Dealing With Your Pet's Pain:
Severe Acute and Chronic Pain
By Christie Keith
This article was updated with new information on August 13, 2008.
In the first article in this series, I showed that recent veterinary research had demonstrated that controlling pain in animals speeds healing and recovery, and that uncontrolled pain in and of itself is harmful to the animal. In the second article, I looked at some alternatives for dealing with mild injuries and chronic pain, such as mild arthritis. In the last article in the series, I am going to look at options for handling pain after surgery, from severe injuries, and severe chronic pain.
Some vets and pet owners appear to believe that a little pain is a good thing if it helps keep the pet quiet during recovery from surgery or an injury. Given the fact that pain lengthens recovery time and suppresses the immune system, this attitude is one that must be laid to rest forever. If the pet needs to be kept from moving around, crates, cages, carriers, leashes, and other forms of confinement must be used instead of pain. Furthermore, pain is a very unreliable form of restraint.
Whether the surgery is a simple neuter or spay or hours-long orthopedic surgery, it will cause pain in your dog or cat. Even if your pet is frisky and hungry the next day, this does not mean he or she is not experiencing pain, and that relieving that pain will not be beneficial to your pet.
For minor surgeries such as neutering or a dentistry, discuss pain management with your vet prior to the surgery, and find out what, if any, pain medications they will give your dog or cat after the procedure, and how long it will last. If they do not regularly prescribe any post-procedure pain medication to use at home, request something to use if your pet is in pain.
It is possible, even likely, dog owners will be offered the drug Torbugesic (butorphanol), usually in VAL syrup. While commonly prescribed, Torbugesic is a very poor pain drug for dogs, lasting an extremely short amount of time and not controlling pain very well during that time.
If you ask for something other than Torbugesic, the next most common suggestion is a drig such as Rimadyl, Metacam, or a number of other drugs in the class known as non-steroidal anti-inflammatories, or NSAIDs. While these drugs are, in my view, over-prescribed for minor and chronic pain, and carry a number of risks many dog owners aren't aware of, they play an important role in the control of severe pain, including post-surgical pain. However, there is another option that can be used instead of, or sometimes in combination with, NSAIDs, and that's the human drug Tramadol (Ultram).
My first experience with this drug was when it was prescribed for my dog Rebel after surgery. This drug is being increasingly used in veterinary medicine, and I've found it to be invaluable for post-surgical pain as well as for certain injuries and even chronic pain. I wrote an article about Tramadol for the veterinary technician blog VetTechs, and it can be found here: Tramadol.
I will discuss complementary and alternative veterinary medicine for mild post-surgical pain control in dogs below.
Cats are generally prescribed the drug Buprenex (buprenorphine), which is administered by rubbing or squirting on the gums, for pain management at home. It is usually dispensed in pre-measured syringes and is very effective.
For more serious surgeries, including full abdominal surgery such as a spay (a spay is not, contrary to popular perception, a minor surgical procedure; ask any woman who has had a hysterectomy), I have had extremely good results using narcotic pain relievers for my dogs. Morphine, fentanyl, and other powerful drugs can serve to keep your dog sedated and resting and pain-free while he or she recovers from the enormous stress and assault of major surgery. I have used holistic alternatives, but in every case these were as complements to, not instead of, allopathic pain medications prescribed by my vet. For example, narcotics tend to make dogs queasy, and so I usually give a product called Minty Ginger by the company Herbs for Kids to dogs who are on narcotic drugs. Tramadol does not seem to cause the nausea that narcotics often do.
Orthopedic surgeries tend to be the most painful of all, and if your dog or cat is having such a procedure, it's best to have it done by a surgical specialist. Most surgeons will be able to guide you in selecting a proper course of pain management for your pet. Because the pain from such surgery tends to be worse and longer lasting than abdominal surgery, this is a time when I might consider using NSAIDs after a period of narcotics. I don't like the effects of long-term narcotic use, although addiction is not the issue with pets that it is with humans, and after a few days of dozing and recovering, it's not really practical to keep the dog groggy when he or she could be aware and interacting with family members. If the dog or cat has good kidney and liver function as determined by pre-surgery blood panels, and if you and your vet can continue to monitor kidney and liver function while the pet is on the drugs, this is a time you might want to consider Rimadyl, Deramaxx, or one of the other Cox-inhibiting pain medications. Tramadol may be a better choice, as it doesn't have the GI side effects of the NSAIDs, and is not as sedating as Fentanyl or morphine. However, at the higher doses, it will have a sedative effect. The combination of Tramadol and COX-inhibitors is especially effective, and the harm NSAIDs cause to the GI tract can be minimized with certain supplements, herbs, and even other drugs. For more information, you can review my article Misoprostol and More: Making NSIADs easier on your dog's gut.
Prevention is Better than Cure
It is better to prevent pain than to try to eliminate it after the fact, and for that reason, most state-of-the-art anesthetic protocols include pre-procedure pain medication. This prevents what is called "wind-up," and is an excellent method of minimizing the adverse effects of pain on your dog's recovery.
New techniques including applying Duragesic (fentanyl) patches the night before surgery, or using epidurals, are very effective in dogs and cats and can speed recovery time substantially. If your vet is not familiar with this approach, ask him or her to contact UC Davis or another veterinary school, and consult with an anesthesiologist. If your vet does not stock Duragesic patches, he or she can phone a prescription in to your local pharmacy, where you can pick it up and bring it to the office for application. Obviously this is something that requires advance planning.
For minor surgical pain or injuries that are more severe than discussed in the previous articles in this series, some holistic alternatives are extremely effective. If available, acupuncture will both relieve pain and relax your pet, helping him or her cope with stress better. For dogs, buffered aspirin or the herb white willow bark can take the edge off minor pain. Do not use these on cats.
For dogs or cats, the homeopathic remedy arnica can be powerful for post-surgical pain, or pain from injuries. For severe pain I use arnica in the 1M or 10M potency. For dosages and directions, please consult your holistic veterinarian or refer to my earlier article on minor pain.
Herbal or homeopathic gels containing calendula officianalis are wonderful for putting on incisions. They help with pain, itching, and irritation; I've used them on my own surgical incisions and the relief was immediate and unmistakable. I have noticed that my dogs or cats leave their incisions alone much more readily when they are treated with calendula.
What about holistic alternatives for serious pain, surgical recovery, or severe chronic pain? In the case of severe chronic pain, the types of approaches I've outlined in the previous article on managing chronic pain will already have been tried and either did not work, or have stopped working. The owner has decided that quality of life is low, and the big guns need to be brought in. When that time comes, holistic alternatives are likely to become complements to allopathic drug treatment instead of primary therapies. Unless the animal is young and recovery is likely, the only questions to ask at this point are questions about quality of life: Is my dog or cat suffering? Can I relieve that suffering? If not, is it fair to let him or her continue to suffer? Certainly if euthanasia is the only alternative, risky drugs are well worth trying.
Veterinary NSAIDs like Rimadyl, Etogesic, and Deramaxx have gotten a lot of positive hype but also been the subject of an enormous amount of negative Internet attention. I believe these drugs are more dangerous than most people realize, but are also valuable tools in the management of serious pain. Putting your pet to sleep without trying them is a tragic missed opportunity. Even if liver and kidney function is not perfect (as is often the case in older and chronically ill pets), it is still worth discussing their use with your veterinarian. Draw baseline bloodwork, monitor the levels after a week or two on the drugs, and then at frequent intervals thereafter, and you will do a great deal to reduce the risks. Work with a holistic vet on supportive supplements and herbs, and you can reduce those risks even further. (For more information, again, you can read my article on minimizing the impact of NSAIDs on the dog's GI tract here.) This does not mean your pet will not be harmed by the use of NSAIDs; drug reactions tend to be highly individualized, and some pets have died while on NSAIDs. Nonetheless, if quality of life is poor, and alternatives do not help, it is a risk most pet owners will take. Just do it with your eyes open, instead of blindly accepting the NSAID prescription as if it were no more risky than a dog biscuit.
Even if the pet is on NSAID or other drug therapy, don't abandon the alternatives, both holistic and conventional, outlined earlier. For example, if your dog has arthritis or similar conditions, acupuncture can be powerfully effective in combination with allopathic medications, and the drug Adequan actually rebuilds cartilage and lubricates and cushions your pet's joints. Let the NSAID handle the pain, but continue using alternatives to help heal and support the body.
Similarily, drugs such as Tramadol can be used with NSAIDs to great effect, and many dogs with severe arthritis or cancer pain also get excellent pain control from a combination of those drugs with those that address neurological pain such as amantadine, gabapentin, and even stronger narcotics. Use all the tools available to give your pet the best possible quality of life. There is nothing "holistic" about suffering or pain.
A Closing Note about Veterinary Care
It is always difficult, as a layperson, to evaluate the course of medical treatment prescribed by a veterinarian. There are many vets I know in whose hands I would willingly place my pets' pain control needs, and know that they would use the safest, most effective, and most up-to-date protocols. But just as with any profession, from human medical doctors to car mechanics to hairdressers to contractors, there are those veterinarians who are more skilled, and who do more research, than others. If a veterinarian caring for one of my pets does not appear share my beliefs on the importance of pain management, I seek another veterinarian.
Also just as in human medicine, it is sometimes hard for general veterinary practitioners to be up-to-date on every specialty, such as surgery or pain management or anesthesia, and often, a specialist will be able to give your pet better care in a specific area than your general practice vet will. Just as I would not go to my regular doctor for surgery, I do not use my regular vet for surgery either; I seek out a surgeon. And when it comes to anesthesia and analgesia, I seek out, or consult with, or have the surgical staff consult with, an anesthesiologist. The two drawbacks to this practice are that it's expensive, and it sometimes offends your regular vet. Fortunately my regular vet is in a practice with specialists, so she is able to remain the vet of record while I'm able to avail myself of the services of the specialists. The issue of cost is a valid one, but if affordable for the pet owner, well worth the investment in terms of improved safety and better outcomes. I even used boarded surgeons for simple spays and neuters; while much more expensive, in absolute terms the surgeries do not cost that much money and I feel it's worth it.