Pain Management
In veterinary medicine we are limited in the number of
oral pain medications we can use for control of pain.
- NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
or 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.
- 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:
- Decreased appetite
- Decreased activity
- Licking, chewing or scratching at a specific body site.
- Guarding or splinting of the affected area.
- Restlessness, not sleeping, pacing.
- Vocalization
- Dilated pupils and anxious wide-eyed expression.
- Rapid breathing, panting.
- Increased heart rate.
- Sensitivity to touching a body part or area.
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