Pain Management

1. NONSTEROIDAL ANTI-INFLAMMATORY DRUGSor NSAID's include two distinct subclasses: the carboxylic acids and the enolic acids. The carboxylic acid group can be further subdivided into the salicylates, proprionic acid derivatives and fenamic acids. ASPIRIN, a salicylate, is a very common, mild analgesic (pain relieving) medication. It is useful for the low-grade pain of arthritis and minor trauma. It is available over-the-counter and is inexpensive. IT IS TOXIC IN CATS! The most common side-effects are gastrointestinal irritation. NAPROXEN (Aleve®),IBUPROFEN (Motrin®, Nuprin®) and KETOPROFEN (Orudis®) are proprionic acid derivatives. These can NOT be used in dogs or cats as they have a higher incidence of moderate to sever side-effects such as gastrointestinal tract hemorrhage, ulceration and perforation and kidney failure. They are not used in veterinary medicine. NSAIDs reduce pain by inhibiting the inflammatory response that increase sensitivity to pain. They also act centrally in the spinal cord as well. These agents are useful for soft tissue pain. Two new veterinary NSAIDs are now available, RIMADYL® (carprofen) and ETOGESIC® (etodolac). These drugs have greatly increased our effectiveness in managing the pain of arthritis and mild post-operative pain. Side-effects have been minimal. Again, these agents are not used in cats.

2. NARCOTICS (OPIOIDS) are potent and specific analgesic drugs. Morphine is the oldest and most well-known of these agents. Opioids interact with specific receptors in the spinal cord to inhibit pain signal transmission to the brain. They also act in the brain to block the perception of pain. The most common agent used in veterinary medicine is TORBUTROL® (butorphenol). This is available in tablet form and we often dispense a 3-5 day supply as a post-operative analgesic. During surgery we usually give this drug as an injection to begin the pain management protocol. This drug is a controlled substance which requires record keeping and is more expensive than aspirin -- it is also a much more effective pain relieving medication. Other opioid drugs are not that useful because they can't be given orally for at home care. SEDATIVES AND TRANQUILIZERS ARE NOT ANALGESICS, although they are often used in conjunction with pain medications.

WHAT DOES PAIN LOOK LIKE IN OUR PETS?

One of the main problems associated with pain management in animals is that our patients can't communicate with us verbally. We have to watch for signs of pain through behavioral changes such as:

1. Decreased appetite
2. Decreased activity
3. Licking, chewing or scratching at a specific body site.
4. Guarding or splinting of the affected area.
5. Restlessness, not sleeping, pacing.
6. Vocalization
7. Dilated pupils and anxious wide-eyed expression.
8. Rapid breathing, panting.
9. Increased heart rate.
10. Sensitivity to touching a body part or area.