Multi-modal Analgesia

It is hard to believe, but there was a time (not long ago, really) when veterinarians did not prescribe pain relief medications to animals. Either because they don't cry like humans do or simply can't say "Ouch! That Hurts," it was believed that they didn't feel pain as we did. Others might have thought pain was present, but that it was a good thing, especially post-operatively, because it would keep a patient quiet and thus less likely to injure itself. That is just ridiculous, of course. I am so glad those times are behind us! Animals certainly do feel pain; they just express it in different, possibly more subtle ways. My veterinary technicians or nurses are trained to recognize these signs, particularly in post surgical patients. Vocalizing or crying is a pretty obvious sign. Rapid heart rate or dilated pupils may indicate pain or fear. The pet may have an abnormal posture or gait/lameness, or may be trembling or shaking. They might be licking or chewing at the sight of pain, be restless or depressed. A once totally sweet critter might now be grumpy or aggressive or might be distancing themselves from their humans. The only sign of pain might be anorexia (not eating.)
Treating for pain can be complicated by the patient's personality (cats are notorious for being difficult to medicate) or their reactions or sensitivities to some medications (non-steroidal anti-inflammatory medications, NSAIDs, for instance, commonly affect the gastrointestinal tract, causing vomiting or diarrhea or may affect the kidneys or liver when used long term.) We do know that it is usually better to use lower doses when possible to avoid side effects, but those low doses might not be as effective at managing the pain. That is why veterinarians are commonly using what we call "multi-modal"analgesia or pain management. It can start with combinations of drugs before, during and after surgeries, as well as medications for chronic pain.
My dog, Verbal, is a typical patient who gets several medications or therapies, often at lower doses than using just one of them alone, and getting far better benefits. She has very bad DJD or degenerative joint disease from hip and elbow dysplasia as well as an improperly healed cruciate ligament rupture in one knee. She is on a special diet for joint health, (some dog's are given additional supplements like glucosamine and chondroitin.) Verbal gets an NSAID called Derramax for the antiinflammatory benefits, and also gets tramadol, a weak opiod-type drug when she "over does it." There are many NSAIDs and opiods to choose from if dogs or cats have reactions to particular ones. I have also used medications such as gabapentin for neurogenic pain, and have just started using one called amantadine. It is also important not to forget the alternative therapies such as acupuncture, massage, or herbal remedies.
It can be a bit confusing for owners, juggling all the different pills and powders and foods, but if it is better for their pet's health, most are willing to give it a try. I hope to continue to learn and apply that knowledge to make my patients as comfortable as possible for as long as possible. They certainly deserve it!
Peace,
DrReneigh