Multi-modal therapy for acute and chronic pain in companion animals

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BVSc, PhD MANZCVS (anaesthesia), GradCertEdStud (Higher Education)

Senior Lecturer in Veterinary Anaesthesia, Sydney School of Veterinary Science, University of Sydney

* Unfortunately there are a few dips in audio on the recording from Adobe Connect. Please bear with it as the majority of the talk has recorded in good quality. For fullscreen streaming please click on the Vimeo logo in the bottom right hand corner of the video.

Abstract:

Like humans, animals experience pain as a complex physiological, sensory and emotional phenomenon, even though they cannot verbally express the emotional component that is unique to each individual. You as future veterinarians and animal welfare advocates, have a duty of care to minimise pain and suffering in your animal patients. This means pain management should be as important as the diagnosis and treatment of disease.

 

Pain management is a complex decision making process that requires a sound working knowledge of the pain pathway and the many pharmacological and non-pharmacological strategies that can be used to target pain. Yet even with this knowledge, pain remains one of the hardest clinical challenges veterinarians face on a daily basis. This is because there is still so much that we don’t understand about pain and how it manifests in different animal species. We know that most pain is evoked by a nociceptive stimulus. However, pain perception is not just the simple transmission of a noxious stimulus to higher brain centres (Figure 1. pain pathway). Physiological modulation of nociceptive pathways occurs at a number of sites in both the peripheral and central nervous system, and these sites are what we target when treating pain. We also know that pain manifests differently in different disease states and not all pain is the same. Pain can be physiological, inflammatory or neuropathic. How animals display pain is also different in different species. Animal pain behaviour is by no means an exact science and yet clinical decisions about pain management are often based on assessing changes in behaviour (Figure 2. acute pain posture displayed in cats). Effective pain management requires thorough pain assessment and a balanced, multi-modal approach to achieve optimal pain control with minimal side effects. This means targeting the pain transmission pathway at multiple sites using different classes of drugs such as opioids, NSAID’s, local anaesthetics, and NMDA antagonists. It also means utilising different techniques and routes of administration, such as oral, transmucosal, transdermal, epidural, infusions, and infiltrative techniques (Figure 3. carpal block).

 

This presentation aims to bring together the relevant physiological, anatomical and pharmacological knowledge that students need, and apply it in a clinical setting. It provides an overview of analgesic drugs and techniques commonly used to manage both acute and chronic pain in cats and dogs, and introduces participants to a framework that can be used to develop effective pain management plans for their future patients.

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