Using a multimodal approach to treat and manage pain

Using a multimodal approach to treat and manage pain

A Q&A with pain management and anesthesiology specialist James Gaynor, DVM
Oct 01, 2010

James Gaynor, DVM, Dipl. ACVA, Dipl. AAPM
Q: DVM: What led you into pain management and anesthesiology?

A: Gaynor: Actually, I started out in anesthesiology. It's like living physiology. With everything you do for the patient, you can see reasonably effective and measurable results. I like to get that rapid feedback.

Often, we had to treat postoperative pain. Frequently, after patients left my care, they would become painful, which is how I became more adamant about pain control in patients. Eventually, I began consulting on oncology patients that were months out of treatment and now had chronic pain. Up until that time, chronic pain management was a relatively untouched subject in the veterinary world. Today, many of the patients we see in our clinic have osteoarthritis, the most common source of chronic pain in dogs and cats.

DVM: How do you approach the assessment of pain on an initial patient visit?

Gaynor: We have an in-depth discussion with the client about changes he or she has seen in the animal's behavior and activity level at home. Animals do tell us when they're in pain; we just need to recognize how and what they are experiencing. It's important to define the signs, so we know what we're dealing with.

Helping them feel no pain: Postsurgical pain should be treated early and aggressively and, ideally, addressed before surgery with preemptive analgesia.
Animals tend to hide their pain in the presence of strangers because they don't want to show vulnerability. It goes back to animal behavior in the wild where they don't want to show weakness in the face of a potential predator. So some animals we see appear completely normal. That's why a thorough history from the client is so important. We ask about what's happening at home.

DVM: When a pet is presented with a traumatic, non-life-threatening injury, at what point do you institute pain management therapy? How important is timing?

Gaynor: As soon as the life-threatening aspect is taken care of, we start to treat for pain. For example, if the animal is bleeding or is not breathing well, we take care of that first, and then pain control follows quickly behind, because pain is detrimental to those patients.

DVM: It's been said that dogs and cats have a higher tolerance for pain than people? Is that a myth?

Gaynor: Based on videotapes we've seen of postoperative patients that have no human intervention, they do show signs related to pain if not treated appropriately.

Dogs and cats are very good at hiding pain. Again, it could be because they don't want to show vulnerability in a situation in which they feel threatened. So the idea that they have a high tolerance for pain may simply be a misperception. Maybe they have pain before they show any of it to humans.

DVM: Why do you think pain management has received so much attention in the past few years?

Gaynor: Little attention was paid to this topic during the previous decades. Our knowledge about pain has greatly expanded in recent years. Also, there are more drugs available for pain treatment, and even more in development, compared with 20 years ago. We can do a lot more for pain control these days.

DVM: When it comes to pain management after surgery, can you offer a tip for general practitioners?

Gaynor: Treat early and aggressively. Animals can have more pain than a veterinarian can perceive. I advise treating for pain before surgery. If you consider that an animal won't show pain easily, the veterinarian needs to be aggressive in this regard.