PAIN
Linda Aronson, DVM

Not very long ago the popular wisdom was that animals not be given pain-killers because they would be overactive and pull open sutures or delay healing.  We now know that relieving pain allows dogs to heal faster and they do not try to do too much.  Without pain they can rest and heal.  Since this was established the next big hurdle was to determine when the dog was in pain.  Dogs tend to hide pain.  This could be because before domestication a sick dog couldn’t keep up with the pack and would be seen as a liability and be abandoned.  Given the numerous examples of dogs who mourn lost pack mates – human and canine – this may be an oversimplification.  There are human stoics who can withstand a lot of pain, but still feel it, and benefit from having it addressed and relieved.  We know that humans with arthritis can have quite severe lesions before they feel pain, and that it can then appears to come on suddenly and be quite debilitating.  This could well be the case also with dogs.

We are very fortunate that we have so many different drugs and therapies to address pain, and yet people may be afraid to try them because of a bad reaction from one of their own dogs or a friend’s dog, or something they read on the Internet.  The same treatment could be just what the present dog needs.  The good news is we have so many different options close to 100% of dogs’ pain can be removed, we just have to match patient and therapy. 

When assessing your dog’s level of pain you are better equipped than most vets.  Living with him, you are able to quickly notice changes in posture, movement, level of activity, vocalization and general behavior.  Keep a record, and if you believe your dog is hurting insist that this is addressed.  Of course, we have all met the Beardie divas who leap and scream even if you brush against their hair.  Sometimes though, if they are really hurt these same dogs can be as quiet and still as any other dog.  If the dog has been injured or has a surgery or procedure we know would be painful to a human we can assume that the dog is in pain.  We should also remember that a dog in pain can act atypically, and bite to protect himself from further pain. 

Drugs are often the first line of treatment for pain.  Non steroidal anti-inflammatory drugs (NSAIDs) give consistent, predictable results.  However, 1 to 3 % of dogs will suffer from adverse effects (remember most of these will be mild).  Short term the most common problems are gastrointestinal.  The older less specific drugs like aspirin can cause gastric ulceration, and should be given with a drug such as omeprazole to protect the stomach.  However, even the COX2 specific newer NSAIDs (carprofen – Rimadyl; deracoxib – Deramaxx; meloxicam – Metacam; firocoxib - Previcox) can also cause anorexia, diarrhea and/or vomiting.  Long term these drugs can result in acute renal failure or exacerbate existing kidney disease and sometimes liver disease.  In rare cases these may prove fatal.  It must also be remembered though that many dogs receiving these drugs chronically are elderly, may have unidentified underlying illness, and might well have died anyway.  Before the dog is placed on any of these drugs bloodwork should be done to rule out preexisting conditions, and the dog monitored for potential adverse effects.  If the dog is to receive these drugs long-term, blood work must be repeated every 3 to 6 months to look for changes in liver and kidney function or other systems.   

For surgical patients, anesthetics do not control pain, and the dog should receive analgesics prior to induction of anesthesia.  Combining a fast acting drug with a short duration of action with one whose onset is slower but which lasts longer is a good choice.  This enables the anesthetist to maintain the dog on a lighter plane of anesthesia which is safer for the dog.  Pain killers may be given constantly throughout surgery with intravenous fluids too.  Epidurals are not used as frequently as they would be helpful in veterinary medicine. 

Opiates are being used quite often for pain control.  In general, I find they are less effective for treating chronic pain like arthritis, but they are good for short term surgical pain.  Side effects can include constipation, loss of appetite vomiting and occasionally diarrhea; anxiety, agitation, tremors, dizziness, tremors, and sometimes intense itching.  Tramadol is the most commonly prescribed oral opiate.

Often overlooked in pain management are simple procedures such as applying heat and ice.  Ice is most often used for acute injuries in the first 48 hours.  Do not apply the ice pack for more than 20 minutes at a time, but repeat frequently.  It will reduce pain and swelling.  You can also apply ice to old injuries right after activity exacerbates the injury.  Most often heat is used for chronic conditions though, relaxing and loosening tissues and stimulating blood flow.  It should not be used in the 48 hours after injury or after activity, but it can help old injuries warm up before exercise.  (While humans can decide to play hurt, I do question the wisdom of asking an animal to do so as it can worsen preexisting injuries.  However, if your dog is determined to do Beardie bounces despite chronic arthritis, warming her up before heading out on a walk will help.)  You can use a heating pad or hot wet towel, but just as over icing can cause frostbite, keep the heat moderate to avoid burns, and 20 minutes is usually plenty for any application. 

Passive range of motion exercises can also ease stiffness and reduce pain.  Warm up and cool down exercises before and after athletic work outs can reduce injury and pain.  For more extensive rehabilitation work rehabilitation hospitals are springing up more frequently.  Sports medicine may soon be a board certified veterinary specialty.  Rehabilitation pools and underwater treadmills can help maintain muscle tone during healing without putting excessive strain on injured limbs.  Electrical stimulation, ultrasound and laser treatment are all being used to relieve pain and restore mobility.  Drugs alone do not address the loss of strength and mobility that accompanies acute injury or chronic debilitating disease.  Together with effective rehabilitation techniques, the dog can remain an active and engaged companion far longer than with drugs alone. 

Low level or cold laser therapy can be a godsend for canine athletes.  It treats immediate pain, while speeding healing thereby reducing the duration of the pain.  Acupuncture and electro acupuncture can also produce dramatic response in some patients, and sometimes even a single treatment can provide long-term pain relief.  Other options include supplements and herbs as well as chiropractic.

We owe it to our dogs to relieve their pain and improve their quality of life.  The more we know about the options to achieve this, the better we can serve them.

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A grateful thank you to Linda Aronson, DVM for this article.