5 steps to prep for painful discussions

"Your pet's in pain." It's a difficult message, and one that may prompt feelings of guilt, fear, or even shame for pet owners. They'll have questions, too. "How long has she been hurting?" or "What can I do to make it go away?"

You can help by offering a mix of compassion and facts, says Firstline Editorial Advisory Board member Sharon DeNayer, practice manager for Windsor Veterinary Clinic and the Downing Center for Animal Pain Management in Windsor, Colo. Consider this advice to help take some of the sting out of this uncomfortable conversation:

1. Offer reassurance. "We remind clients that dogs and cats are by nature predators," DeNayer says. "And when predators are weak, they become someone else's prey. So it's in the nature of animals to hide or mask their pain. They're really good at it, and some are much better than others. So it's not unusual for people to fail to recognize that their animals are in pain."

Often, she says, clients will say things like, "I just thought they were slowing down." They may complain that Fido isn't running around as much and he doesn't want to chase the ball or go up and down the stairs. Remind pet owners that a lot of the signs of pain are very subtle. And when they're living with an animal every day, they may not notice those changes.

2. Conduct a pain assessment on every pet at each visit. "In veterinary medicine, if you're only seeing an animal once or twice a year, there can be a lot of changes that happen within that period of time," DeNayer says. "We see animals each day that are in pain and their owners don't realize it. That's why we do a pain assessment on each animal."

3. Deal with denial. It's not uncommon, DeNayer says, for pet owners to be reluctant to acknowledge their pets' pain. During a pain palpation, veterinarians at Windsor Veterinary Clinic firmly touch specific areas of the pet's body to identify pain. Sometimes painful pets cry out. That's when the doctor will say, "I'm doing a pain assessment now, and what I am doing is applying firm pressure. Not painful pressure but firm pressure. And the reaction the pet just gave me was one of pain."

Sidebar 1: Stay positive

"In fact, we show the pressure we use by demonstrating on the person's forearm so the owner can realize that shouldn't hurt," DeNayer says. "When an animal that's normally very docile turns around and would like to take a bite out of you, that may signal pain."

The stakes are high. If pet owners don't think the animal is painful, they aren't going to treat the pain. "So it's really important to get them on board," she says. "It's very common for owners to fail to recognize pain."

So your first responsibility is to help pet owners recognize their pets' pain. There are usually plenty of visual clues during the pain exam, such as the pet slinking down and looking for a place to hide. At this point, DeNayer says, most every client can see the pet's pain and any lingering denial fades.

4. Use a consistent pain scale—and train the rest of your team on the same scale. This way, you can note the pet's pain score on the report card at each visit. "Clients feel good to see the notation that their pet has zero pain today, and for many young pets that's what the pain score is going to be," DeNayer says. "When they get used to the fact that you're going to be doing this each time they visit your practice, they understand this is part of the exam. You can then identify pain before pets really begin to react to it. It gives the doctor a baseline for future reference."

Sidebar 2: Lunch and learn

If a pet scores a 4 on one visit and a 1 on the next, clients can see that their efforts help the pet feel better. And once they've watched the doctor perform a pain palpation, some clients will check their pets at home for pain between veterinary visits.

"Frequently when they come back in for followup visits, pet owners say they've been checking their pets and they've noticed an improvement," she says. "You've now given them a tool to get a sense of the animal's pain."

The palpation also opens the door to ask clients questions about the pet's behavior, including any changes they've noticed. The client may be visiting because they've noticed a behavior problem—for example, the cat urinates right next to the litter box. By recognizing the pet's pain you might identify one possible reason for the pet's behavior. And in this case, you might suggest a litter pan with lower sides in addition to treating the pet's pain.

"We have had clients who've cried when they realized their animals were in pain," DeNayer says. "You can't do something about the pain if you don't know about it. But once you do know it, it's your responsibility to relieve that pain."

Next, it's important to remind clients that they can't do anything about the past. "We need to start where we are now," DeNayer says. "We know that this hurts. So what can we do to ease the hurt so that we can get your cat or your dog back to its old self? Then we can discuss treatments."

DeNayer says her practice uses a multimodal approach to pain. Many of their pain discussions are focused on helping clients understand how different elements work together to treat the pain and why it's important to use all of them. This conversation is key to ensuring compliance with your recommendations, from administering medications and scheduling acupuncture to practicing home exercises.

"That really becomes the team's role, to reinforce the doctor's message," DeNayer says.

5. Use creativity to solve pets' problems. If a dog that loves to go for walks has pain in the neck, you're not helping by letting him go for a walk with the leash and collar that he's always used. Maybe you can fit him with a harness at the clinic or advise the owner to buy a harness, DeNayer says. Or perhaps you can rig a temporary harness with a free clinic leash so the owner can get to the store to purchase one.

Sidebar 3: Quick fact

"Team members are in a really good position to make changes within their practice," DeNayer says. "They can be the pain champion in the clinic and lead these changes."

The owners who feel guilty about their pets' pain are going to be the most compliant to ease that pain. Often there are simple adaptations the owners can make, DeNayer says. For example, they can put food dishes in places easier for the cat to reach or use area rugs to prevent slips on hardwood floors.

DeNayer also recommends equating the pet's pain to the pain people experience. For example, you might remind clients just as they might have trouble bending over to tie their shoes when they suffer from back pain, their pets might struggle to bend over to reach the food or water dish.

"If we can solve a problem before it becomes a much larger problem, then the client's happy and we're doing our job—advocating for the pet," DeNayer says.

Portia Stewart is a freelance writer in Lenexa, Kan. Share your thoughts at dvm360.com/community.