Pain management tips for the veterinary technician

Veterinary technician content is sponsored by Elanco for the month of October.

There were various firsts at Fetch dvm360^®’s home conference this week in Atlantic City, New Jersey. One was a rebranding of the event to be named Fetch Coastal and another was debuting an afternoon keynote speaker.

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), founder of Veterinary Anesthesia Nerds, took the stage sporting a dress with black cats on it and a ton of enthusiasm to discuss her favorite topic: veterinary pain management. In this presentation,¹ sponsored by YuMOVE, she inspired attendees to become fellow pain management advocates, shared insight on helping animals remain pain-free, and described how technicians can be used to their fullest potential in the process.

Fetch Coastal's first-ever afternoon keynote speaker Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), smiling on stage.

“I know I have letters after my name, that I am a certified veterinary pain practitioner. But I will also argue that all of you in the audience are probably just as passionate about pain management as I am,” said McNerney. “I think we all [pursued] veterinary medicine because we wanted to ease animal pain and suffering in some way. You are the advocates for those animals, you are their voice when they can't have a voice, especially if you are the veterinary technicians in the audience.”

Multimodal approach

According to McNerney, when she first started in practice there was an emphasis mainly on using opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). However, now she knows that a multimodal approach is most effective and that along with these traditional analgesics, physical therapy, nutraceuticals, and supplements can help aid in pain management.

“I do a lot of stuff with opioids and NSAIDs,” she shared. “But when we talk about pain management, especially chronic pain management and long-term pain management, it's not just opioids and NSAIDs anymore. There's a lot we can do non-pharmacologically for our patients and we can utilize the technicians that we have in our practice, to help make sure we are getting as much comprehensive care as possible.”

She added that in human medicine patient recovery outcomes have been improved by reducing opioids and increasing regional anesthesia.² “[It gets] them back to eating, feeling much better. Back in the day when I first started and everything was opioid, NSAID, opioid, NSAID, I'm kind of drawing back a little bit with the opioids and trying to put in more local and regional anesthesia.”

Various types of pain

McNerney pointed out that depending on your area of work in veterinary medicine, you may be confronted with patients experiencing different types of pain. For example, those who do surgery likely deal with acute pain in patients, those in a rehabilitation facility often deal with chronic pain, and professionals working with senior patients may be faced with osteoarthritic animals. Each type of pain should be addressed separately, McNerney advised, “We need to make sure that all our team members understand the differences and the way we treat acute pain versus chronic pain, and some subtle differences and things to look out for. And this goes for not only observing the animal, but some things we can train our staff members on how to communicate with the owner so we can pick up on signs of pain.”

Along with addressing the specific pain the pet is suffering from, incorporate an individualized approach. Be mindful of what the anticipated level of pain is that you are about to inflict with the surgery and what level of fear, anxiety, and stress, the patient comes into the hospital with, added McNerney. These factors can help determine the analgesic drug protocol.

Post-operative monitoring

Post-op monitoring is especially important with acute and surgical pain. McNerney recommended that practices have a dedicated recovery technician, if possible, to regularly check on the patient for signs of pain and advocate for them if more analgesia is necessary. “[Having a dedicated recovery technician] is fantastic because instead of them having to deal with 6 surgery patients, and 'oh, by the way, in between your surgery, go over and check on this patient,’” McNerney said, they can focus solely on the patients recovering and ensure they are as pain-free as possible.

Alternatively, if a dedicated recovery technician isn’t a viable option, McNerney suggested purchasing a small kitchen timer. This can be placed on a patient’s cage as a reminder to periodically check them and ensure they received their medication and are doing well. McNerney suggested to ask yourself, “'Did they get the opioid when they were supposed to? If they did, how are they reacting? Am I seeing any signs of acute pain? Do I need to go to my clinician and advocate for more analgesia?' Things like that.”

Pain scales

It doesn’t matter which pain scale is used in your practice, whether it is the Glasgow Composite Measure Pain Scale, the Colorado State University Canine or Feline Acute Pain Scale, or the Feline Grimace Scale, it is mostly important that technicians are trained in how to use them.

She highly recommended attendees download the Feline Grimace Scale app on their phones to help determine feline pain as well. This free, validated tool was developed by University of Montreal researchers, and “it looks at a couple of different things like ear position, eye position, whiskers, where the head is relative to the shoulders. It helps to show where this cat is on an acute pain scale,” explained McNerney. She stands by this app because it has been validated through various studies^3,4 and it can be incredibly helpful to inform technicians who are monitoring post-op patients on whether the patient needs additional analgesia.

References

1. McNerney T. The 5th vital sign: Pain management as the key to purpose, profit, and possibility. Presented at: Fetch Coastal; Atlantic City, New Jersey; October 9-11, 2023.
2. Soffin EM, Lee BH, Kumar KK, Wu CL. The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse. Br J Anaesth. 2019;122(6):e198-e208. doi: 10.1016/j.bja.2018.11.019
3. Evangelista MC, Watanabe R, Leung VSY, et al. Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Sci Rep. 2019;9(1):19128. doi: 10.1038/s41598-019-55693-8
4. Monteiro BP, Lee NH, Steagall PV. Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A large bilingual global survey. J Feline Med Surg. 2023;25(1):1098612X221145499. doi: 10.1177/1098612X221145499