Pain management: A Q&A with veterinary expert Dr. James Gaynor
Veterinarians are making huge strides in managing patient pain. But as the number of treatment modalities has increased, the amount of information veterinarians must learn and apply has also ratcheted up, along with the need to educate clients.
DVM Newsmagazine recently asked pain-management expert James Gaynor, DVM, MS, DACVA, DAAPM, to answer basic questions on the subject. Dr. Gaynor directs the Peak Performance Veterinary Group in Colorado Springs, Colo.
DVM: When addressing pain management, what's the most significant challenge for general practitioners?Gaynor: The main challenge is recognizing changes in behavior and activities that are indicative of patients that are uncomfortable, and then making sure to get those owners back into the clinic with their pets for reassessment. Owners don't always know how the process works. They need to be educated. That's our job as veterinarians. When we're talking about chronic pain, this is something we don't fix. It's long-term management.
DVM: What about pain management for geriatric patients specifically?
Gaynor: All patients require the same level of care. It's about being cognizant of what an individual patient's underlying problems are. It is understanding what their underlying disease processes are and what their level of organ function is. Obviously, geriatric patients have more of those issues, such as liver, kidney, and GI problems. It's not that they require special care, but are just dealing with more health issues, more than likely.
DVM: Do breeds differ in their response to pain management?
Gaynor: Pain management is less breed-specific and more individually based. Many people think some breeds are more stoic than others. As practitioners we need to be careful and really look at every patient individually.
From one Labrador to another, we may have the same painful condition, but it can manifest itself differently in each patient.
DVM: What are some trends in anesthesia and pain management?
Gaynor: One of the great trends is the understanding of why it's important to manage pain. Ten years ago, veterinarians promoting pain management really had to convince their peers to treat pain. Now that's rarely the case. Most people recognize animals need to be treated for pain.
Today we're fine-tuning pain management. Today's best approaches to pain management differ from the best approaches 10 years ago. There are more pain-management modalities—drug and nondrug. We also have more knowledge about acute and chronic pain. Most acute pain can be treated relatively simply. If you follow basic principles, treatment should be very effective.
No patient should be euthanized just because the pet is in pain. There is always something we can do. That's different from what we were seeing just 10 years ago. Euthanizing a pet to spare it pain because "there is nothing left to do" shouldn't happen.
DVM: If you had one long-standing myth to bust about anesthesia and pain management, what might it be?
Gaynor: From an acute pain perspective, there's the myth that certain drugs with long-acting sedative effects also have long-acting analgesia. For instance, with butorphanol, some think it's a great pain reliever. But we know that in dogs, high doses provide analgesic benefit for only 40 to 45 minutes, even though sedation may last up to six hours. People get fooled into thinking that because the dog is sedated, it is therefore comfortable. That's long been a misunderstanding.
There's also a myth among owners that older animals have decreased function. Older animals slow down, but the decreased function may be related to their discomfort. They should be able to do virtually everything they did before, for a shorter time. For example, some think that cats don't jump on the counter anymore because they are getting old. It may be because they hurt.