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Sunday, August 19, 2012

Pain In Animals Is Real

Last week I did a routine spay on two little kittens.  Everything went well, the kittens recovered normally, and they were getting lots of attention before they left because they were so cute.  When the owner came to pick them up our receptionist offered pain medication for them to go home with.

The owner said "Do they really need it?"

Okay, stop and think here for a minute.  We just took two young cats, each about five pounds, cut through their skin and abdominal muscle with a sharp knife, pushed around their internal organs with a probe, pulled out their uterus, tied off the appropriate areas, cut away the uterus and ovaries, and then put in several layers of sutures to close everything up.  After all that we are asked "do they need something for pain"?

Unfortunately there is a perception among many people that animals don't feel pain, or don't feel it in the same way that we do.  There are even some vets who don't feel convinced that pain control is necessary, and that pain can help a patient by forcing them to restrict their activity.  Both of these viewpoints are severely flawed.

Quite a lot of research has been done on pain in animals over the last 15-20 years, and the overwhelming conclusion is that they feel pain as acutely as we do.  Just like some people can push past it while others are a bit wimpy (raising my own hand, here), some animals show more obvious symptoms than others.  But they certainly do have pain receptors just like we do.

Why does this matter?  So what if they hurt a little bit?  It doesn't really bother them, does it?

Pain is the result of stimulating certain nerves and those signals begin a cascade of chemicals released into the body.  Pain increases stress hormones which have been shown to slow healing.  Pain also causes significant mental stress and can lead to long-term trauma and aversion of events or locations where the pain occurred. All of this can have tremendous effects on a pet.

Let's put it very simply.  Painful animals suffer mentally and physically and heal slower.  Pain-free animals have a much faster recovery and healing process with less stress and trauma.  Whenever  an illness, injury, or surgery causes pain, it is absolutely in the pet's best interest to do everything we can to control that pain.

Think about yourself.  If you had surgery how would you feel?  What would you think of a doctor that didn't worry about controlling your pain?  Extend that attitude towards your pets and you're in the right direction.

12 comments:

  1. How do you think clients would respond if you didn't make post-op pain meds an option, and simply included them in the surgery cost from the start?

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  2. thanks Andrea - i agree - although I wasn't sure if they were "offered" the already prescribed pain meds and didn't want them, or 'offered" the option of having meds prescribed?
    Either way, I cannot believe we let this be optional, or a way of cutting the price to compete against other clinics.
    All animals should be given pre and post op pain relief, and sufficient take home option for 2-3 days - for all invasive surgery.
    Failure to supply this is really a breach of their five freedoms - s much as the owner failing to give them.

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  3. Great question, Andrea. I should have been more clear in my original post. All of our surgery prices included injections for pain both pre- and post-operatively. I wouldn't do surgery without it and it's not optional. The way our computer software works we only have a single price for spays and neuters, regardless of the pet's size. However, at-home analgesics will vary based on the size and species. For example, I might send home carprofen for a dog and meloxicam or buprenorphine for a cat. Because there is such variability in the medication we might use to control pain we can't include a single price in our surgery packages. Also, US prescription laws require very specific details on the label, so we can't just order "pain medicine". Because of these logistical challenges we have to order at-home meds separately, which means that the client does have the opportunity to decline them. Thankfully it's very rare for them to do so. If I had an easy way to include it in the surgery packages, I absolutely would.

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  4. Thanks for answering my question before I could ask! :o) I was going to inquire as to which post op meds you recommended.

    One of the clinics that works with our shelter originally refused to send animals back with pain meds. When we insisted it was our policy they relented.... And started to send cats back with Tramadol. I have never seen such violent reactions to meds. Almost all foam horribly at the mouth, many vomit and some cats just plain old won't let you touch them anymore because they don't trust us. :o(

    I've gotten to the point where I figure they won't die without it - and they seem like they'd prefer to be in pain than take Tramadol. We have no problems administering Meloxicam or Buprenorphine. We are not fond of the Tramadol vet at all....

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  5. Unfortunately, there are also still plenty of vets that don't use much analgesia. When inquiring about pain medication for my cat that was having bladder surgery, I was told by the vet "Oh, he doesn't need any". Well I didn't accept that, and said I would prefer that he have some (I was being polite, there wasn't going to be any surgery without meds). They agreed, but when I picked the cat up, they didn't have any ready, and the tech said "he probably got something with surgery". (he had an nsaid with surgery, I hope) Again, I insisted, and she told me to not give him the tramadol until the next day. Ummm... no.... cat was pretty painful when I got him home. And had I not insisted, repeatedly, it would have been much worse. Similar thing with a puppy who needed ortho surgery - vet insisted the correct thing was to deliberately leave him in pain a few days until surgery to "keep him quiet". Again, no... Very sadly, it's not just the clients.

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  6. T, unfortunately this is still the case in some areas and I worked for a vet like that. I'm completely opposed to this viewpoint, for the reasons I've stated in the post. In fact, pain medication is now veterinary standard and failing to do so can legitimately be accused of being sub-standard medicine.

    Karissa, Tramadol is actually a great medication, though I don't use it in cats often. The foaming you described is because of a very bad taste, not a reaction, and is common with many bitter medications. Still, meloxicam and buprenorphine are better choices in my opinion.

    Which meds to I recommend? For dogs I generally use carprofen and cats meloxicam. However, if it's a very painful procedure I'll use buprenorphine for cats and add Tramadol to carprofen for dogs.

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  7. I wish it was standard - I understand what you're saying. Where I live (and I'm only about an hour from a huge city) I'd say half of vets, at best, practice reasonable pain management. And I've been told that the veterinary board will not act on inadequate pain management practices, as it isn't considered a violation of standard of care. One vet (not mine) has pain medication as an owner selected extra option on his surgical consent form. Lovely. I'm glad he doesn't have anesthesia as optional!
    Yes, I am passionate on the subject. I think many animals receive inadequate analgesia.
    TAM

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  8. I think many vets, myself included, would say that analgesia IS a standard of care. I know many specialists that are equally if not more passionate about this subject who would argue strongly that it is the standard of practice. Thankfully the vets who have graduated in the last 10+ years have been receiving increasing emphasis on pain control in their studies, so the trend should be moving to MORE analgesia, especially after surgery.

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  9. I am glad to hear of more vets thinking that way, I wish the boards would start to enforce that. There was a case (or 2?) in Minnesota. But I have heard from differently from a board member in another state. Some people around here do major ortho surgery, enucleations, etc. without more than an nsaid, tramadol if they're lucky. No morphine or such, not even as part of the anesthetic protocol. Lots of "old school" still out there, unfortunately.
    TAM

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  10. Believe it or not, surgery was done without analgesia on infant humans up until '86 because they thought they couldn't feel pain. Yikes.

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  11. Though I am not a medical professional, I do happen to have a husband who now has fibro because his post-trauma pain wasn't controlled properly. My dog is getting his pain meds after his neuter (he has an undescended testicle so it's going to be a bit more invasive than normal) or I'm going to a different vet.

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