Pain Control in Vet Medicine: It's Not Just For Kids Anymore
Imagine my shock and dismay when one of you, a dear reader and knowledgeable cat owner, had no idea that pain medication was available for her felines. Perhaps that’s because pain control in veterinary medicine has come such a long way in the past five or ten years. I’m sure she’s not alone. How sad to think that patients might be going without the humane use of drugs due to the slow adoption of this indispensable innovation in veterinary medicine.
The sad reality is that pain drugs are not new to the profession. They have only now, however, begun to play a major role in how we treat our patients. It’s hard to believe, but veterinarians used to think that cats and dogs did not require the same kind of pain relief that humans do.
In fact, twenty-five years ago, human pediatric medicine was similarly inclined. Infants and children did not receive proper pain control after surgery or during painful procedures. I distinctly recall having my own fractured and dislocated arm set by a team of healthcare providers—with nary a pain drug in sight. I was eleven. I didn’t sleep for four nights afterwards. Yet I’m told I never once complained. In fact, after falling off that d--- horse they didn’t take me to the hospital for hours, assuming I’d let them know if I was in serious pain.
I’d like to think this experience served a purpose, making me more sensitive to the plight of the stoic pets we perform painful procedures on daily. My Bruticaine trauma, as I refer to it (invoking the veterinary term for anesthesia through brute force), served as a great reminder in vet school when, snug in my bed, I’d have to rouse myself for 2AM treatments: gotta give the pain meds was the mantra that replaced the one about the donuts.
Dogs and especially cats, like animals in the wild, will hide their pain so as not to reveal their weakness to a predator—and because they have no choice. They have to keep hunting, feeding their babies, and whatever else they have to do. They don’t have time to sit in a hospital room and whine like we humans do. And so they don’t tend to vocalize.
Recognizing this, we humans have to be extra-vigilant for signs of pain and, in most cases, assume pain is there, even when we can’t tell one way or the other. I can’t tell you how often a pet owner refuses drugs for the chronic pain of arthritis just because the dog isn’t whining. But he won’t whine!, I plead. Just humor me for a week. (I know most everyone eventually gets the picture when they tell me the dog is acting like a puppy just a few days later.)
Although most of the pain relieving drugs aren’t approved by the FDA for use on dogs and cats, we use them anyway. It’s legal for us to do so if no similar approved drug is in our arsenal. So we use direct-acting opiates like fentanyl (in a patch and as an injectable), butorphanol (pills and injectable), oxymorphone (injectable), buprenorphine (injectable), tramadol (pills), oxycodone (pills), hydrocodone (pills), etc. We also use tranquilizers and sedatives (acepromazine, valium, alprazolam, etc.) to reduce their awareness level, which aids in the stress-related wind-up of the pain mechanism.
Something I`ve recently become a big advocate for is the use of nerve blocks. This form of pain control is identical to the shots we get when a dentist does a root canal or when a woman gets an epidural before giving birth. However, we tend to use them when the animals are already sleeping. They help prevent the pain of a localized procedure from getting out of hand. The patients seem more comfortable and bite at their incisions less.
Pain is a funny thing. If you let it get started you’re in trouble. It’s always easier to prevent pain than it is to treat it after the fact. So nerve blocks on the belly before you make an incision or in the legs before a declaw can make a gigantic difference in how a pet feels later. (I would never do a declaw without at least three different pain meds.)
The most commonly used pain relievers in dogs and cats, however, are in the NSAID family. These aspirin-like drugs (like Rimadyl, Metacam, Previcox, etc.) have come a long way in the past ten years. Because they can be used relatively safely in dogs on a regular (even daily) basis, they have changed the way we manage chronic pain. Dogs with severe arthritis can now live one to five years longer than they otherwise might have—comfortably.
Cats can get these drugs, too, but their tolerance is not so great for the daily NSAIDs. We prefer to use patches or frequent oral dosing of opiates—neither of which is a great option for a lot of cats. What cat wants a pill shoved down its throat every four hours? And patches are pricey and hurt the skin over time. Hopefully we’ll have a good daily-dosed medicine for cats soon.
With the sophistication vet medicine has achieved in treating and preventing pain, there’s no excuse for failing to use a pain reliever for any painful procedure (except perhaps when to use a pain reliever might actually be more painful or traumatic, as when drawing blood, for example).
So now that you’re armed and educated, what will you say when your vet says pain control isn’t necessary for your cat’s spay? I’m sure you’re right, Doctor, but could you give it anyway?
In writing this I hope not to make my colleagues seem ignorant. They’re not. I have a tremendous respect for the skill, experience, and personal practice style of others. Some vets are just not used to all this pain control mumbo-jumbo. As I said, it’s a new thing and old ways of thinking are hard to let go of. But take it from a Bruticaine victim: pain meds are awesome.