Canis ISSN: 2398-2942

Pain: management

Contributor(s): Jeff Ko, Jo Murrell, Sheilah Robertson

Introduction

  • The growth in scientific knowledge of the pathophysiology of pain Pain in small animals allows us to select a wide variety of pharmaceutical agents combined with other techniques for pain management. Pain management can be divided into 2 very broad categories: acute and chronic pain control. This article primarily discusses pain management drugs and includes recent information and developments.
  • The goal of pain management for trauma patients is to immediately alleviate the intensity of pain by administering appropriate primary analgesics. This usually involves opioids in combination with sedatives.
  • The goal of acute pain management for patients undergoing elective surgery is to prevent pain by using analgesics Analgesia: overview pre-emptively, intraoperatively, and postoperatively according to need Pain: assessment. This usually involves one, or a combination of the following: opioids Analgesia: opioid ; local anesthetics Local anesthesia: overview ; constant rate of infusion with an NMDA (N-methyl-D-aspartate) receptor antagonist, opioids, and local anesthetics; and NSAIDs (non-steroidal anti-inflammatory drugs) Analgesia: NSAID.
  • The goal of managing non-malignant chronic pain is not only to alleviate pain daily but also to improve the function of the patient over time and improve quality of life. This may involve the use of opioids, NSAIDs, tramadol, and drugs used to treat neuropathetic pain, such as amantidine, gabapentin Gabapentin , and NMDA receptor antagonists.
  • The goal of managing malignant pain is to provide comfort and may involve using the whole spectrum of analgesics and sedative agents over the course of the disease.
  • Using various analgesic agents at different times or in different combinations may drastically improve the quality of pain management. Strategies such as pre-emptive analgesia and balanced analgesia (or multimodal analgesia) are frequently used.
  • Pre-emptive analgesia operates on the principle of administering analgesic drugs before the painful stimulation occurs, thereby preventing central nervous system sensitization (or wind up), which amplifies the sensation of pain. The use of the balanced analgesic technique allows practitioners to use the various mechanisms of action of the different analgesic agents to provide pain control, minimizing the side-effects of a single large-dose of any one analgesic agent. The use of various low-dose analgesic agents may also provide synergistic analgesic effects, benefiting the patient more than a single analgesic agent.
Print off the owner factsheet Managing pain in pets Managing pain in pets to give to your client.

Pre-emptive analgesia and premedication

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Combination of opioids and NSAIDs for pre-emptive analgesia

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Regional anesthesia-analgesia techniques and local infiltration

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Constant rate of infusion

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Recent developments in pain management

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Further Reading

Publications

Refereed papers
  • Recent references fromPubMed.
  • Epstein M, Rodan I, Griffenhagen G, Kadrlik J, Petty M, Robertson S, Simpson W (2015)2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. JAAHA51(2), 67-84PubMed.
  • Goyenechea Jaramillo L A, Murrell J C, Hellebrekers, L J (2006)Investigation of the interaction between buprenorphine and sufentanil during anaesthesia for ovariectomy in dogs. Vet Anaesth Analg33(6), 399-407PubMed.
  • Valverde A, Cantwell S, Hernandez J et al(2004)Effects of acepromazine on the incidence of vomiting associated with opioid administration in dogs. Vet Anaesth Analg31(1), 40-45PubMed.
  • Muir W W 3rd, Wiese A J, March P A (2003)Effects of morphine, lidocaine, ketamine, and morphine-lidocaine-ketamine drug combination on minimum alveolar concentration in dogs anesthetized with isoflurane. Am J Vet Res64(9), 1155-1160PubMed.
  • Wagner A E, Walton J A, Hellyer P W et al(2002)Use of low doses of ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs. J Am Vet Med Assoc221(1), 72-75PubMed.
  • Lucas A N, Firth A M, Anderson G A et al(2001)Comparison of the effects of morphine administered by constant-rate intravenous infusion or intermittent intramuscular injection in dogsJ Am Vet Med Assoc218(6), 884-991PubMed.
  • Muir W W III, Woolf C J (2001)Mechanisms of pain and their therapeutic implications. J Am Vet Med Assoc219, 1346-1356PubMed.
  • Ko J C H, Lange D G, Mandsager R E et al(2000)Effects of butorphanol and carprofen on the minimal alveolar concentration of isoflurane in dogs. J Am Vet Med Assoc217(7), 1025-1028PubMed.
  • MacPherson R D (2000)The pharmacological basis of contemporary pain management. Pharmacol Ther88(2), 163-185PubMed.
  • Kehlet H, Dahle J B (1993)The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg77, 1048-1056PubMed.
  • Beaver W T (1984)Combination analgesics. Am J Med77, 8-53PubMed.


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