Visiting Veterinarian : Pain management for pets
Pain. In the early days of veterinary medicine, little attention was paid to treating pain. Animals were commodities used for labor, food, and fiber. An animal that could not be saved economically wasn't saved. Many people assumed animals did not feel pain in the same way as humans, since they often appear to endure injury and illness with little outward display of distress.
But, thankfully, times have changed. Cats have moved from the barn to the bedroom and dogs from the doghouse to the den. Sensitivity to animal suffering has expanded to include everything from how we treat farm animals, to whether we should ban declawing of cats, to how veterinarians handle pets' pain.
"Is she suffering, doc?" That's the question with which we often begin. How do we tell if Boo-boo, the Burmese, is in pain? What about Owwy, the Old English Sheepdog?
It's not surprising that your average pet owner can't always tell. Sick or injured animals instinctively try to hide signs of illness. After all, in the wild, it is the weak who catch the eye of the predator. And there are two categories of pain that can present quite differently — acute and chronic. Acute pain is something sudden, like a wound, broken bone, surgery, or rapid-onset illness such as pancreatitis. Chronic pain stems from long-term conditions such as arthritis or cancer. Let's start with acute situations.
If Boo-boo is not in pain, he will look content and quiet when unattended. He will be curious about his surroundings, and appear relaxed and comfortable when resting. We should be able to examine him all over without getting much reaction. (Assuming, of course, that he lets us touch him when he is well: always take into account each pet's normal demeanor.) Perhaps you noticed something subtle at home. He's withdrawing from his usual routines. He may respond when you interact, but in general is less interested in what is going on and carries a little extra tension in his body.
Maybe you can't put your finger on it. "Owwy's just not himself," you say, wondering if you were imagining things, as he trots energetically around the room. Or "I swear Boo was limping yesterday," you say as he leaps off the exam table. No, you are not losing your mind. Natural instincts and adrenalin from being at the vet's are masking symptoms. What you are seeing at home indicates mild pain.
With moderate pain, Owwy may whimper and be more reluctant to move and interact. Boo-boo is clearly not well. Where a dog at this stage may seek attention, most cats will isolate, laying curled up or sitting hunched with feet tucked under the body and eyes partly closed. Boo will likely stop grooming, leaving his coat unkempt, but may lick excessively at the painful area.
Some dogs will eat less at this point, though I have seen Labradors chow down no matter how severe their injuries. Cats in moderate pain usually have decreased appetite, and respond aggressively or fearfully if you try to touch them. Use caution in trying to handle or move any animal in this condition, but definitely seek veterinary care. These pets deserve pain relief.
Few people will miss severe pain and we all understand that these animals need treatment. Cats in distress may yowl, growl, or hiss, even when alone, and may bite or chew the painful area. Otherwise, a hurting Boo-boo will barely move, unless you try to touch him — in which case you might set off a fit of aggressive behavior or fearful flight. Dogs in this kind of pain will bite even the most dearly beloved people. Although it seems harsh, placing a muzzle before moving a dog in this state is the safest option.
Cats? Well, a hurt cat takes more finesse. Sometimes you can gently prod them into a carrier, or lift them in by covering them with a towel or blanket that protects you. If Boo is seriously aggressive, consult your veterinarian about options and protect yourself from injury. Animals in the most extreme stages of pain may lie prostrate, holding the body rigid to avoid any movement. These cases may appear unresponsive, or unaware of their surroundings, as the pain is their overwhelming focus.
Chronic pain looks different. Owners may think pets are just "getting old," "slowing down," or "going senile." Geriatric pets may sleep more or pass on the five-mile jog, but major behavioral changes may indicate underlying pain. The old cat that poops outside the box may not be senile, but too achy to climb stairs or get into the litter pan. The old dog that doesn't greet you when you return home may not simply be deaf, but also reluctant to rise because his back hurts. The pet with cancer who stops eating may not be succumbing to the tumor, but merely reacting to being in pain. All these animals can benefit significantly from appropriate medications.
Do not, I repeat, do not take something from your own medicine cabinet and give it to your pet. They have different biochemistry and physiology than humans. Too many animals have died when well-meaning owners gave them the wrong drugs. Always consult your veterinarian about pain medication.
What about side effects and safety? All drugs have potential risks, and elderly animals are more prone to problems such as kidney or liver disease that predispose to adverse reactions.
We can avoid risk completely by never giving pain medications, but is that the right thing to do? How do we decide when benefit outweighs risk? Pre-treatment screening, appropriate dosing, ancillary supportive care, and regular monitoring all serve to let us relieve suffering while minimizing risk.
If your pet is exhibiting any of the behaviors discussed today, they may be in pain. They can't go to the drugstore themselves. They can't tell us in words when they are hurting. They count on us to interpret their behavior correctly, to advocate for them, and to assure their days are comfortable and free from pain.