While many perceived obstacles to implementing a comprehensive and integrated pain management system exist in a veterinary
practice,1 expense or lack of profitability should not be among them. Indeed, pain management provides one of those rare convergences
of benefit for the pet, reward to the veterinarian and staff, satisfaction for the client and boost to the economic health
of the practice.
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Pain management strengthens veterinary practices directly through a fee-for-service construct, but it can lend several other,
less-obvious economic advantages. Chief among these is the enhancement of job satisfaction. Team members are often highly
intuitive about their patients' comfort and will score them as more painful compared with veterinarians' assessments.2 Team members can also be more aware than veterinarians of clients' distress about their pets' discomfort. Team members who
subsequently struggle with the ethics and patient-care consequences of a poorly conceived or implemented pain management system
can leave a practice prematurely, requiring replacement and, in turn, potentially causing a significant economic penalty to
the practice.
Pet owners are generally very sensitive to the comfort and abilities of their pets. Practices that enjoy and promote a culture
emphasizing pain control are apt to increase client satisfaction, as well as referrals of like-minded pet owners—the A+ clients
we all desire and actively seek.
Finally, there's direct remuneration for providing pain management services. The client fee may be calculated based on the
cost of goods but also should be commensurate to the value to the patient, which is often high.
Improving both patient care and a practice's vitality
The profit margin on most pain management drugs is often quite satisfactory (although arguably the least profitable among
them are the highly effective and commonly used NSAIDs). Whenever a special technique (vs. a simple injection or oral prescription)
is required for delivery, fees should reflect the additional supplies and, most important, the expertise required to use them.
Such special techniques include epidurals, constant-rate infusions (CRIs), local or regional nerve blocks and infusion catheters.
The prospects of simultaneously improving both patient care and practice economic health are almost boundless. For example,
there are pain management opportunities for even the most common, seemingly mundane procedures such as gaining vascular access.
Properly applying a commercial topical lidocaine-prilocaine product on the shaved skin over the vein of choice can save the
patient the discomfort of indwelling intravenous catheterization while minimizing the anxiety associated with restraint to
accomplish the task (anxiety itself has been demonstrated to enhance pain3). The ease of catheter placement diminishes not only the patient's stress but also stress on team members performing and
assisting with the procedure. In properly premedicated patients with preapplication of topical lidocaine-prilocaine, it becomes
possible for one skilled technician to place their intravenous catheters, without an assistant to restrain the patients. Charging
even a small fee for this substantial patient and staff benefit, when repeated hundreds, if not thousands of times a year,
will bring income to the practice commensurate to the value to the patient.
The same construct applies with the routine use of local and regional blockade to surgical incisions and major wound repair.
Mastery of the tool's many applications is within the ability of any primary care clinician. Examples include simple line
or paraincisional blocks; intratesticular, intra-articular, intercostal, pleural, peritoneal and epidural blocks and diffusion
catheter application. The cost of materials, lidocaine and bupivacaine is minimal, yet locoregional anesthesia demonstrably
lowers postoperative pain scores and simultaneously minimizes the quantities of required systemic analgesic medications, limiting
the potential for adverse effects. The value to the patient can be unmistakable, as can the benefits to the practice.
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