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Key points

  • Alleviating pain is a professional obligation and a key contributor to successful case outcomes and enhancement of the veterinarian–client–patient relationship.
  • Recognition and proper management of chronic pain can be as life-saving as any other medical intervention in veterinary medicine.
  • Pain management treatment should focus on the underlying cause of pain (nociceptive, inflammatory, or pathological) rather than strictly on its duration.
  • Appropriate pain management requires a continuum of care that begins with a case-specific pain assessment and treatment plan, including anticipation of pain, early intervention, and evaluation of the treatment response on an individual-patient basis.
  • In addition to pharmacologic treatment of pain, there is a strong role for nonpharmacologic modalities of pain management as part of a balanced, individualized treatment plan.
  • The most accurate method for evaluating pain in animals is observation of behavior, including deviation from normal behaviors and development of new behaviors, utilizing a validated pain-scoring tool for dogs and cats.
  • Every veterinary health care team member should be able to recognize pain-associated behaviors in patients and know how to respond appropriately.
  • Pain assessment should be a routine component of every physical exam.
  • Pain-scoring tools should be routinely used to assess acute and chronic pain.
  • To target multiple pain pathways, effective pain management involves a balanced or multimodal strategy using several classes of pain-modifying medications.
  • Opioids are the most effective drug class for managing acute pain.
  • Because the majority of painful conditions have an inflammatory component, nonsteroidal anti-inflammatory drugs are a mainstay for managing chronic pain and for perioperative use.
  • Pharmacologic intervention can usually be enhanced by various nonpharmacologic approaches, including weight optimization, physical rehabilitation, environmental modifications, and proper-patient handling techniques.
  • Although degenerative joint disease, including osteoarthritis, disproportionately affects older patients, its onset often begins at an early age in dogs and cats.
  • Early intervention can delay the onset and severity of degenerative joint disease and should involve the caregiver as part of the treatment strategy.
  • In cases involving hospice and palliative care, it is important to offer explanations of probable outcomes and to provide end-of-life choices designed to relieve the pet’s pain and suffering.
  • Pain management in clinical practice is a team effort, with the pet owner functioning as an integral part of the team.
  • All veterinary health care team members should have a defined role in the practice’s approach to providing compassionate care to its patients.
  • Proper handling of older patients at home and during veterinary visits is an important component to minimizing discomfort of degenerative joint disease and other chronic pain conditions.
  • Each pain management plan should include patient-specific instructions, given verbally and in writing to the pet owner, including the prevention and recognition of adverse drug effects.