The Essential Role of Veterinary Nurses in Effective Pain Management

Each year the team at Zero Pain Philosophy run the Big Pain Survey. Our most recent survey was split into one survey for vets and one for vet nurses. The survey was reviewed by the ethics committee of the Association of Anaesthetists and ethical approval was obtained prior to launching the survey. In this article, published during Veterinary Nursing Awareness Month, we focus on the role of the veterinary nurse in the provision of analgesia both in the acute and chronic setting.

We will review the answers to the questions we asked, which provide further insights into the thoughts that our survey respondents have regarding pain management. The Zero Pain Philosophy community is a global community. In the vast majority of regions in the world, vet nurses are unable to prescribe. We therefore phrased our questions in the survey around asking those nurses what was the approach of the clinic they work in. Seventy-eight percent of responds work in small animal practice, with 68% working in the UK. Fifty percent of respondents were over 10 years qualified. 263 vets and 103 nurses responded. We focused on three key areas in pain management where we feel veterinary nurses have potential to influence, namely osteoarthritis, dental pain and client education.

Licensed options for osteoarthritis

When we asked nurses to describe their clinic's approach to the treatment of osteoarthritis, 56% of nurses stated that non-steroidal anti-inflammatories (NSAIDs) were first lines of treatment for osteoarthritis. 5% stated that nutraceuticals were first line of treatment and 18% said the vets in their practice consider other management strategies prior to moving to drug therapy.

Looking specifically at the NSAIDs used for the treatment of osteoarthritis in those practices, 62% of respondents stated that meloxicam was the main NSAID used in their practice

A question that we asked to both vets and nurses was ‘In your opinion, how effective are NSAIDs in managing the pain of osteoarthritis’? This question was answered using a rating system out of 10, with zero being ineffective and 10 being very effective. The responses from vets and nurses were very similar. The majority of nurses rated NSAIDs having an efficacy of 7/10, and the majority of vets rated NSAIDs as having an efficacy of 8/10. When asked, ‘does the practice use bedinvetmab as a first line treatment for OA in dogs’? 62% of respondents said no, NSAIDs first line, with 23% responding yes, bedinvetmab is used as a first line treatment for OA. A small proportion, 5%, stated that neither of those are first line. Both NSAIDs and bedinvetmab are licensed for the treatment of the pain of osteoarthritis. The third licensed class of drugs we have are the piprants. We asked the same question to our respondents about how effective grapiprant is in managing the pain of osteoarthritis. The majority of nurses perceived that grapiprant is less effective than NSAIDs, with most of those nurses rating grapiprant with a 5 out of 10 score. Interestingly there are no studies comparing the efficacy of grapiprant to traditional NSAIDs so this represents a research opportunity to clarify this opinion. When we asked that same question for bedinvetmab, the responses were more varied. However, the vast majority of nurses rated bedinvetmab with an efficacy of 8/10. Recent work comparing meloxicam to bedinvetmab for the treatment of OA in dogs reported both products are equally effective in managing OA pain, with efficacy improving over time for both treatments. Bedinvetmab was associated with fewer adverse effects (Innes et al 2025).

Whilst veterinary nurses are not the prescribers of these drugs, they will be talking to clients in nurse clinics so will form their opinions based on client feedback. Furthermore VNs have the ability to influence the client despite not being able to prescribe. It is therefore important that both pain management educators and pharmaceutical companies provide suitable education to VNs around efficacy of licensed options for the treatment of OA in dogs and cats.

This leads on to our second question: if a dog is being treated with NSAIDs for OA and the pain progresses, which second-line analgesic do you see used by the vets in your practice in this situation? The response to this question was understandably varied. The majority answer was 29% of respondents stating that bedinvetmab was used as a second line analgesic. 25% said it depends on the specific case and 21% stated that gabapentin was that second line option. The next most popular response was paracetamol at 11%.

It stands to reason that bedinvetmab is a second analgesic to use in this situation given that it is licensed. If we use the vet responses to validate the answers given by VNs, the majority of vets (32%) said that the second line analgesic depends on the specific case, followed by 22% saying bedinvetmab would be their second line. 19% said paracetamol, and 12% chose gabapentin as their next step.

An option that featured lower down in responses from both groups was amantadine. This is interesting when considering those unlicensed options, because amantadine is the one drug that has some evidence for regarding its use as an adjunct analgesic alongside NSAIDs (Lascelles et al 2008), whereas that evidence does not exist for either gabapentin or paracetamol. There appeared to be little familiarity with the NMDA antagonists such as amantadine which represents a further educational opportunity for pain education providers. Considering the role of the veterinary nurse in osteoarthritis clinics, it is important that nurses are equipped with the correct tools in order to gather information from caregivers that can be reported back to the veterinary surgeon. The use of pain scales which are validated in osteoarthritis are usually important here. Examples of these are LOAD, the Liverpool Osteoarthritis in Dogs Score, and CBPI, the Canine Brief Pain Inventory. Both of these are completed by the client and provide a useful tool for monitoring the efficacy of our analgesics. In those cases where osteoarthritis is diagnosed and the pet has been treated with a licensed option, it is important that veterinary nurses undertake education around second line options for osteoarthritis in order to further their own understanding of management of the disease. An appreciation of the options available in those difficult cases should facilitate booking a consultation with the vet to discuss those options with the client.

CBD

An option that is increasingly popular with clients is the use of CBD. There is an increase of evidence in the literature that CBD is effective in dogs with osteoarthritis and we expect to see further developments in this field of pain management. We asked, is CBD prescribed routinely for pain management in dogs at your practice? 70% of nurses responded never, with 5% responding that we see good results with CBD. If we compare that to the same question asked for vets, 31% of vets said if there was more evidence I would consider prescribing and 26% said if there was a reliable product, it would increase my prescribing. 10% of vets said they've had good results with CBD. Our view is that the evidence base is growing for CBD and essential to future use is a reliable product which is prescribed by the veterinary surgeon where CBD content has been verified.

Intra-articular therapies

Turning now to intra-articular therapies. As pain specialists, we feel there is a role for intra-articular therapies in the management of osteoarthritis, which could be more widely used in practice. The results of our survey give an interesting understanding of how widely these treatments are used and are a useful benchmark given the recent 2023 launch of a licensed stem cell product for dogs (Punzon et al 2022). When nurses responded to this survey, which intra-articular therapies are used for treatment of arthritis cases at your practice? 43% said that intra-articular therapies are not used at our practice. When we asked the same question to vets, the most common answer from 59% was, I don't use intra-articular injections and I would like to know more.Looking further into intra-articular options, it would appear a variety of products are being used by those considering intra-articular therapies, such as stem cells, hydrogels, corticosteroids, platelet-rich plasma, and hyaluronic acid.It is clear from these survey results that further work is required to document the benefits of intra-articular treatments and to share those results with the veterinary community. Our view is that these treatments represent a targetted option for OA – which is much in need given the evidence that shows 23% of dogs under the age of 4 years have radiographic and clinical evidence of OA (Enomoto et al 2024).

Nutraceuticals

When we asked veterinary nurses, are nutraceuticals recommended for OA management in your practice? only 5% said no. When we asked specifically which products were recommended in the practice, the three most common products were glucosamine and chondroitin, green-lipped mussel extract, and other omega-3 supplements.Of the most common supplements used, glucosamine and chondroitin featured highly, despite there being a clear lack of evidence for its use. With some authors stating that glucosamine and chondroitin products should not be used for the management of osteoarthritis (Barbeau-Gregoire et al, 2022). Based on our review of the literature, the supplements that we would recommend are omega-3 containing supplements (Barbeau-Gregoire et al, 2022) and there is good evidence for specific omega-3 supplementation such as the specific types of green-lipped muscle extract and supplements containing krill oil (Kampa et al 2023).

Feline OA

Looking specifically at cats, we asked nurses, is frunevetmab a first-line treatment for arthritic cats in your practice? and 50% of those said yes. When we asked how effective frunevetmab is in managing the pain of OA, the vast majority scored it at 8/10.When we asked in your opinion how effective are NSAIDs in managing the pain of OA in cats, the responses were more varied and ranged from 5/10 to 8/10.If a cat is treated with NSAIDs and the pain progressed, which second line analgesic are vets using in that situation? The nurses' response to this survey said that in 32% of cases it depends on the specific case, in 30% of cases frunevetmab is that second analgesic, and in 27% of cases gabapentin is that second analgesic. These answers are similar to the answers that were provided to the same question when asked about dogs. It shows that vets are using other licensed options first, which is a correct approach according to the cascade. With cats on this topic, there are three similar studies looking at the efficacy of amantadine or gabapentin or tramadol in that situation where the cat requires further analgesia and all of those studies are small studies and therefore are underpowered to give definitive outcomes. However, a positive benefit was seen in cats with each of those treatments. Therefore, when we are faced with a situation as a clinician, either amantadine, gabapentin, or tramadol could be a suitable option in those cases.We then asked nurses, how confident are you that the pain of OA can be controlled in cats? And as you might expect, we got a variety of answers. When we asked for a score out of 10, the most common answer was 8/10.

Client understanding

Looking specifically at the client aspect of pain, when we asked how well do you feel clients recognise pain?, the vast majority of nurses rate a client's understanding and recognition of pain as low.In response to that question, we asked what type of resources do you need to assist client education. Ideas which were suggested included

·      web resources for clients to help them understand pain

·      specific resources such as leaflets and videos created by pharmaceutical companies  

·      videos featuring key opinion leaders

·      videos from our own practice team demonstrating the benefits of analgesia and conditions which require pain management.

Dental pain

Dental disease is underdiagnosed and nurses agree that dental pain is a leading welfare issue in dogs and cats.When asked which analgesics are used as first choice for dental pain, this survey reports NSAIDs being used as first choice for the treatment of dental pain.Thinking about those patients that then undergo dental work, we asked does your practice use local anaesthesia for dental extractions? Of the people responding to the survey, 10% said no, my practice doesn't use local anaesthesia for dentals. When we said why is local anaesthesia not used for dentals? The most common answer was lack of experience with techniques. We need to remember that the population responding to this survey are subscribers to Zero Pain Philosophy and therefore have an interest in pain management.

Barriers

Our final question was tell us your biggest barriers to optimal pain management. Client understanding and financial restraints were some of the most common answers. Other answers were limited assessment tools and knowledge gaps.

Conclusion

These survey results provide useful insights into pain management practices in primary care practice and the role of the veterinary nurse. Nurses have a key role to play in pain management and upskilling RVNs in this field is essential to the continued advancement of analgesic excellence.

References

Barbeau-Grégoire (2022) A 2022 Systematic Review and Meta-Analysis of Enriched Therapeutic Diets and Nutraceuticals in Canine and Feline Osteoarthritis. International Journal of Molecular Sciences 23 doi:10.3390/ijms231810384

Enomoto M et al. (2024) Prevalence of radiographic appendicular osteoarthritis and associated clinical signs in young dogs. Scientific Reports 14 doi:10.1038/s41598-024-52324-9

Innes JF. et al (2025) A randomised, parallel-group clinical trial comparing bedinvetmab to meloxicam for the management of canine osteoarthritis. Frontiers in Veterinary Science 12 https://www.frontiersin.org/journals/veterinaryscience/articles/10.3389/fvets.2025.1502218

Kampa N et al (2023) Study of the effectiveness of glucosamine and chondroitin sulfate, marine based fatty acid compounds (PCSO-524 and EAB-277), and carprofen for the treatment of dogs with hip osteoarthritis: A prospective, block-randomized, double-blinded, placebo-controlled clinical trial. Front Vet Sci. doi: 10.3389/fvets.2023.1033188.

Lascelles BDX et al (2007) Amantadine in a multimodal analgesic regimen for alleviation of refractory osteoarthritis pain in dogs. Journal of Veterinary Internal Medicine 22 doi:10.1111/j.1939-1676.2007.0014.x

Punzón et al (2022) Equine umbilical cord mesenchymal stem cells demonstrate safety and efficacy in the treatment of canine osteoarthritis: a randomized placebo-controlled trial. Journal of the American Veterinary Medical Association 260 doi:10.2460/javma.22.06.0237