Mark E. Epstein, DVM, DABVP, CVPP

It is now a settled matter that the adaptive capacities of animals, coupled with the innate biases of human observers, seriously impairs our ability to "know" which of our patients are in pain, how much they are in pain, and sometimes, even where they are in pain. Historically the absence of behaviors easily associated with pain (crying, whimpering, etc.) has been equated with the absence of pain.

Pain can be protective, but through the stress response it may also contribute significantly to patient morbidity and even mortality. Undermanaged acute (peri-operative or post-trauma) pain can slow or even prevent recovery, and chronic pain is not merely acute pain of extended duration.

In the last 10 years, the veterinary profession has undergone what can only be described as a sea change in perspectives about animal pain and pain control. A 1993 evaluation of a veterinary teaching hospital surgical caseload revealed only 40% of patients that had undergone highly invasive, painful procedures (including orthopedic repair, thoracotomy, and intervertebral disc decompression) received any sort of pain control, and then only based on clinical signs.

The framework of effective pain management systems rests solidly on the foundation of recognition/assessment, pre-emption, and using multiple modalities.

The neuro-anatomic, physiologic, and molecular basis of nociception is a rapidly evolving field of study.

Many modalities may be employed to minimize both acute and chronic pain, but it is clear that non-steroidal anti-inflammatory drugs will likely remain one of the most commonly used tools in veterinary medicine.

Pain can be protective, but through the stress response it may also contribute significantly to patient morbidity and even mortality.