It’s pain awareness month and we are feeling philosophical! Well of course we are, it’s part of what we do. So, for 5 minutes let’s stimulate some ideas and get you thinking.
We need to have an idea of what pain means, so we can select the best analgesic options for our patients and explain pain to our clients.
Of course we understand acute pain, because generally, we all have experience of acute pain. It hurts like hell! Acute pain makes sense. But how do you explain the value of chronic pain? This is elegantly described by Melzack & Wall in their book, The Challenge of Pain;
‘Pain has many valuable functions. It can be a warning or force us to rest our bodies. Yet most chronic pain has no discernable cause and diminishes countless lives’.
Recent work has shown that 50% of dogs with arthritis are diagnosed too late. So how do we educate pet owners to notice signs of pain in their pets and prevent these animals suffering in silence. I use that phrase fairly deliberately, on account of the number of times I hear an owner say ‘well he’s still eating and he doesn’t cry in pain’. We ourselves need a fair understanding of what pain is in order to educate clients that these are extreme signs of pain. It’s no wonder we diagnose arthritis too late if the patients are not presented for pain.
I find it useful to use a phrase with owners – ‘it’s not how painful they are, it’s how the pain makes them feel’ when I’m explaining the behaviours that we are looking for – and how individual these are. We know dogs don’t cry in pain and that we need to assess how the pain is interfering on a daily basis. It’s amazing how once owners understand that, they then start to notice pain behaviours. These elements are captured in a number of chronic pain scores and pain scoring to figure out these valuable indicators form an essential part of my history taking. With effective analgesic treatment we look to see resolution of these behaviours.
Pain hurts! But it hurts differently for different people. We are all different and so is the way we process pain. And different pain aetiologies produce different symptoms – from the ouch we see with inflammation to the strange burning, shooting, stabbing from neuropathic pain.
The phrase ‘Pain is whatever the experiencing person says it is, existing whenever he says it does’ was championed by a nurse called Margo McCaffery in the late 1960s.
Her goal was to individualise pain management to the patient and her work in this field is well-renowned. I find this an all encompassing phrase which helps explain what our approach to pain should focus on.
With a number of effective analgesic options we are well-positioned to make a rational start to treating pain. We have effective options for arthritis and are understanding more about neuropathic elements of pain.
At Zero Pain Philosophy we are here to share our knowledge of pain with you, to enable you to provide the most effective solutions to your patients. Why not share some of these ideas with the vet team at your next practice meeting? And if you need specific solutions, let us know. We are here to help with videos, pain updates, webinars, courses and telemedicine.