Dallas, cool water, which is a natural anesthetic for skin, provides temporary relief for allergic pets.
Extreme pain, on the other hand, causes a stress response that alters immune function, impairs blood clotting and wound healing, and has a negative impact on the cardiovascular system. Intense pain has the potential to alter neural pathways permanently, resulting in a neurological “memory” that causes pain to persist long after the injury has healed. Because chronic neuropathic pain is extremely difficult to treat medically, human anesthesiologists use a combination of general anesthesia and a nerve block to prevent it. A local anesthetic can also be injected into a pet’s spinal cord to act as a regional nerve block, preventing pain signals from reaching the brain.
“Recent studies show that if we do medical therapy before making the incision, pets require less post-operative medication,” Dr. Messonnier says. Preventive pain management also reduces the need for general anesthesia and lessens the severity of post-surgical side effects. Preventive pain control, for example, promotes easier postoperative breathing because deep breathing is less painful.
However, pain management can interfere with other treatments, according to Jennifer Reding, a veterinary technician in charge of post-surgical pain management at Veterinary Surgical Associates in San Mateo, California. “You must exercise extreme caution not to overmedicate and suppress vital signs,” she cautions. “Sometimes, pets are so sick that pain management is low on the priority list – we want to make sure they live first and foremost.”
Dogs frequently express their dissatisfaction. “They scream at you,” says Reding. Stephanie Harpham knew she needed to seek immediate assistance when Chaplin, her six-year-old pit bull, became ill. “I could tell he was in pain from moving,” she says.
Cats in pawithin would rather hide than raise an injured leg or yelp and flinch. Fearful behavior can mimic feline pain symptoms. “If a cat can’t relax enough to close her eyes and sleep,” Reding says, “she’s probably in a lot of pain.” Acute pain in cats can also cause significant behavioral changes. “They crouch and hide frequently, have big eyes, and are nonverbal until you touch them, at which point they completely freak out and try to kill you!”
Because each pet is unique, it’s also difficult to generalize about pain symptoms. Two years ago, Gibson, Reding’s Australian shepherd, was behaving strangely. “He was a little slow. “He’s a big eater, and I had to force him to eat,” Reding explains. A potentially fatal pyothorax, or chest infection, was discovered during the examination.
Many prey species (birds, hamsters) instinctively hide their pain, and while working, some dog breeds (pit bulls, terriers, hunting dogs) are pain-insensitive, but this does not mean they are not hurt or injured. Experts advise that if the same condition would be painful in a human, it is likely to be painful in a pet.
Managing the Hurt
Pain can be controlled with drugs at any point along the nerve pathway, but pain tolerance varies between pets and humans. “In humans, there is about a five-fold variation in pain tolerance for the same surgical procedure,” Dr. Tranquilli explains. A one-size-fits-all approach will fail.
Nonsteroidal anti-inflammatory drugs (NSAIDs), which are available over-the-counter, are the most commonly used analgesics. Consult an integrative veterinarian for the best options for your pet., aspirin, Tylenol®, Advil®, and other similar medications. NSAIDs can be extremely helpful in a variety of painful conditions, including cancer.
Harpham claims that “they didn’t find Chaplin’s cancer until he was too sick to move.” Despite the fact that prednisone increased his “accidents,” she was only concerned that it gave him significant pain relief. When prednisone was no longer effective, the pit bull was given the NSAID (human drug) piroxicam, which not only relieves pain but also induces remissions in some canine bladder cancers. “Piroxicam worked fantastically well,” says Harpham.
Because pets metabolize drugs differently than humans, keep in mind that human medications can be toxic to pets and should never be given without a veterinarian’s approval. Pain relievers are particularly irritating to cats. NSAID medications for dogs, such as carprofen (Rimadyl®) and meloxicam (Metacam®), can cause toxicity in cats, according to Dr. Susan Little, a feline specialist in Ottawa, Ontario. Cats should never be given acetaminophen (Tylenol), and aspirin can be toxic; use it sparingly and only as directed by a veterinarian.
Dr. Little claims that drugs like oxymorphone and butorphanol work well in cats to control post-operative pain after elective procedures like spaying, neutering, or dentistry. Ketoprofen is a pain reliever that is frequently combined with other anti-inflammatory medications. For example, Winky’s cancer biopsy was so deep and painful that the cat couldn’t use that foreleg. His owner, Mary Williams, took him to specialists for treatment, including pain management. “When Winky took the ketoprofen, he seemed to sleep better and move around more on three legs,” she says.
Morphine, codeine, and Demerol® are narcotic pain relievers that can only be obtained with a veterinarian’s prescription. Orthopedic surgeries are excruciatingly painful, and morphine or a morphine-derivative medication is frequently used to alleviate the pain. For severe or chronic pain, buprenorphine, which is 25 times more potent than morphine, takes longer to work but has a longer duration of action. Torbugesic can be given to pets as an oral delivery mixture – Torb-in-Syrup® – to rub on their gums for absorption through the mucus membranes.
Codeine is well absorbed in canine and feline digestive tracts and provides effective relief for all but the most severe forms of pawithin, such as cancer-related pawithin. Codeine can be mixed into peanut butter or fish paste to improve pet acceptance. After surgery, drains can deliver continuous treatment into the chest and abdominal cavity, the joint, or even intravenously via a catheter. Chemotherapy and radiation can also help to relieve some types of cancer pain.
Fentanyl® (duragesic) is an opioid drug that comes in the form of a transdermal patch and provides long-lasting narcotic relief to dogs and cats. According to Reding, nearly every painful patient at her clinic receives a Fentanyl patch. “It makes a huge difference, especially in cats,” she says. “After surgery, some cats beg to be petted because they are so happy with the patch.”
Gibson, Reding’s dog, required a chest tube to clear the infection, and she was well aware that penetrating the chest cavity is excruciatingly painful. ” Morphine only provided temporary relief from his pain. “On the first day, he didn’t want to move or stand up,” she says. A Fentanyl patch began to work after the first 24 hours. “Within three to four days,” she says, “Gibson was running around like nothing was wrong with him.” Gibson fully recovered after a few weeks on antibiotics.
Dr. Messonnier believes that conventional drugs should be used in conjunction with alternative pain management therapies. Hydrotherapy (water therapy), massage, magnets, chiropractic, and acupuncture are all common treatments.
Shepherd/collie Sophie recovered quickly from her tumor removal surgery, and Daiter sought advice from a number of specialists on how to relieve her dog’s cancer pain. Several conventional pain medications, as well as dietary changes, acupuncture, and massage, were used. “She loved being touched, especially with massage,” Daiter says.
Dr. Messonnier concurs that drugs are best for acute and severe pain relief, while herbs, homeopathy, and nutritional supplements are best for chronic conditions. “For a dog with arthritis, I would use Rimadyl for a bad day and glucosamine and acupuncture for a long-term approach,” he says. Canine disk disease may be treated with acupuncture and a homeopathic remedy called Hypericum (veterinary strength, not over-the-counter) for nerve injury. He recommends homeopathic Arnica for any type of trauma or wound, as well as a proprietary herbal mixture called Post Care to control the bruising, swelling, and pain associated with surgery or trauma.
Light therapy can also be beneficial. “My Cornish rex got on the wrong side of a dog and was bitten on the hock,” says Claire Marsh of New Zealand. Ren’s wound healed well thanks to veterinary care, but the four-year-old cat was still limp. X-rays revealed a bone chip and a detached ligament. “The vet predicted Ren would be paralyzed for life,” Marsh says. A Bioptron light was then loaned to her by a friend.
Bioptron® Light Therapy Systems are said to have a biostimulant effect on living cells, which improves blood circulation, promotes wound regeneration and healing, and relieves pain. Ren felt the impact right away. Right in the middle of his first treatment, Ren began chasing the other cat for the first time in seven weeks.
Despite the fact that he still favors that leg slightly, Marsh claims that after 10 days of therapy, “Ren zooms around the house like his old self.” She plans to have additional X-rays taken with the veterinarian to confirm his recovery. Bioptron products have been approved as medical devices in Europe and Canada. These products are available in the United States, but they are only for cosmetic purposes.
Sophie’s stomach tightened every time she was carried up or down the stairs in the final weeks of her life because the building’s elevator was broken. “You could tell she was in pain, but she never lost her dignity,” Dale says of the dog, who remained friendly to strangers. As the end approached, Daiter’s priority for her pet was to make sure Sophie enjoyed the time she had left. “We used a morphine patch to relieve her pain so she could leave the building happy with me and her friends.”
Finally, what an owner is able or willing to do for their pet determines treatment. “There is no right or wrong,” says Dr. Messonnier. Because twice-weekly acupuncture may be impossible for those without transportation, pills are used instead.
“There is a cost for pain relief,” explains Reding. In a clinic, a Fentanyl patch, for example, may cost an additional $40 to $60.
Some clinics, according to Dr. Messonnier, cut costs by eliminating pain medication. “Don’t assume your veterinarian isn’t using pain medication,” he says. “A light should go off if the spay is only $50 – ask!” Remember that anesthetic does not relieve pain. According to Dr. Messonnier, ketamine (a common injectable anesthetic) only alleviates superficial discomfort and does not alleviate the visceral pain associated with spay surgery.
According to the most recent research, pain in cats and dogs can be a serious health issue. Regardless of their condition, providing proper pain management always improves their quality of life and can help them recover more quickly and completely. It is also a matter of ethics. For those who adore cats and dogs, relieving their suffering is simply the right thing to do.
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