The importance of pain management
Dr Robin Downing takes a deep dive into pain management and owner compliance
This content is sponsored by Zomedica.
During her lecture at the Fetch dvm360® conference in San Diego, California, Robin Downing, DVM, MS, DBe, DAAPM, DACVSMR, shared the philosophy of Descartes: "If you cannot speak, then you cannot think, and if you cannot think, then you cannot feel pain." However, when looking at that thought process, she pointed out to attendees that several important groups are left out, including animals.
Throughout the rest of her lecture, Downing explained to attendees why preparing at the beginning of a case is crucial to a pain management plan, how to get owners to participate in the plan, and treating pain nonpharmacologically.
Starting at the beginning
It is important to start your pain plan from the beginning to address and treat pain, Downing said. Although it may sound like common knowledge, Downing explained that paying attention to the beginning can help accurately diagnose a patient's pain so the treatment can begin.
“I think it's easy to forget some of the details beginning at the beginning. So we need to make sure we get a good metabolic profile and we need to make sure we create and then carry through with an appropriate diagnostic plan. Three times, I have had dogs referred to me for managing chronic osteoarthritis pain, only to uncover that they had osteosarcoma. Don't be that doctor. I will tell you that those are 3 of the hardest conversations I've had to have in my entire 36-and-a-half-year career,” Downing shared with the group.
Clients play a crucial part in their pet’s pain management plan, and Downing encourages veterinary professionals to discuss the options and what is happening with their clients. If you explain what is happening and the importance of following the plan, it can help gain compliance for the treatment, resulting in a better and more positive outcome for pets.
“If we lose a client, we've lost everything. Meaning we can be really smarty pants people who know a lot about pain and pain management but if we cannot help our clients understand and embrace what needs to be done, and if we can't dialogue with them to find out what they can get done, what can they do? And what can they pay for? This is not about X-rays in their wallets from the weigh-in. This is about having an open and transparent discussion about these are things I recommend. What can we get done,” she expressed.
Without communication and understanding of clients, the pain plan can be at risk of not working, putting the patient's health at risk. Through an open dialogue and understanding of who is sitting across from you in the exam room, the pain management plan can work efficiently to help both pets and clients.
Breaking the pain cycle nonpharmacologically
When it comes to pain, there are other ways to treat it besides medications. According to Downing, there is a physical medicine that can help treat our patient’s pain, such as hot and cold lasers, medical massages, acupuncture, hydrotherapy, and chiropractic/osteopathic manipulation. With these treatments, Downing explained that some of these are not only easy for veterinary professionals to learn how to do but also for pet parents.
“We have excellent textbooks now with protocols that make this stuff not so mysterious. Like you can teach any of their clients how to use heat and cold seriously and you can use [and] you can learn how to do medical massage and there are excellent opportunities to use photobiomodulation. What we now know is better described as photobiomodulation versus therapeutic laser,” concluded Downing.
Downing R. The future is now: the science (not science fiction) of today’s pain management. Presented at: Fetch dvm360® Conference; San Diego, California. December 2-4, 2022.