Modern Approaches to Managing Pain in Pets

Watch any commercial TV station for an hour or two and you’re bound to see advertisements for a variety of products to control, prevent or alleviate pain, from gels and creams to compression wear and prescription pain medication. If you’ve ever recovered from a painful injury, post-surgical pain or have a chronic condition like arthritis, you understand how pain can negatively impact your quality of life.

Thankfully, we’ve moved far beyond the days when some veterinarians thought an animal in pain would be less active following an injury or surgery to understanding that alleviating pain isn’t only a major component of compassionate care, but that untreated pain suppresses the immune system, interferes with sleep and slows healing time.

Difficult to diagnose and treat

Pain can be difficult to diagnose, particularly since many animals act differently once they get inside a veterinary clinic. Pet owners may not recognize that their pet is in pain, especially if they have an older animal whose activity has changed over time. A 2020 study found that over 80% of pet behavior problems have their basis in pain, so it should be ruled out first before attempting to treat unwanted behavior.

The pain phenomenon is complex, and multimodal pain management is often the most effective treatment. This may include a combination of pharmaceuticals, supplements and treatments like laser therapy, massage, hydrotherapy, thermotherapy — the application of heat or cold — and assisted mobility devices like slings, harness support and booties.

The concept of multimodal analgesia has also gained acceptance, using multiple pharmaceuticals that target different pain pathways. This approach has the benefits of both enhancing pain relief while minimizing adverse effects with lower doses of each drug. Veterinarians may prescribe a combination of NSAIDs, opioids, local anesthetics and adjunctive agents like gabapentin or pregabalin to manage side effects or enhance the effectiveness of the primary treatment.

Many of the same products are used to resolve short-term, acute pain as for chronic pain management, but long-term conditions should include measures to slow the progression of pain-related problems. Cancer, spinal problems, dental issues or recurring skin and ear infections can all cause chronic discomfort. The most common cause of chronic pain in pets is osteoarthritis (OA).

The term “OA” is a broad description for an inflammatory condition that progressively leads to the breakdown in the components of a joint, including cartilage, capsular material and the surrounding tissue and bone. This results in the loss of normal joint function and can lead to destruction of the joint capsule. OA typically results from normal wear and tear on a joint as a pet ages, but traumatic injury such as a cranial cruciate ligament (CCL) rupture can cause early onset of arthritic changes due to joint instability. OA estimates are probably underreported in pets, but it’s assumed that it affects at least 40% of dogs, and radiographic evidence has shown OA in 90% of cats over 12 years old.

Since cats can be pros at masking pain, OA is often underdiagnosed and even overlooked until significant pain or mobility issues emerge. A recent study published in the Journal of Feline Medicine and Surgery showed why this is frequently the case. When cats were screened for OA by a veterinarian using a typical physical exam and asking the owner questions, just 1% were diagnosed with orthopedic-related issues. When the Feline OA Checklist was used as a screening tool, 39% of the cats were found to have at least one behavior consistent with OA.

The checklist consists of just 12 quick questions about a cat’s mobility going up and down stairs, jumping or playing, and any changes to their personality, litterbox habits and activity level. Your clinics can give cat owners a hard copy to fill out at check-in, email them a copy to fill out before an appointment, or text a link to fill out the checklist on their website. Early recognition of OA is critical to improving quality of life, and utilizing a simple tool like the Feline OA Checklist gives clinics the opportunity to screen all cats in the practice.

Pain management options

Both NSAIDs and monoclonal antibodies are recommended as first-line defenses against the pain and inflammatory damage associated with OA. The newest OA therapies are frunevetmab (Solensia) for cats and bedinvetmab (Librela) for dogs. Both drugs are species-specific monoclonal antibodies designed to target and bind to nerve growth factor (NGF) proteins and prevent the pain signal from reaching the brain.

While monoclonal antibodies can be used in conjunction with NSAIDs, they can also provide an alternative for animals with liver or kidney disease where NAIDs are contraindicated or for pets that don’t tolerate NSAIDs due to side effects. Both Solensia and Librela are administered as a monthly subcutaneous injection, so they provide a solution for pet owners who may struggle to give daily medication to their pets and give veterinarians a great opportunity to monitor the pet on a regular basis.

Recognizing the impact of pain and the emphasis on preventing and treating it has been one of the biggest benefits to pet well-being in veterinary medicine. Alleviating pain is an essential element of successful treatment outcomes and client satisfaction. Your knowledge of the growing spectrum of treatment options for acute and chronic pain will help your clients provide optimal care to their patients.

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