We must all die. But that I can save him from days of torture, that is what I feel as my great and ever new privilege. Pain is a more terrible lord of mankind than even death itself. ~ Albert Schweitzer, 1931
Several years ago a study was done showing that two thirds of dogs and nearly all cats did not receive any analgesia after various major surgical procedures. There were many reasons for this; concern that the drugs would mask' evidence that the patient's condition was deteriorating, the potential for toxic or adverse reactions, and lack of recognition that an animal was in pain.
Times have changed.
Pain management is a cornerstone of medicine at Animal Medical Hospital. Our goal is to make every patient as comfortable as possible, to minimize the pain they feel, and to allow them to return to their normal place in the family as quickly as possible. This is especially important after surgery, when a pet's pain tends to be the most intense, or after a traumatic injury. This brochure will explain some of the most advanced drugs and methods of delivery used at our hospital to keep all pets as pain-free as possible.
It is now widely recognized that if we administer analgesics before the pain starts we have much better control of the pain. The drug molecules occupy places on the pain receptors, effectively blocking (or at least decreasing) the transmission of pain impulses. This means that the pet feels less pain during the procedure and less pain after as well, allowing us to use lower doses of analgesics than we would ordinarily. At Animal Medical Hospital we give pre-emptive analgesics in to all of our surgery patients as part of their pre-anesthetic medication.
Some pets who are undergoing surgeries on the hind legs, tail, anal area or flanks can benefit from an epidural. Morphine, and sometimes a local anesthetic, are injected into the space around the spinal cord. This delivers the drug to its site of action either at the receptors within the spinal cord or at the nerves just as they leave the spinal cord. This gives profound analgesia which lasts longer than if the drug is injected in the usual way, intravenously or intramuscularly. This is an excellent adjunct procedure in many pets, but is not necessary or indicated in all pets.
Analgesics during and after painful procedures
In addition to the pre-emptive drugs, we give a number of other medications that help to decrease pain during and after painful procedures. Ketamine is a drug that is normally used for anesthesia. Given in very small amounts (low enough that there is no effect on the pet on a visible level) this drug binds a specific kind of receptor that is involved in the "wind-up" of the pain response. It also enhances the effect of opioids, meaning that we can give much less of these drugs with the same benefit. We give ketamine in the intravenous fluids during and after surgery.
Also during and after surgery we give injections of opioids, usually morphine in dogs or a drug called hydromorphone in cats. We will repeat these injections as needed throughout the day and before the pet goes home. In conjunction with ketamine, the opioids should make your pet very comfortable. Comfy pets will sleep soundly; painful pets will whine and pace or be unable to settle.
Oral medications for home administration
Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for mild to moderate pain in dogs and cats. One in particular, meloxicam (Metacam) is particularly safe and effective. It should only be used in otherwise healthy pets without significant kidney or liver disease. Other NSAIDs that may be prescribed include tolfenamic acid, ketoprofen and carprofen. Some NSAIDs used for people have the potential to be extremely toxic to pets. No NSAID should ever be administered to any pet except on the advice of a veterinarian. This includes ibuprofen, aspirin, and acetaminophen.
Metacam is used extensively to control the inflammation and pain associated with osteoarthritis. We also prescribe it after some surgeries as part of an overall pain management strategy. It can be used in addition to opioids for additional pain relief.
Other medications that are commonly prescribed are oral codeine, morphine, and buprenorphine, tramadol, amantadine and gabapentin. These are given at home to ensure the pet's continued comfort. It is very important that the pet's guardians are careful in following the prescribed dose and frequency for these medications.