Pain Management: The Creature Comforts Difference

This past weekend, I took a road trip to Richmond and Williamsburg, Virginia to see an exhibit at the Virginia Museum of Fine Arts, stroll the light show in the Lewis Ginter Botanical Gardens, 

participate in the “Tacky Christmas House Tour”,

visit Yorktown, and walk the streets of Colonial Williamsburg. 

Although I missed the Grand Illumination in Williamsburg that occurs the first Sunday in December, there were plenty of other beautiful and fun sightings.

My biggest question was which direction to go home?  I elected to take the Jamestown Ferry home via the Courtland, Virginia route. 

It brings to mind the many directions to approach pain. What is time tested versus new?

WHAT IS PAIN?

Pain is an unpleasant and emotional experience associated with actual or potential tissue damage. Pain is a constant concern of all pet owners during any dental, medical, or surgical procedure, as well as for age-related conditions.  In simple terms, it HURTS! As a member of the International Veterinary Academy of Pain Management, Dr. Sigmon’s objective is to promote the interdisciplinary approach to animal pain management by WORKING with experts all over the country in the area of pain management. 

SINCE PETS CANNOT SPEAK FOR THEMSELVES AND RARELY VOCALIZE PAINFUL CONDTIONS AT HOME, HOW DOES AN OWNER RECOGNIZE SIGNS OF PAIN?

Hiding, not eating, curled up in a corner, stiffness on rising, difficulty posturing to urinate/defecate, and guarding the back, abdomen, or limbs. In dental disease, rubbing the mouth, drooling, and dropping of FOOD are among those on a checklist that CCAH utilizes.

Creature Comforts offers the following options to lower pain.

SURGICAL AND DENTAL PRE-EMPTIVE PAIN CONTROL

_____Lidocaine gel patch 20 minutes prior to catheter placement

_____ Pre-surgical, Pre-dental pain medications tailored to your pet’s needs and thus decreasing depth of anesthesia as much as 20%

____Pre-emptive(interventional) pain medications during surgical procedure

____ Local blocks of surgical sites to further decrease depth of surgical requirements

____Injectable pain meds post operatively to allow your special pet to “snooze” or rest post-operatively

____ Oral pain medications dispensed and discussed at discharge 

WHAT ARE SOME OF THE NEWER COMBINATIONS++ OF ORAL PAIN MEDS FOR DOGS?

1.      NSAIDS- rimadyl, previcox, and metacam (or generics) 

2.      GABAPENTIN (also for nerve pain, seizures) – may take up to 2 weeks to be effective

3.      AMANTADINE (also for Parkinson’s disease) 

++ Multi-modality (many different combinations) of pain medications using recommendations and recent developments of experts from veterinary research facilities

ARE THERE SOME HOLISTIC OPTIONS?

_____Diet management (ROYAL CANIN MOBILITY DIET) and weight control (cut intake 1/3^rd & add veggies)

_____ Omega 3 fatty acids 1000 TO 2000 MG PER 20 LBS, START SLOW

_____ joint supplementations injectable (Adequan)

_____ Dasuquin, Cosequin, oral, natural joint supplements

____ Rehabilitation, physical therapy-written plan, not just free play in back yard

____Acupuncture

____Herbal supplements

HOW MANY LONG TERM PAIN MEDICATIONS ARE APPROVED IN THE UNITED STATES FOR CATS?

ZERO. Currently all pain medications for cats used long term are considered extra-label usage.

 WHAT’S NEW ON THE HORIZON FOR PAIN MANAGEMENT IN 2015?

______Prozac

______Elavil or Clomicalm (medications prescribed for depression & anxiety)

______Capsaicin (think Liquid Heat home remedy)

______Resveratrol in red wine and how much pain control is new study

______Minocycline antibiotics

______Steroids

_____Tanezumab ( utilizes the immune system via monoclonal antibodies to attack a mediator of pain- nerve growth factor) – not on market , allowed 6 weeks of pain control from a single injection

_____Aratana –grapiprant

____Fentanyl patch or gel-Recuvyra fentanyl gel lasts 4 days (keep away from children

____Exparel (liposome encapsulated) and lasts 72 hours

Betsy T. Sigmon, DVM, Diplomate American Board of Veterinary Practitioners, Canine & Feline

Creature Comforts Animal Hospital

Cary, NC

Many thanks to Memphis Woodall's family for the holiday photos. Below are some of the door decorations from Colonial Williamsburg.