The multimodal approach to veterinary pain management
Many medications available to treat pain in animals are considered safe and effective, including both analgesic and anesthetic
drugs. These drugs can be used preemptively or perioperatively to head off pain. They can target existing pain and help manage
chronic conditions. In patients with more severe pain, several drugs targeting different pain pathways can be used in combination
to provide relief.
Evidence suggests that combining drug therapies with the therapeutic modalities used in human physical therapy can significantly
improve outcomes for patients. An accurate diagnosis is critical to developing a therapeutic plan that doesn't just rely on
the old standbys: rest and NSAIDs. Hot and cold therapies, electrical stimulation, laser therapy and therapeutic ultrasonography
can all be used to help control pain in animals. Ideally, these modalities should be performed by a certified rehabilitation
professional with the training and hands-on experience to ensure that they are used properly. The various modalities are described
- Heat therapy is generally used to reduce pain from arthritis, trigger points and muscle spasms. Heat creates vasodilation,
leading to increased local circulation, a decrease in pain, relaxed muscle tone, reduced muscle spasm, an increase in tissue
extensibility and cellular metabolism and improved local tissue oxygenation. Heat can be applied with hot packs, infrared
light, hydrotherapy and therapeutic ultrasound.
- Cold therapy creates analgesia by decreasing nerve conduction velocity. It is commonly used in the acute period after injury
or surgery. Cold can be applied via ice bath, ice massage, ice pack, vapocoolant gel or circulating ice compression units.
- Electrotherapy works to control pain at many levels, affecting both sensory and motor nerves. Transcutaneous electrical nerve
stimulation (TENS) creates an overload of interneurons that limits the ability of sensory nerves to transmit pain signals
to the brain. TENS is used immediately postoperatively and during therapy to help a patient work through a painful treatment.
Neuromuscular electrical stimulation (NMES) rehabilitates muscles by stimulating the motor nerve that causes the muscles to
contract. NMES can be used to help prevent muscle atrophy, increase local blood circulation and maintain or increase joint
- Low-level laser treatment also can be used for pain management. The physiological effects include accelerated cell division
via mitochondrial stimulation, increased leukocyte phagocytosis, stimulation of fibroblast production, enhanced synthesis
of ATP and angiogenesis.
- Therapeutic ultrasonography provides pain relief by creating deep local heating, an increase in blood flow and breakdown of
scar tissue. This modality can be used in veterinary rehabilitation to treat a number of conditions, including joint swelling,
muscle spasms, strain lesions and bicipital tenosynovitis.
A multimodal approach to pain management can also include dietary modifications, exercise therapies, acupuncture and nutraceuticals.
Many resources are available to veterinary professionals interested in learning more about the principles and applications
of multimodal pain management, including the International Veterinary Academy of Pain Management (IVAPM). The IVAPM is dedicated
to promoting, advancing and enhancing pain management in animals. Membership is inexpensive, especially if multiple members
of a practice join. Visit their Web site at
The successful veterinary team recognizes the need to combine meticulous diagnosis methods with a multimodal approach to therapeutics,
keeping pain management a top priority at all times. Today's clients expect their veterinarians to provide appropriate pain
management for their pets. Gone are the days when pain therapy would be offered as an option for patients going home from
the hospital. Pain is now being addressed with preemptive approaches, new drugs, alternative routes of administration and
a focus on diagnostic techniques that allow veterinarians to provide better — and more humane — care.
Dr. Van Dyke is the founder and CEO of the Canine Rehabilitation Institute in Wellington, Fla., with locations in Fort Collins, Colo.,
and Annapolis Junction, Md.