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referral in place. A second aspect of integrative pain management is the multimodal use of medications that either block or modify multiple pain pathways. A multimodal approach also reduces reliance on any single agent, minimizing the potential for adverse drug events. Pain management in clinical practice is a team effort, with the pet owner functioning as an integral part of the team. All healthcare team members should have a defined role in the practice’s approach to providing compassionate care to its patients. That enables the practice to speak with one voice and in a consistent manner in the implementation of pain management protocols. Client education is a key component that enables the pet owner to manage pain in the home setting. Direct involvement of the client in pain management efforts is consistent with the continuum of care concept and a demonstration of the practice’s commitment to the pet’s QOL. A fully integrated approach to pain management, involving recognition and systematic assessment, pharmacologic and nonpharmacologic methods, and one that includes both healthcare team members and the pet owner, ensures that TABLE 5 Summary of Appropriate Interventions for Pain in Dogs and Cats Notes: 1) Local or regional analgesia may be useful in localization of pain and short term relief of significant DJD pain. 2) See section concerning the use of NSAIDs in cats. 3) The addition of other analgesic drugs will depend on patient characteristics and extent of the procedure. 4) These interventions will be helpful pre- and post-operatively for the relief and/or prevention of post-operative and chronic pain. 5) Ideally premedications should precede other preparations for general anesthesia such as placement of IV catheter. 6) These are invasive procedures and should be treated as such to optimize patient care and minimize trauma/tissue damage and post-procedural pain. 7) The level of intervention will be tailored to the invasiveness of the procedure. Deep ear cleaning will require more significant intervention than superficial cleaning in most cases. 8) In non-emergent settings (e.g. routine pre-surgical application). 9) Chemical restraint in lieu of manual restraint when patient fractious, distressed, or otherwise intolerant of procedure. 10) Sterile lidocaine lubricant; caution in cases of urethral or bladder mucosal damage. GAG ¼ glycosaminoglycans, CKD ¼ chronic kidney disease, DJD ¼ degenerative joint disease. 80 JAAHA | 51:2 Mar/Apr 2015 everything possible has been done to relieve a patient’s pain once it enters the practice’s care. FOOTNOTES a Recuvyra; Elanco Animal Health, Greenfield, IN b Simbadol; Abbott Laboratories, Abbott Park, IL c Cerenia; Zoetis, Florham Park, NJ d Adequan; Luitpold Pharmaceuticals, Inc., Animal Health Division, Shirley, NY REFERENCES 1. American Animal Hospital Association; American Association of Feline Practitioners; AAHA/AAFP Pain Management Guidelines Task Force Members, Hellyer P, Rodan I, Brunt J, et al. AAHA/AAFP pain management guidelines for dogs & cats. J Am Anim Hosp Assoc 2007; 43(5):235–48. 2. AAHA/AAFP Pain Management Guidelines Task Force Members, Hellyer P, Rodan I, Brunt J, et al. AAHA/AAFP pain management guidelines for dogs and cats. J Feline Med Surg 2007;9(6):466–80. 3. Reid J, Scott M, Nolan A, et al. Pain assessment in animals. In Practice 2013;35(2):51–6. 4. Woolf CJ. What is this thing called pain? J Clin Invest 2010;120(11): 3742–4. 5. Shanan A. A veterinarian’s role in helping pet owners with decision making. Vet Clin North Am Small Anim Pract 2011;41(3):635–46. 6. American Animal Hospital Association-American Veterinary Medical Association Preventive Healthcare Guidelines Task Force.
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