Pain is a hot-button topic in veterinary medicine—and for good reason. Our knowledge about pain has exploded in recent years. Not so long ago, well-intentioned veterinary school faculty members taught eager students that, “some pain in pets is a good thing.” Fortunately for pets and the people who love them, we’ve come a long way. We now know that pets’ nervous systems are wired the same as ours. That means if a procedure or condition would be painful for us, we can presume it will be painful for our pets. And we realize that experiencing pain is not a “good thing” for pets or people. 

This understanding creates a good-news, bad-news scenario. It’s good news because acknowledging that pet pain is a problem opens the door for treating it. It’s bad news because while we understand pain’s importance, we struggle to identify cats and dogs experiencing it when they can’t talk to us in our language. That said, knowing the way the nervous system works allows us to make useful presumptions about preventing and treating pain in pets. This is powerful information for you, too. It gives you the opportunity to advocate on your pets’ behalf since they can’t advocate for themselves. 

ACUTE PAIN 
Let’s look at the nervous system and clarify the importance of treating pain early and adequately when possible. Pain actually serves a critical role in survival. When we touch a hot stove, our ability to perceive pain protects us from burning tissue by activating the reflex that automatically withdraws our hand. When we sprain an ankle, the pain reminds us to protect the joint until it heals. These are examples of adaptive pain—pain that serves a useful purpose—and pets experience it just like we do. Adaptive pain includes all inflammatory pain, and inflammation is a major factor in many veterinary scenarios, such as following surgery or trauma. 

Problems begin when we don’t effectively prevent or treat adaptive pain. When this happens, physical changes occur in the spinal cord and brain, leading to pain that is called maladaptive. Unrelenting pain transforms from adaptive pain that serves a useful purpose to maladaptive pain, or “pain as disease.” In the maladaptive pain scenario, pain becomes self-perpetuating, an escalating source of misery and suffering. Fortunately, when veterinarians can either prevent pain or identify and treat it early, we can avoid a long-term pain experience for the pet. 

Pets don’t deserve to hurt, and they rely on the people in their lives to do everything possible to help them.

Surgery is the most common pain situation pets face. By asking the right questions, you can be confident your pet will receive appropriate pain management. There are several steps in a surgical or dental procedure where veterinarians can prevent pain, starting in the preoperative period. Giving a preanesthesia dose of a narcotic pain reliever reduces the dose of drugs veterinarians need to induce anesthesia and keep the patient asleep. Local anesthesia blocks pain from the incision or at sites of tooth extraction. And the combination of a narcotic with a nonsteroidal anti-inflammatory drug (NSAID) postoperatively keeps the pet comfortable and enhances healing. Depending on the type of procedure, your veterinarian will outline the pain management protocol that will be best for your pet. 

Traumatic injuries—sprains, strains, fractures, and lacerations—can be pretty unpleasant experiences for pets. Veterinarians can help pets through these painful experiences while treating their injuries. Untreated or undertreated pain interferes with healing, so it’s important to utilize appropriate pain management options. When your veterinarian prescribes pain medications for a pet following surgery, a dental procedure, or after an injury, it’s important that you give the medication exactly as it’s prescribed and give all the doses. Don’t stop giving prescribed pain medication just because you think your pet is fine and it’s not feeling any pain. Pets don’t always make it obvious to us when they’re in pain. Appropriate acute pain management prevents the pain from evolving into the maladaptive pain state described earlier—pain as disease. 

CHRONIC PAIN 
Chronic pain presents its own set of challenges for both pet owners and veterinarians. Most pets that suffer chronic pain are experiencing maladaptive pain—pain that serves no useful purpose. This pain often becomes self-perpetuating or expands beyond the original painful site due to changes in the nervous system. Osteoarthritis (OA), the most common cause of chronic pain in pets, is a progressive disease that may begin with vague symptoms. 

The early signs of OA generally don’t include limping or stiffness. Instead, pets in pain often exhibit subtle behavior changes that pet owners can mistakenly misinterpret as part of “getting older.” These behaviors may include decreased stamina, increased sleeping, decreased interaction with family members, or diminished enthusiasm for previously energizing activities. Pets that previously slept on the bed or furniture may choose the floor. Cats may eliminate outside of the litter box if it becomes painful for them to climb in and out of it. As OA progresses, lameness and stiffness may emerge and the pet can become reluctant to perform simple activities like climbing stairs. 

The good news is that there are multiple effective strategies for addressing and relieving chronic pain. We now understood that a multimodal approach to chronic pain—an approach that targets multiple aspects and origins of the pain—is effective. This approach maximizes the effectiveness of the pain relief protocol, allowing for gradual reduction of medications down to the lowest effective doses, and it exercises the principle of synergy among pain management components. Synergy means that all the pieces of the pain management protocol work together. 

If your cat’s or dog’s behavior has changed in some way, visit your veterinarian so your pet can be evaluated for the possibility of pain. Your veterinarian will try to localize the pain source as much as possible in order to guide the diagnostic plan. Radiographs, CT, or MRI may be needed. Before prescribing any medication, the veterinarian will analyze your pet’s blood and urine to evaluate metabolic function. 

Once chronic pain is diagnosed, there are several important steps that should occur simultaneously in the initial stages of chronic pain management. Don’t overlook weight reduction. In many studies, human and animal, weight loss alone reduced the signs and symptoms of OA pain. While weight management is initiated, medications will reduce pain allowing the pet to be more active, which will in turn assist in weight management. Therapeutic nutrition to support osteoarthritic joints and nutraceuticals to support joint health are also options. Before making any nutritional decisions, be sure to consult your veterinarian in order to choose products that have been demonstrated to be effective and safe. Other techniques like acupuncture, therapeutic laser, medical massage, and therapeutic ultrasound can be leverages to break the pain cycle. Your veterinarian will recommend the therapies and medications that are best for your pet. 

Once the pain cycle is under control, additional techniques like physical rehabilitation (working out in an underwater treadmill), therapeutic exercise, and chiropractic adjustment can restore function and build strength. Once a pet is comfortable and more active, your veterinarian can slowly and systematically reduce the medications to the lowest doses required to sustain as pain-free a state as possible. 

THE PATH TO PAIN FREE 
Keeping pets free of pain is both exciting and challenging, but in all cases it’s extremely rewarding. Our pets don’t deserve to hurt, and they rely on the people in their lives to do everything possible to help them. While we can’t avoid all pain-producing experiences for our pets, we can certainly intervene on their behalf when they face the inevitability of a painful experience. So talk to your veterinarian at the first sign of pain. With your veterinarian’s help, pets can live longer and better. After all, good pain management is good medicine. 

Acute vs. Chronic Pain
Know the difference between the two types of pain and how they affect your pets. With this information—and your veterinarian’s guidance—you can help your pet live pain free.

Definition
Acute pain: Adaptive pain; helps bodies heal
Chronic pain: Maladaptive pain; serves no purpose

Causes
Acute pain: Untreated pain from a traumatic injury, sprain, strain, fracture, or laceration
Chronic pain: Osteoarthritis is the most common cause of chronic pain in pets

Treatments
Acute pain: Narcotics and NSAIDs are effective
Chronic pain: Multimodal approaches are effective