1. What are the most common pain relievers used in veterinary practices today?
Non-steroidal anti-inflammatory (NSAIDs) drugs such as etodolac (Etogesic©), carprofen (Rimadyl ©), meloxicam (Metacam©), deracoxib (Deramaxx©), firocoxib (Previcoxx©), and robenacoxib (Onsior©) are the medications most veterinarians reach for first. These drugs certainly have a role in pain management, but unfortunately, they are not effective for all types of pain and are the medication class with the greatest side effect potential.
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2. Are there risks associated NSAID use?
This class of drugs has the greatest potential to have damaging effects to the kidneys, liver and gastrointestinal tract. Stomach ulcers can form, leading to gastric perforation. Close monitoring for vomiting and diarrhea as well as periodic blood and urine tests is important. NSAIDs tend to have a narrow dosing window and can be especially dangerous when combined with a corticosteroid such as prednisone or dexamethasone.
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3. What kind of pain relievers will the APMC use to manage my pet's pain?
There many outstanding pain relieving medications available to us today. We tailor pain medications to the need of the patient; it is a negotiation process that may take weeks to months to provide optimal benefit while minimizing unwanted effects.
Our preferred pain medicine therapy strategy is referred to as multimodal pain therapy. Multimodal pain therapy involves the coordination of compatible pain relievers to achieve better pain relief with fewer side effects as compared to single agent therapy.
Once effective pain relief is achieved, we gradually reduce the patient's pain medications based on their potential for adverse effects and their cost. We work together with the client to find the lowest possible amount of medication that any given patient requires.
We also incorporate naturally derived supplements and disease modifiers to further reduce the need for long term pain medicine therapy.
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4. I see OTC aspirin in my pet store. Is aspirin a good pain reliever for my dog or cat?
Aspirin (acetylsalicylic acid) is NOT a good home remedy for either dogs or cats. Aspirin has more potential to cause digestive system damage than newer generation NSAIDs. Cats metabolize aspirin very slowly which increases their toxicity risk substantially.
In addition, if you start aspirin therapy at home you handcuff your veterinarian; starting with aspirin, then switching to a new generation NSAID greatly increases the risk of adverse effects.
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5. Is ibuprofen or naproxen sodium a good pain reliever for my dog or cat?
Both ibuprofen and naproxen sodium are common OTC human NSAIDs but they are NOT considered safe choices for dogs or cats.
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6. Is acetaminophen (Tylenol©) safe for dogs and cats?
Acetaminophen is occasionally used for dog pain therapy but ACETAMINOPHEN/TYLENOL IS DIRECTLY TOXIC TO CATS; NEVER USE ACETAMINOPHEN UNLESS DIRECTED TO DO SO BY YOUR VETERINARIAN.
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7. What is the best dose schedule for tramadol?
Research has shown that dogs metabolize tramadol much faster than people. Effective pain reliving dosing starts at 5 mg/kg 4 times daily (or 3 mg/kg 6 times daily).
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8. Why don't most veterinarians referrer their patients for physical rehabilitation therapy (PRT) after major surgeries?
Most veterinarians do not have a physical therapy perspective. There is little to no PRT training in most vet schools; they simply aren't adequately educated about the need for PRT. The common mind set seems to be that the surgery fixes the problem and the dog or cat seems to do well enough in most cases. We know from research and clinical experience that our patients have a much quicker recovery and return to maximum function with the aid of PRT. In human medicine, PT is thought to be an integral aspect to recovery, as it should be in veterinary medicine.
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9. What are the critical elements that make up a bonafide physical rehabilitation therapy (PRT) program?
Therapist training! Vet and vet tech school rarely incorporates PRT, so interested professionals need to seek out a certification program and maintain continuing education. There are two programs, the Canine Rehabilitation Institute and University of Tennessee/Northeast Seminars which certify veterinarians, veterinary technicians, physical therapists and physical therapy assistants. These programs include hands-on learning, internships and examinations to ensure competency. In recent years, equipment such as low level lasers and underwater treadmills have been sold to facilities without proper training. This equipment looks fancy, but can be ineffective or even harmful if not used correctly.
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10. What are ADLs and why are they important?
ADLs or activities of daily living describe the day to day routine of a patient. What does the patient need to do every day, or most days, to maintain quality of life and function as normally as possible? These may include challenges to move around the house or get in and out of the car. Identifying these can help set PRT goals.
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11. What are HEPs?
The HEP, or home exercise plan is a very important part of PRT. These are the exercises and activities that are specially selected for a patient to work on strength, flexibility and balance at home. Just as the visits to the facility are important, the HEP performed daily to multiple times per day will help in a successful outcome.
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12. What is PRT?
We use the term physical rehabilitation therapy instead of physical therapy (PT) because PT is a term reserved for licensed physical therapists to perform on people.
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13. Why is pain management so important when undergoing PRT?
Controlling pain is the first step to recovery and rehabilitation from an injury, surgery or chronic condition. It is unfair to ask a non-verbal patient (dog or cat) to perform exercises and participate in PRT without adequately controlling pain first. Most dogs and cats internalize their discomfort. Very few cry out or show overt signs of pain. Initiating a PRT program results in more physical activity, which could lead to an increase in discomfort if pain management measures are not in place. Just think of how sore you can be after starting a new exercise program or going to the gym after some time off. Controlling pain will maximize the PRT outcome and lead to faster recovery.
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14. Can't I just take my dog swimming and get the same benefits?
Swimming
in an open-water environment can be beneficial for some orthopdeic patients but harmful to others. If you watch videos of a variety of swimming dogs you will notice that some barely move their back legs while other dogs kick in an explosive manner. The first group of dogs may only extend their lower paw from the ankle down while the second group extends the entire leg in a violent snapping motion.
The point is that free swimming isn't controlled. An underwater treadmill provides the perfect controlled environment for orthopedic rehabilitation therapy and sports conditioning. The water level can be adjusted to finetune weight support and forward resistance. The treadmill speed and the length of the session can be adjusted to suit the needs of any given patient.
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