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Modification In acute injury, including surgical areas, cold compression has a demonstrable benefit in reducing pain, inflammation, and return to function.115 In the case of chronic injury, heat can improve comfort and function through a variety of mechanisms.116 Environmental Modifications There is strong evidence that the stress of hospitalization inhibits normal behaviors in animals, including eating, grooming, sleeping, and elimination.117 Fear, anxiety, stress, and distress lead to hyperalgesia in both humans and animals.118–121 Strategies to mitigate hyperalgesia therefore include providing bedding, blankets, or clothing from home with familiar scents; allowing visitation of hospitalized pets; separating the dogs from the cats; placing cages so that animals do not see each other; using speciesspecific synthetic pheromones; and proper handling, especially during procedures.122–126 Detailed information on handling feline patients has been recently published.127,128 In patients with DJD, throw rugs and ramps will improve mobility and abilities at home. Chiropractic Care This Task Force has not found sufficient, reliable, noncontradictory evidence for the use of chiropractic care for pain management in veterinary medicine at this time. That said, chiropractic care has many well-defined applications in human medicine that have been supported through reliable research. Homeopathy Incontrovertible evidence that homeopathy is effective in either human or veterinary medicine for the treatment of pain is lacking. Sole reliance on homeopathy to treat a painful condition is in essence withholding pain treatment. Thus, the guidelines Task Force discourages the use of homeopathy for the treatment of pain. Gentle Handling Techniques The importance of gentle handling of patients with either acute or chronic pain cannot be overstated, especially when working with arthritic dogs and cats. Conscious avoidance of careless handling will ensure the patient’s comfort, allow for a more thorough and effective physical exam, and avoid exacerbating anxiety in the agitated, fearful, or aggressive patient. An important additional benefit of gentle handling is that it demonstrates to the pet owner that healthcare team members are compassionate and aware of the significance of pain in their patients. Managing Surgical Pain This Task Force suggests that pain management for dogs and cats undergoing a surgical procedure include the following: A preoperative opioid plus a tranquilizer/sedative (e.g., acepromazine and midazolam or diazepam and dexmedetomidine) Administration of an NSAID either pre- or postoperatively based on patient risk factors and clinician preference A LA For patients undergoing procedures with risk factors for more severe, protracted, or maladaptive postoperative pain states, the following interventions or drugs should be strongly considered: Cold compression An a-2 adrenergic agonist A ketamine CRI A lidocaine CRI Gabapentin Epidural anesthetic(s) Managing Pain Associated with DJD Overview of DJD in Companion Animals DJD, including OA, is one of the most significant and underdiagnosed diseases of cats and dogs. DJD is clinically relevant because of its overall prevalence and universal incidence in older animals. Whereas diagnostic approaches for canine DJD are well established, the best tools for diagnosis of feline DJD are still being developed. The pain treatment continuum for DJD starts with the onset of disease, which usually starts at a very young age in dogs (e.g., 76 JAAHA | 51:2 Mar/Apr 2015 conformational etiology) and cats (unknown etiology), which persists throughout the animal’s life. Perhaps more so than any other pain condition, the management of DJD benefits from an integration of both pharmacologic and nonpharmacologic treatments. Once a diagnosis is made, treatment goals, expectations, and outcome measures should be considered prior to initiating any treatment. The caregiver is an essential part of any treatment program and should be considered a part of the team. Canine DJD: Therapeutic Considerations Because early intervention can delay the onset and severity of DJD, this Task Force emphasizes that chief among all preventive and treatment modalities for canine DJD is weight optimization. Maintaining a lean body condition from an early age demonstrably minimizes DJD development in predisposed breeds.129–131 In overweight patients, weight loss alone, even a modest 6.1–8.85%, improves clinical signs of DJD.132 There is strong evidence to support the use of NSAIDs for the management of DJD pain in dogs. Data on the safety and efficacy of long-term NSAID administration in dogs appears to suggest an overall benefit from this modality for a sustained period of time at labeled doses and intervals provided the patient does not have additional risk factors.22 NSAID therapy should be tailored to suit every individual patient’s needs. Veterinary NSAIDs studied for chronic use (between 28 days and 1 yr) demonstrated satisfactory safety profiles in dogs, with 95–97% of dogs able to receive their NSAID at labeled doses and intervals without adverse effects for the duration of their study.22 There is currently no evidence that a higher risk for NSAID-induced adverse effects exists as the duration of treatment increases. Some dogs may require several weeks of NSAID treatment before clinical improvement is noted.133 In addition to NSAIDs, there are other options to consider. First, PSGAGs are more likely to have a beneficial effect when given early in the disease process.92 As mentioned earlier, an FDA-approved product with established efficacy and safety is available. Second, data supporting analgesia and functional improvement from therapeutic exercise is well established in humans and is beginning to accrue in dogs.134 Third, a systematic review analyzing data from several placebo-controlled blinded studies, affirmed the utility of diets rich in eicosapentaenoic acid for dogs with DJD.135 Various other strategies can be and often are employed, but currently their supporting evidence is weak, conflicting, or altogether lacking at present. Feline DJD: Therapeutic Considerations Until the early 2000s, little