Pain management is a bit of an obsession at Lehigh Regional. We use multiple drugs and techniques to decrease pain before, during, and after surgery.
Let’s go over seven myths and misconceptions we hear all too often.
1. My pet doesn’t cry; therefore is not in pain
This is a complete myth in dogs and especially in cats. Crying, vocalizing, whimpering, and screaming in pain are more likely to happen if you step on your pet’s foot or tail by accident, just like you may shout “Ouch” (or worse) if you stub your toe. Beyond the initial pain, it’s unusual for a pet to continue whining about it. This is especially true with the most common reason for surgery: limping. Most pets who limp do not cry. Yet remember this: about 99% of the time, LIMPING = PAIN.
If your pet holds the leg up, it’s because they know that if they put weight on it, it’s going to hurt. So they learn, and they limp or hold the leg up to stop the pain. A pet may stop eating because of severe dental disease, yet they may never cry about it. A cat may groom less because of severe arthritis, yet they may never cry about it. A dog may have a completely torn ACL, a torn meniscus, and severe arthritis. They will not put much weight on the leg, yet they may never cry about it. Crying is only one way to express pain.
2. My pet is just old
Age is blamed for many changes in habits, routines, and behaviors. Yet I know an 18-year-old cat who would chase a laser all day if someone had the time!
So when a pet’s activity decreases, there is usually a good reason, which very well could be a pain. A pet may urinate or defecate in odd places. Yes, it could be senility, or it could be because of a bladder infection or bladder stones, or bladder cancer, all of which cause discomfort, if not pain. A pet may stop jumping to a favorite spot to nap or sleep, not because they’re old, but because there are full of arthritis.
A dog who used to catch a ball in mid-air may now just chase it and then barely be interested in it, not because they’re old, but because there are in pain. A cat who used to do the “zoomies” after peeing or pooping may now run three steps and be done, not because they’re old, but because there are in pain. Unrecognized pain is much more likely to be the issue than old age.
3. Pets don’t feel pain like humans
There is an unfortunate myth that we (pet owners and vets) used to believe: pets don’t feel pain like humans. And therefore, we didn’t take pain management as seriously as we do today. To be fair, we also had fewer pain medications available at that time. The reality is we’re all the same! Pets have the same nerve endings and pain perception as we do. And therefore, we should treat pain in pets just like we do in humans. (I personally think that we do a much better job at pain management in pets, but that’s another story)
One could even argue that pets feel more pain than humans because they can’t anticipate pain, they don’t understand what’s happening (e.g., the surgery will reduce the pain in a joint or in a bone), and they can’t anticipate that their pain will eventually stop. They may think that the pain they feel now might be forever.
4. There is nothing we can do to treat pain
We hear from clients that their pet was given one pain medication, which didn’t do much, so the treatment was stopped, and the pet has been in pain ever since. There is almost always another way we can help treat pain. We now have access to a variety of pain medications in different classes that we can switch to, combine, or increase the dose or frequency of.
And then, there are non-pharmaceutical ways we can consider treating pain, such as weight loss, acupuncture, and physical therapy. Only when all modalities have been exhausted, finances are an issue, or another health problem becomes a limiting factor (e.g., liver or kidney disease), only then is it reasonable to have a discussion about quality of life and humanely ending pain.
5. Postop pain is beneficial
There used to be a time (and I still hear it regularly) when we used to think that pain was beneficial after surgery. It was believed that a patient who is in pain before or after surgery will be quieter, move less, and be less likely to injure the surgery site. Now, we understand that untreated pain has all kinds of negative effects. We understand that pain in pets deserves to be taken seriously and treated seriously. So we send pain medications home after any surgery, even considered “quick” or “minor.”
6. Pain medications are dangerous
There is a stubborn myth that pets with liver or kidney disease cannot receive pain medications. That’s simply not true. It is true that anti-inflammatory drugs can have side effects on the liver and the kidneys. But that doesn’t mean that pets with liver or kidney disease should be allowed to be in pain. There are drugs we can use that do not affect the liver and the kidneys. Or we can lower the dose or the frequency of anti-inflammatory drugs. Many things we do in medicine are compromises.
As long as the pet owner and the vet have a heart-to-heart discussion about the pros and cons of a pain medication protocol, then it’s perfectly possible to treat pain, even in old or debilitated pets. We have done invasive surgery on 18-year-old dogs and 23-year-old cats, and we still treated their pain as thoroughly as we could.
Here are some consequences of untreated pain in old or debilitated pets:
- They may walk less and lose more muscle.
- They may eat less and not get the nutrients they need to heal.
- They may drink less and get dehydrated, which can make kidney disease worse.
- They may not pee or poop normally and have accidents in the house.
Not only can it have consequences for the pet’s health and well-being, but it can also mean the end of their life!
7. My pet wasn’t in pain, so I stopped giving the pain medications
It’s surprising how often we hear that from pet owners after surgery. We typically prescribe pain medications for 7 to 14 days, and it’s not unusual that we call a client for a variety of reasons; they say, “My pet wasn’t in pain, so I stopped giving the pain medications.” I would argue that it’s quite the opposite. These pets are not in pain BECAUSE they’re receiving pain meds, so stopping them is the last thing to do. Stopping pain medications too early can have all kinds of negative consequences, short-term and long-term.
At Lehigh Regional, we take pain extremely seriously.
We use up to 10 ways to treat it – for each pet – before, during, and after surgery. This includes anti-inflammatory drugs, doggy or kitty morphine, local anesthetics inside a joint, and local anesthetics around the surgery area.
There is no one-size-fits-all approach when it comes to pain management. Every pet is different. If one pain medication doesn’t work or causes problems, there is almost always something else we can do to help keep them comfortable.
If you would like to learn how we can help your pet with pain control, safe surgery, and anesthesia, contact us through www.LRVSS.com.
Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified