Manage pets' pain

Now you may be thinking you don't have a role in managing pets' pain. And it's true that there are some things only a veterinarian can do for patients—make a diagnosis, perform surgery, and prescribe drugs. But you can still help ensure all animals receive the right care and support to minimize or eliminate their pain. After all, an effective pain management program is much more than a pill or a shot. It's a personalized plan for every pet that addresses the cause and severity of the pet's pain. And it's your job to offer clients the support they need to follow through with the doctor's pain recommendations.

Start with a plan

So what does it take to create a pain management program? First, your team needs to share a commitment to excellence in medicine. Good medicine is good business, and good pain management is good medicine. These steps will help you build a foundation for a strong pain management program in your practice.

1. Adopt pain scoring systems. While there are several different pain scoring instruments, there's not a single universal pain scoring system yet for animals. This is where your medical team will use its best judgment to choose the right instrument for the patient in front of you.

You'll find several examples of pain scoring instruments in The Handbook of Veterinary Pain Management by Drs. William Muir and James Gaynor (Mosby, 2002). And the University of Glasgow Web site offers the Composite Measure Pain Score-Short Form, a tool designed to assess acute pain in dogs.

2. Get the right tools. The practice will need to purchase the medications and other tools necessary to manage pain with a multimodal approach. This includes appropriate prescription medications and nutritional products that are designed to help the pet live comfortably.

3. Then get the right training. Continuing education (CE) has never been so easy to acquire. Your options may include online training, in-house training through your veterinarian or on CD-ROM, formal CE meetings, audio teleconferences, and published resources.

4. Plan a team meeting. Your team will talk about your pain management approach, which may include medication, nutrition, environmental management, weight management exercise or controlled exercise, acupuncture, and physical rehabilitation.

Next, your team will brainstorm the painful scenarios a pet may face and create a plan to address different levels of anticipated pain. Think through dental pain: extractions, loose teeth, infection, decay, and abscesses. Ovariohysterect omies and neuters require a different pain plan than orthopedic procedures. Bone surgery may be more traumatic and painful. Bowel resections may require a more aggressive pain management plan than removing a tumor from the torso skin. Then discuss the appropriate responses.

Team recommendation checklist

Also talk about pain management plans for your trauma patients. What will you do for the dog or cat that's been hit by a car? What about a cat with a fractured leg? Remember, cats aren't small dogs and can't receive the same pain management drugs and doses. You'll also discuss how to identify which cases should be referred.

Once you have a solid foundation of knowledge and re sources to build on, it's time to develop key messages to explain their pets' pain to clients. The two types of pain you'll most often discuss with clients are acute pain and chronic pain. Consider these two cases:

Case 1: Madison

Age: 6 months old

Reason for visit: Ovariohysterectomy

When Mr. Smith calls to schedule the surgery, the veterinary nurse reviews the treatment plan with him, emphasizing that the goal is to offer Madison safety and comfort with lab work and pain medication before, during, and after surgery. The day of surgery, Dr. Care admits Madison, reminds Mr. Smith about the importance of pain management, and receives Mr. Smith's consent to offer pain medication. When Mr. Smith returns for Madison's discharge appointment, the doctor or veterinary nurse discusses the medications prescribed to manage Madison's pain and reviews any handouts with the client.

Case 2: Buddy

Age: 10 years old

Reason for visit: Regular checkup

When Mrs. Allen calls to schedule an appointment for Buddy, an obese Labrador, the receptionist asks the reason for the appointment and listens for clues that pain may be an issue. For example, the client may say, "Buddy's not as active as he used to be,""Buddy's stiff in the morning,"or "Buddy's tired all of the time." Then the receptionist mentions that looking for pain will be one priority during the visit. When Buddy arrives for the appointment, the veterinary nurse will look for evidence of pain during the preliminary exam. Like the receptionist, the nurse will listen for clues about pain in Buddy's history.

During the physical exam, Dr. Care demonstrates to the client that Buddy is suffering pain by manipulating Buddy's back, joints, and legs to show how he flinches or cries out. When Mrs. Allen sees Dr. Care identify painful areas, she's more likely to buy in to the doctor's pain recommendations.

Next, Dr. Care orders a metabolic profile. A team member uses the practice's in-house lab equipment to run the test, and Dr. Care creates the pain management plan.

Because Buddy needs to lose weight, the doctor prescribes a specific nutritional diet, along with exact portions and feeding schedules. The veterinary nurse becomes the fitness coach and participates in Buddy's scheduled weigh-ins.

Watch for pain in older pets

Before Ms. Allen leaves, the receptionist asks her to call ahead to refill Buddy's prescriptions. Then the receptionist watches for red flags, like medications that last longer than they should or not as long as expected.

The receptionist will also track when Buddy will run out of food, so she can call Ms. Allen before she runs out, remind her to stop by, and ask whether she can set aside a bag for her. Once Dr. Care establishes a schedule for lab work, the receptionist will record the dates and remind Mrs. Allen to return for the tests.

Lock in client compliance

Clients need to hear the same message from every member of your team, so make sure everyone learns your pain protocols and recommendations. When your whole team offers specific, consistent recommendations, clients are more likely to listen to your advice. Use these strategies to educate your clients and make sure they follow through with all of the care their pets need:

• When you discuss pain with clients, use analogies. For example, much like ovariohysterectomies are for people, these procedures are big abdominal surgeries for pets, and they hurt. Explain that if it would hurt us, it will hurt them.

• Remind clients they're your eyes and ears to identify any possible health problems their pets experience.

• Discuss the handouts you're sending home with pet owners.

• Ask clients for their questions and answer them. If you don't know the answer, find someone who does.

• Know how to explain the potential side effects of any prescribed pain medications in simple language.

• Remind clients to stop the medication immediately and call the practice if they witness any suspicious reactions or behavior.

• Review the medical record and confirm the medications the pet receives at every visit.

• Remember the three Rs of veterinary pain management: recheck, reassess, and revise. Always schedule the next appointment for the pet's recheck or treatment before the client and patient leave your practice.

You want pets to be pain-free, and you need clients' support to make that happen. When your team works together to create a consistent message about the care pets need, you help clients make the best decisions to help their pets live long, happy lives.

Robin Downing, DVM, DAAPM, a certified veterinary acupuncturist, owns Windsor Veterinary Clinic and The Downing Center for Animal Pain Management in Windsor, Colo. She is President of the International Veterinary Academy of Pain Management. Please send your questions to firstline@advanstar.com

Robin Downing