By Gwen Covey-Crump, Clinical Anaesthetist & Pain Specialist at Langford Vets
Each September, the International Veterinary Academy of Pain Management (IVAPM) heads a campaign to celebrate Animal Pain Awareness Month with veterinary professionals around the world. The campaign is intended to raise owner awareness and recognition of both acute and chronic pain in animals. September was selected to coincide with human medicine’s Pain Awareness Month.
“Under recognised and undermanaged chronic pain can result in premature euthanasia. Conversely, proper recognition and management of chronic pain can be as life preserving as and other medical treatment in veterinary medicine” AAHP/AAFP Pain Management Guidelines for Dogs and Cats 2015.
As pets live longer with advances in veterinary medicine, chronic pain is becoming an increasingly common presentation. However, our ability to recognise and treat it is still in its infancy. In contrast to acute pain, the key to recognition of chronic pain is client education. Owners are best placed to observe their pets in the home environment.
Pain is not simply a welfare issue. Untreated acute or chronic pain results in a number of deleterious effects such as central sensitisation (pain ‘wind-up’) immune suppression, delayed wound healing, endocrine alterations and wide ranging changes in many physiological functions. For example, severe stress or pain in rabbits may result in reduced gut motility leading to stasis. Changes in gait, posture and activity results in muscle weakness, altered load bearing of joint surfaces leading to osteoarthritic change, and pain in muscles and fascia.
Assessment of chronic pain is considered to be more difficult than acute as an animal learns to adapt their behaviours to their discomfort. Observation of the animal in the non-stressful home environment noting spontaneous behaviour as well as changes in willingness to play, interact and exercise are more useful than measures used in acute pain.
It is worth reminding owners that just because a dog chases squirrels, it does not mean pain is not present. Our understanding of how an animal’s affective state can influence pain thresholds has increased over the past decade through research undertaken at the University of Bristol. If the reward (chasing a squirrel) is greater in that moment than the chronic pain experienced, then the squirrel will be chased and the pain ignored! It is not until chronic pain becomes disabling that the dog may chose not to chase and this is frequently the point at which veterinary advice is sought for the first time.
Signs of chronic pain in dogs as observed by the owner may include:
Pictured: An elderly dog with abnormal posture and unwilling to lie down.
Cats provide more of a challenge than dogs as many of these markers are more difficult to assess. Response to a trial of a non-steroidal anti-inflammatory drug (NSAID) is a quick and easy method of subjectively demonstrating the presence of pain in cats. Signs of pain in cats may include:
Pictured: Cats naturally like to climb. Absence of this behaviour may indicate pain.
Rabbits, being a prey species, alter their behaviour dramatically when placed in a foreign environment with an unfamiliar person. Owner assessment of the rabbit at home is therefore essential. Changes in behaviour may include:
Pictured: Matted fur and faeces resulting from reduced grooming behaviour in a rabbit may be a result of dental pain, arthritis or obesity.
The first task in effective management of chronic pain is being aware of it in the first instance.
At Langford Vets, we offer a comprehensive Rehabilitation and Pain Clinic. Our physiotherapists and pain specialists are available to give free advice to vets in practice. For more information, visit our website.
Further reading For more information, please consult the AAH/AAFP Pain Management Guidelines for Dogs and Cats 2015. Epstein M, Rodan I, Griffenhagen G, et al. (2015) AAHA/AAFP Pain management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 51:67-84 .