Pain management

relationship between pain and problem behavior

presenting complaint as a direct manifestation of pain, unidentified pain underpinning secondary concerns within the initial behavior problems, exacerbation of one or more signs of problem behavior as a result of pain, adjunctive behavioral signs associated with pain

preemptive method of pain control vs proactive approach to pain control

preemptive: treat pain as early as possible acute pain= before sx chronic= tx early as possible

proactive: understanding when pain may be present, actively assessing for pain, engaging the entire veterinary team and pet owners, make owners aware of risks and early signs, especially in at risk breeds or age groups

assessment tools for acute pain in cats

owners input of observation sudden behavioral changes

assessment tools: grimace pain scale, glasgow pain scale, colorado pain scale

assessment tools for chronic pain in cats

owner has a central role

clinical metrology instruments= screening, diagnosis and monitoring

assessment:

screening six behaviors: running, jumping up, jumping down, going up stairs, chasing objects

diagnosis= feline musculoskeletal pain index, Montreal cat arthritis test

monitoring= client specific outcome measures developed for owner assessment of the impact of pain on the cats ability to perform activities that are specific to each individual cat

assessment tools for acute pain in dogs

in clinic: appetite, demeanor, behavior and palpation

clinical metrology instruments: pain scales

owner: observations of sudden changes in normal behavior

assessment tools for chronic pain in dogs

musculoskeletal most common type of chronic pain

in clinic: observation of motion, posture, hands on evaluation

owner: observation of gradual changes in their dog behavior

questionaries for owners: canine brief pain inventory, liverpool OA in dogs, canine orthopedic index

acute vs chronic pain

acute: adaptive/protective pain: nociceptive and inflammatory

chronic: maladaptive/ pathological pain: neuropathic and functional (no longer protective, causes changes in the physiological pain pathway, amplifying pain) longer it goes on the more difficult it is to treat

1st tier chronic pain management for dogs/cats

2nd tier chronic pain management for dogs/cats

3rd tier chronic pain management for dogs/cats

NSAIDS

opioids

long term no recommended for chronic pain control (risk of human abuse, poor oral absorption)

Gabapentin and pregabalin

nt: gaba-amino butyric acid (GABA)

Acetaminophen

intraarticular treatments

Amantadine

Amytriptyline

cannabinoids (CBD)

not fda approved

Medications to treat chronic pain in dogs: chart with MOA and frequency

Medications to treat chronic pain in cats: chart with MOA and frequency

Frunevetmab (solensia) feline anti NGF monocolonal antibody

Lenivia (bedinvetmab)

Portela (frunevetmab)

Radiosynoviorthesis

nonpharmacological approaches

low level laser therapy, hydrotherapy, weight control, nutrition: omega 3 fatty acids and caloric restriction, acupuncture, environmental modifications, physical therapy

nutraceuticals (3)

acupuncture MOA and techniques

hydrotherapy

Photobiomodulation therapy

Environmental modifications