Handbook of Veterinary Pain Management

James S. Gaynor, William W. Muir

• Publisher: Mosby
• Year: 2014
• Print ISBN: 9780323089357
• eBook ISBN: 9780323222143
• Edition: 3
• Topic: Medicine
• Subtopic: Veterinary Medicine

- NEW! Eight new chapters include the latest information on: - the human-animal bond- local and regional techniques- preventive and multimodal analgesia- energy modalities- acupuncture- physical examination with emphasis on isolating and locating pain- therapeutic goals- pain in laboratory animals- NEW! Completely updated drug information, with new agents, doseforms, and routes provides the most current pain management therapies for use in the clinical setting.- NEW! Expanded sections on the cat and exotics address the growing popularity of these pets by providing additional species-specific information.

Part One

Basic Concepts

Chapter 1

Pain Management and the Human-Animal Bond

Robin Downing

“Pain is a more terrible lord of mankind than even death itself.”

Albert Schweitzer, MD

The Buddhists have a saying: “Pain is inevitable; suffering is optional.” Those of us who work in veterinary medicine have pledged ourselves to recognize, relieve, and prevent pain and suffering in the animals entrusted to our care. The veterinarian’s oath states in part, “I solemnly swear to use my scientific knowledge and skills for the … prevention and relief of animal suffering…” Ours is a sacred trust to advocate on behalf of beings who cannot advocate for themselves.

To review the history of veterinary pain management is to see the good, the bad, and the ugly. It was not so long ago that the “experts” believed that animals experience pain differently from humans. This was an easy conclusion to draw if we only observed animals. We could witness an animal with a known injury behaving much as it did before the injury had occurred. In dogs with advanced periodontal disease, for instance, it would be easy to conclude they must feel pain differently—or at least not as intensely—as we do, because they continue to eat and drink, whereas we would be immobilized by a similar issue. Cats are notorious for masking any weakness, including pain, until they are so ill or the pain so great that they can no longer function.

Humans have eschewed overt cruelty toward animals as far back as Biblical times. Charles Darwin (1872/1965) recognized that animals possess the fundamentals of consciousness. His reasoning was that “if animals show emotion through behavioral expression, then the behavioral expression of emotion in man must share a similar neurobiological evolution with the other animals capable of expressing similar emotions.” It is only within the past several decades, however, that society has expanded its sensitivity to pain and suffering in animals. Our cultural norm now recognizes that all animal pain and suffering should be mitigated, whether we are considering the companion animals who share our homes and daily activities, the food and fiber animals who provide sustenance and substance, or the laboratory animals who provide opportunities for major medical breakthroughs. The veterinary profession is in the unique position to facilitate the ongoing expansion and sophistication of the pain relief available for and offered to all animals. For animals that are members of the family, the veterinary healthcare team has the opportunity to facilitate, enhance, lengthen, and strengthen the precious family-pet relationship. Relieving pain is one core competency through which to achieve that end.

Veterinary medicine has, throughout its history, emulated human medicine. Much of the current sophistication in veterinary care has been the result of reworking and reapplying human medical techniques in animals. Unfortunately, pain, pain relief, and pain medicine present challenges. The focus in both human and veterinary medicine has shifted away from the art of medicine to evidence based decisions or the science of medicine. Science is objective and can be measured. Pain, on the other hand, is a uniquely subjective experience—the antithesis of objective science. Regardless, veterinarians should employ techniques and therapies that represent best knowledge. Also, emulating a physician’s focus on preserving life has caused veterinarians to emphasize life quantity in deference to life quality.

Richard D. Ryder, in his groundbreaking volume Painism: A Modern Morality (2001), coined several terms important to our consideration of animal pain. For Ryder, a being is “painient” if it has the capacity to feel pain, and “painience” is the principle that a moral code should be based on this capacity. Ryder goes on to state that the terms pain and suffering are interchangeable and that “what matters morally is the degree of pain and not who or what experiences it.” In Ryder’s worldview, pain is the common enemy all living beings face, and it is our common capacity for suffering that maps the similarity between humans and animals. The philosopher Jeremy Bentham, a contemporary of Rene Descartes, laid an important foundation for our current concerns when he wrote in 1780, “The question is not, can they reason? Nor, can they talk? But, can they suffer?”

It is useful to note that anesthesia for veterinary patients was actually developed not for pain relief, but for restraint. The idea was to provide chemical restraint in order to complete procedures on beings that could not simply be told to “hold still.” Several types of drugs were employed for this. Barbiturates provide little to no analgesia once consciousness is regained. Dissociative drugs do not relieve pain or the effects of pain on the nervous system, but scramble cognitive function and pain perception. Paralytic drugs cause paralysis of the voluntary muscles, but do not blunt the pain experience in any way. An animal so affected feels every excruciating moment of its pain, but is trapped inside its own body, incapable of moving or escaping its pain. Sedative drugs affect mentation, but they do very little to mitigate the pain experience. A sedated animal may experience the full complement of its pain, but is too obtunded to react to it.

Likewise, there have been several persistent myths concerning animal pain that have influenced veterinary attitudes about administering pain medications perioperatively or after surgery or other trauma. It was thought that pain medication would suppress an animal’s appetite, so withholding medication would encourage eating. Postoperative or post-trauma pain was considered to be a useful form of restraint that facilitated and prevented further tissue damage. If an animal’s pain was relieved, it was thought, the animal would move around ...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• Dedication
• Preface
• Veterinarian's Oath
• Part One: Basic Concepts
• Part Two: Pain Therapy
• Part Three: Application of Concepts and Therapy
• Appendix: Drugs Used to Treat Pain, Pain-Related Anxiety, and Anesthesia-Related Side Effects as Described in This Handbook
• Index