Dissolving the Stain of Pain

The presence and degree of pain an animal experiences is meant to be beneficial. Pain signals actual or impending body damage, and may help prevent further damage by initiating movement away from the cause or by limiting use of injured areas during healing. Pain associated with acute injury typically has an identifiable cause and can be relieved by resolving the cause. In the veterinary medical setting, acute pain associated with injury is chiefly managed pharmacologically through effective use of non-steroidal anti-inflammatory drugs, opioids, and other analgesic agents. Moreover, the efficacy of a pain treatment plan may be enhanced by engaging the body’s powerful pain-modulating systems through adjunctive pain-relieving modalities such as acupuncture, acupressure, chiropractic manipulation, therapeutic massage, therapeutic ultrasound, or numerous additional methods. With some exceptions, under-treatment of acute or subacute pain generally results from failure of assessment, not from lack of treatment modality.

In treating chronic pain, it is also important to identify the underlying cause(s), as an effective management plan cannot be formulated without a sound, working diagnosis. However, as persistent pain is often multi-factorial in origin, and specific diagnoses may be lacking, chronic pain management can be a very challenging and complex endeavor. Over time, initially untreated or improperly treated disease states or injuries can place undue stress on remote body regions, leading to deconditioned or over-use states. The long-standing stress of chronic painful conditions can overtax, or even exhaust, the hypothalamic-pituitary axis, leading to severe neuroendocrine or metabolic imbalance. Unremitting severe pain can lead to sensory hypersensitization secondary to functional and anatomical changes within pain processing pathways (Type III pain). The result can be a diffuse and complex array of pain sources and dysfunction. For veterinarians trained to seek a single diagnosis to explain all symptoms, this array can be a cause for extreme frustration. A good medical history (particularly with regard to previous treatments and responses), a thorough physical examination, and appropriate diagnostic testing comprise the foundation for developing a successful pain management plan. Additionally, it is essential that the practitioner determine that serious, treatable medical conditions are absent.

Before therapy is initiated, appropriate treatment goals should be determined. These goals will serve as outcome measures by which treatment efficacy is ascertained. Ideally, all symptoms are eliminated by treatment; however, this may not occur quickly. In fact, in the case of long-standing conditions, complete resolution of painful symptoms may not be feasible.

For chronic pain, treatment needs to address not only the physical pathology initiating the pain but also the sequellae arising from long-term adaptation. The goal of pain management is to shorten the duration of disability and to enhance the animal’s ability to perform at some reasonable level of activity. Chronic pain levels may not significantly improve until the patient has begun to recondition and increase the daily exercise level. Treatment, therefore, necessitates a comprehensive approach using both medical and functional rehabilitative modalities. Functional rehabilitation includes identification and management of contributing factors (whether independent of, or secondary to, a primary cause), retraining the animal to some level of work, and client education/training.

Effective control of pain depends on combining various therapeutic modalities, routinely evaluating efficacy of treatment, and changing therapeutic plans according to the needs of the patient.

Contact:
Michael Tomasic, DVM, 505/466-0151, drmtomasic@yahoo.com
Veterinary Pain Management, Santa Fe, N.M.

From Equine Disease Quarterly, funded by underwriters at Lloyd's, London, brokers, and their Kentucky agents.

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Equine Disease Quarterly

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