Providing effective pain management to the geriatric dog or cat is something that we are faced with on a day to day basis. This is the subject of Carl’s lecture today at The London Vet Show.
Chronic pain is a maladaptive state where peripheral injury drives changes in the central nervous system that result in augmented input to the brain. Our geriatric patients suffer a high incidence of osteoarthritis, but may also have concurrent sources of pain.
Considering the precise source of pain is important if there is a specific type of treatment that would be relevant for that condition. This could be joint disease where intra-articular medications could alleviate pain or where surgery could help. Whilst we can consider the effect of individual sources of pain, it is important to assess the overall effect of pain on the individual and this is where pain scoring becomes important.
Which pain scoring system should you choose? What is most important is to pick one that you can work with and stick to it. You’ll find a list of pain scoring systems and links to them at the bottom of this post. Pain scoring is key to evaluating how the owner evaluates their pet’s pain and using a system will make it easier to judge the efficacy of interventions.
New this year is COAST (Canine OA Staging Tool) – which is a tool that evaluates the stage of OA for the dog. We see this playing an important role in decision making – for example a dog with moderate or severe OA warrants treatment with multiple analgesics as opposed to monotherapy. We all understand that OA is a progressive disease and COAST should help to document this progression and enable us to keep on top of the pain as the disease advances. The paper describing COAST is freely available to download here and the tool is here.
Pain management, whatever the inciting cause, has to be multimodal – and not just from a drug point of view. Drugs are just one component and we need to consider weight management, exercise, physical therapy, lifestyle modification and adjunct therapies such as acupuncture to see the greatest benefit to the pet.
Considering drugs, where do we start and when do we move on to another agent and which agent do we choose? Carl gives his opinion on this during the lecture and you can read our post here on this very topic. For information on grapiprant (Galliprant) and amantadine click on the links.
The recent publication of a review entitled ‘Chronic maladaptive pain in cats: A review of current and future drug treatment options’ by Adrian et al (2017) raises a number of interesting questions. This is my interpretation of the review which I feel is a useful update to where our understanding is of chronic pain in cats and what we know of treatment options.
Chronic pain management requires a holistic view of the pet, considering all of the above factors. We are fortunate to have tools available to us and drug options to achieve our overall goal of Zero Pain.
COAST (staging tool for OA rather than a pain score) - links above
Carl Bradbrook is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and is President of the Association of Veterinary Anaesthetists. Carl works at Anderson Moores Veterinary Specialists.
Matt Gurney is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and works at Anderson Moores Veterinary Specialists. Matt is Vice-President of the European College of Veterinary Anaesthesia & Analgesia.
This post was written by Matt Gurney.
Matt & Carl established Zero Pain Philosophy to provide educational resources to veterinary professionals enabling optimal management of pain.