Sample veterinary script: Lets talk about chronic pain
Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CCRP, CVA, MS
Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CCRP, CVA, MS in Clinical Bioethics, is a founder and past-president of the International Veterinary Academy of Pain Management. She owns Windsor Veterinary Clinic and The Downing Center for Animal Pain Management in Windsor, Colorado.
How veterinarians can discuss options with clients for pets who need long-term pain medication.
By and large, veterinary clients whose pets are diagnosed with chronic pain do not, at the outset, appreciate all of the implications of that diagnosis. Many pet owners think that if their veterinarian uncovers pain in their pets, it's a straightforward solution for a straightforward issue. Clients sometimes think of chronic pain like an infection, and they want us to treat it like it one: identify the problem, treat that problem and watch as the problem goes away forever. Correcting this misconception is a critical component of creating success.
So, how do we do that? Where do we start?
Steps 1 through 3: Education, education, education
Our clients cannot know what they don't know. The foundational principle of clinical bioethics-respect for the client's autonomy-obligates us to inform and educate clients to understand, to the best of their ability, what's happening in their pets' bodies. We must illuminate pain, identify where in the body it's present, diagnose the cause whenever possible and give them an appreciation for the intensity of that pain. A careful pain palpation in front of the client is the first step.
Before beginning the pain palpation, demonstrate the pressure to be used by palpating the owner's forearm (with their permission, of course). This shows the clients what firm pressure feels like and helps them appreciate that palpation, while not painful by itself, can reveal pain that's present. Seeing (and feeling) is believing. It allows the pet's reactions to take on deeper meaning. Radiographs or other imaging may also be needed before undertaking treatment.
Step 4: Taking the pain out of pain conversations
Once clients understand their pet's pain, education continues through common questions. Here are some sample responses to questions like these that provide helpful language for pet owner understanding about their pets' pain problems.
I feel terrible! I had no idea Max was in so much pain. I just thought he was getting older and slowing down. How could I have missed it?!
“I know it can be upsetting to learn a family member is hurting. Don't be too hard on yourself. It's important to understand that animals do their best to hide any weakness when they don't feel their best. They're masters at hiding pain, and they do their best to carry on with all the things they're used to doing.
“When I'm doing my physical exam, I'm asking my patients very specifically, “Does it hurt when I touch you here?”, and I watch for the reaction. My examination is very different from the ways in which you touch and interact with Max.
“Max always wants you to think that everything is fine.”
So, now what? How can we help Max feel better and get back to normal?
“The good news is, we have many tools to help Max. But it's important to understand that there is no “magic bullet” for chronic pain. We'll include a lot of these tools in our approach. That could mean nutrition, supplements, medications and physical medicine options like chiropractic that together work better than any single option works on its own. And we'll talk about modifying Max's home environment and lifestyle to help him be more comfortable and active.
“We'll work together to tailor specific treatments to meet Max's needs. Breaking the pain cycle quickly is our No. 1 priority, so we'll use medications that target pain and inflammation as well as medicines that work on the nervous system itself. Some or all of the medications we choose may be in place long term.
“We'll also focus on scientifically proven nutrition and supplements to support joint health, decrease pain and inflammation, and allow us to decrease the doses of medications to the lowest effective doses.
“Finally, we'll discuss physical medicine options-for instance, acupuncture, chiropractic and physiotherapy-that could benefit Max.”
That sounds like a lot. Exactly how long will Max need to take all this medication or use special food?
'It's important to take the long view. You and our healthcare team are now partners in Max's care, working together to help him as his body continues to age and change.'
“Unfortunately, chronic pain is the gift that keeps on giving, so we will need to be doing something for Max's pain management for the rest of his life. It's important to take the long view. You and our healthcare team are now partners in Max's care, working together to help him as his body continues to age and change.”
I'm not sure I can do all of this for Max. To be honest, I'm feeling a bit overwhelmed.
“Don't panic. Part of my job as Max's veterinarian is to partner with you, set priorities among Max's medical issues, and help you understand what we need to focus on first, second, third and beyond. I'm also here to help you identify what you can do at home to help Max remain comfortable and active. I think you'll be surprised at how simple some of that can be.”
Dr. Robin Downing holds a master's in clinical bioethics and is a diplomate of the Academy of Integrative Pain Management, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, a Fear Free Certified Professional, a certified veterinary pain practitioner, a certified canine rehabilitation practitioner, and hospital director at The Downing Center for Animal Pain Management in Windsor, Colorado.