Using a multimodal approach to treat and manage pain - DVM
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Using a multimodal approach to treat and manage pain
A Q&A with pain management and anesthesiology specialist James Gaynor, DVM


DVM: What role can veterinary technicians play in assessing and monitoring pain in patients?

Gaynor: They play a huge role. In fact, everyone in a practice plays a role. Because doctors are often busy doing a lot of other things, it's really the staff who may observe the pet more frequently and be better able to assess the patient's pain. They can alert the doctor by giving a description of what's being observed in the clinic and by the client at home. Receptionists can make notes on the animal's behavior in the waiting room. The entire team can provide important information to the doctor.

DVM: Tell us about your acupuncture practice. Are more clients requesting it?

Gaynor: Oh yes. Many more clients are asking for it and other nondrug therapies. I practice medical acupuncture that's based on physiology, not traditional Chinese medicine. We employ an integrated approach to pain management; that is, integrating acupuncture and drug therapy and other beneficial modalities for which there are reasonable data to believe they should help. Because few of the patients we see respond to just one treatment, we usually use a multimodal approach.

DVM: You've been using stem-cell therapy in recent years. What kind of results are you seeing with it? When is it most appropriate to use?

Gaynor: Most of the time we use it to treat osteoarthritis pain. We don't use it for regenerative purposes.

That said, in my world, stem-cell therapy is the gold standard for arthritis-related pain, because most of our patients respond extremely well to it. In fact, they rarely need the same joint retreated. I say rarely because the exceptions are working and service dogs that use their joints a lot. But for pet dogs, we have rarely treated the same joint twice.

DVM: Are there any other new or in-development procedures or treatments for pain management that you think hold promise?

Gaynor: We are seeing some exciting results with pulsed electromagnetic field therapy, which we do a lot of. The targeted version entails a magnetic impulse that focuses on one reaction and gives a cascading effect that helps reduce inflammation and improve healing rates. The data in humans are really terrific, and it's relatively new in both human and veterinary medicine.

I think, in general, veterinarians shouldn't discount new nondrug therapies. Also, I think we'll see a lot of new pain management therapies coming out in the next five to 10 years.

Editor's Note: James Gaynor, DVM, MS, is the president and medical director of Peak Performance Veterinary Group and Animal Emergency Care Centers in Colorado Springs, Colo. Dr. Gaynor is a Diplomate of the American College of Veterinary Anesthesiologists, a Diplomate of the American Academy of Pain Management, and a current board member of the International Veterinary Academy of Pain Management. Previously, he was section chief and associate professor of anesthesiology and pain management at Colorado State University.

Loyle is a freelance medical editor and writer in Philadelphia and the former primary editor of the North American Veterinary Licensing Examination.


Source: DVM360 MAGAZINE,
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