Pain management makes good sense and good cents

The relief of animal suffering is part of every veterinarian's oath, but Dr. Robin Downing, owner of Windsor Veterinary Clinic PC in Windsor, Colo., takes it especially seriously. She has been passionate about pain management for decades and opened a pain-management referral practice last October within her existing clinic. But Dr. Downing says you don't need to open a second practice to make pain management profitable enough to serve pets long-term. Here are some of her suggestions for treating pain at your existing clinic.

Dr. Robin Downing

Acute pain

For acute pain associated with surgery, Dr. Downing uses a three-pronged approach: local anesthesia at the incision site, an opiate to block pain receptors in the spinal cord and brain, and an NSAID to decrease inflammation and block pain signals at different levels of the nervous system.

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The advantages of multimodal treatment are huge, she says. Patients suffer less and need less anesthesia. Preventing pain also helps to eliminate "windup," a sensitization of the central nervous system that can lead to a state of chronic pain. Last but not least, you can itemize every drug on the invoice and charge for it. Your costs are the drugs themselves, a formulary listing appropriate dosages, and your time calculating dosages and monitoring your patient. As an example, Dr. Downing charges clients about $60 for pain prevention and management before, during, and after a puppy ovariohysterectomy. The "hard cost" to the clinic is about $10 to $15.

Chronic pain

To help with ongoing pain, which is less straightforward than acute pain, start by determining what hurts. "There's no single way to measure pain in animals, which makes this step challenging," she says. "But we need to take pain seriously and follow through to identify problems." Check every animal that comes in, and you'll get better at identifying what's normal and abnormal with pain presentation. Then perform a physical exam, urinalysis, and diagnostic testing to uncover any underlying conditions that could contribute to the pain and affect treatment.

Osteoarthritis is the most common chronic pain problem Dr. Downing sees. Her therapeutic regimen often includes an NSAID and another drug, such as amantidine or gabapentin, to interrupt the pain cycle. She also uses chondroprotectants containing polysulfated glycosaminoglycans to support existing cartilage and help in long-term treatment. And Dr. Downing has seen great success with a therapeutic diet shown to slow osteoarthritis and improve clinical signs. None of these strategies require extensive startup costs.

If you want to expand into alternative therapies and physical rehabilitation, Dr. Downing says, you can expect to pay about $4,000 for acupuncture training classes or training in canine rehabilitation. Physical rehabilitation equipment, such as an underwater treadmill, can add another $40,000 to $60,000.

When it comes to profiting from pain-management treatments, Dr. Downing paraphrases advice from the late veterinary management wiz Don Dooley: "The secret to profitability is charging more than it costs you."