WEB EXCLUSIVE Interview with Bernard Rollin

Easing pain in veterinary medicine

Fort Collins, Colo. -- He's been preaching about pain management for more than a decade. Now he's found a choir: The American Animal Hospital Association (AAHA) and American Association of Feline Practitioners' (AAFP) collaborated last month on new pain-management guidelines.

In a Q/A with DVM Newsmagazine, renowned animal ethicist and Colorado State University professor Bernard Rollin, PhD, lauds the move while addressing veterinary medicine's changing pain-management ethic.

DVM: How has the concept of pain management changed?

Rollin: Veterinarians trained before 1989 were taught to ignore pain. Textbooks published in the 1960s and '70s had no mention of felt pain. Today, there are still some veterinarians who don't do pain control. On average, about one-third each class say they have worked for a veterinarian who does not manage pain routinely.

Manifestly, it is clear that pain has been ignored in human medicine also. It is an ethical issue to not pay attention to pain.

DVM: Is the current thinking about pain management changing?

Rollin: I think changes are largely attributable to federal legislation that passed in 1985 requiring animals used in research had to have their pain controlled. A lot of veterinary faculty are also researchers, so when they started to control pain, they started teaching this to students.

Pets are more important to people. If they expect anything from a doctor, it is pain control. That is true in human medicine as well. There is consumer pressure for pain management, which has helped drive it. There is much more pain management in practice than ever before.

It is an evolutionary process. Historically, there were philosophical impediments to acknowledging pain and even consciousness in animals. The good news is, it is getting better and better.

DVM: Are there medical ethical issues in regard to this practice?

Rollin: Not only is pain management an ethically correct way to treat an animal, it helps an animal heal faster because of reduced body stress. Stress has (many) effects on the body. One is to suppress the immune system. Because of this, infection is likely to set in. Another effect is that the body may heal slower because physiological resources are sapped by uncontrolled pain.

Pain control does not totally eliminate pain. It just raises your tolerance. It is just making you not completely miserable. Typically in the past, if anesthesia was used it was more with the intent of keeping an animal still or preventing it from further hurting itself or the veterinarian. It was not used for the purpose of controlling pain. But who, if you control their pain, will go out and play rugby? A cat will lie under a bed and rest for three or four days.

DVM: What is the standard?

Rollin: I've said if something enters federal law, it becomes the standard of care. The federal laws for lab animals that require pain control also require distress control. In fact, the legal demands for distress control have become stricter. Likewise, if you don't do it in a companion practice, you're below the standard of law.

“With the modalities we have today, there is no reason animals have to hurt in a major way.” (Rollin, quoting Bernie Hansen, DVM, associate professor at North Carolina State University College of Veterinary Medicine, who has written papers on the subject.)

DVM: What do the guidelines mean for veterinary practitioners?

Rollin: The AAHA-AAFP collaboration will absolutely have a strong impact on the veterinary community. That is an internal standard. That is widely respected in the veterinary community.