People and veterinarians want to help keep their pets pain-free. According to both the American Veterinary Medical Association and the American Animal Hospital Association, which has strict hospital accreditation standards, managing pain is both an ethical and medical concern in veterinary medicine. Veterinarians promise to use their knowledge to reduce animal suffering and we spend a large part of every day trying to accomplish that goal. If we visit any pharmacy and simply look at how many aisles are devoted to pain management, it becomes instantly evident how important pain control is to American consumers, and if we want to resolve, manage or avoid pain, it is important to realize several things.
Pain originates when normal energetics of the body are interrupted. Any sudden and uncontrolled accumulation of energy leads to injury, which signals the organism of a threat to its survival through the perception of pain. In traumatic circumstances, it occurs when excess energy is introduced into a tissue in such a way as to disrupt the normal survival patterning of that tissue. Factors that potentially injure or kill cells result in pain. Besides trauma, energy in the form of radiation can injure tissues by entering energy at rates that exceed the tissue's ability to dissipate that energy. When chemicals act to damage normal structure and function we also experience pain, so any condition that results in inflammation can result in pain. The cardinal signs of inflammation, which are redness, swelling and heat, result in discomfort or painful sensations.
From a bioregulatory medicine viewpoint, we see pain result when there is an accumulation of toxic substances or energies, also called homotoxins. These substances interfere with normal functioning and lead to stimulation of local pain fibers that result in the pet experiencing painful stimuli. Bioregulatory therapists measure the progressive levels of damage to tissues on a six-phase scale called the Disease Evolution Table (DET). If we consider the Disease Evolution Table, we can see pain results from inflammation, impregnation, degeneration and dedifferentiation phases. Proper pain managing techniques exist for each of these types of pain, and properly managing pain is much easier if one knows this table and knows how to work cooperatively with the patient's natural systems. Bioregulatory doctors have many more strategies for managing pain than simply giving suppressive medications that disconnect a body part from the experience of pain.
Acute and sudden pain can serve an important biological function that alerts and warns the organism of threats to its survival. If a fish swims into toxic water, it becomes uncomfortable and retreats back into a safer environment. If we attempt to lift too heavy a weight, our back strains and notifies us of the danger. In such ways we need pain and the experience of discomfort to advise us of our present condition, and to allow our biological controls to find optimal solutions to our present problems. While pain can be a good thing when we consider things in that light, chronic pain can lead to a series of destructive events that increase our chances for more serious disease processes and severe, unrelenting pain can even cause death.
Properly managing pain requires two different spheres of work. In the first sphere we have increasing awareness so that appropriate actions can be contemplated and chosen. In the second sphere of pain management we have techniques that help reduce the pain for our patients. These two spheres can conflict, and it can be a challenge to arrive at a balanced strategy of pain management when we are treating our veterinary patients.
Physical trauma and injury, surgical trauma, radiation, injection of medications, ear cleaning or nail trimming techniques can all cause pain. Illnesses may result in direct inflammation and subsequent pain, as well as lead to the need for medical procedures that cause painful stimuli to exist. All these areas require professional consideration in treatment planning. As a veterinarian, most of our efforts and continuing education involves learning about methods that reduce pain, but we also need to address this first sphere of increasing awareness. Since this is so important, let's look at that one first.
One of the most important causes of pain is lowered awareness. Consider a person who is worried about getting to work on time. They just had a disagreement with their spouse and are juggling a hot cup of coffee while trying to drive in traffic. As their cell phone rings, they look down and become less aware of their driving environment only to become involved in a traffic accident. The person's lowered awareness (resulting from sleep deprivation, mental suppression and distraction) results in an environmental imbalance and injury as their car collides with the person in front of them. In veterinary medicine, more pain can occur as the unrestrained dog flies from the back seat to the front seat and smashes into the windshield as a result of the accident. Pain can occur when an animal's steward doesn't understand the importance of proper nutrition and feeds an all-meat diet that leads to abnormal calcium metabolism, brittle bones and eventual fracture. If the owner understood proper nutrition, then the dog would never require veterinary pain management for the fracture.
If we consider things holistically and consider how events come into existence, then we see that many conditions that ultimately result in pain can be affected by properly improving awareness of those involved. These things we collectively call preventative medicine fall into this category. So does education as the more things a person knows, the more tools they have to decide upon in implementing action plans. By taking actions that increase awareness and truthful communication we can prevent many painful conditions. Consider the following:
- Feeding pets properly improves their chances of health and longevity. Just maintaining proper body weight improves life expectancy and postpones chronic disease. This decreases the potential for pain. It's no accident that nutrition is part of most pain protocols in our practice.
- Training pets at an early stage and properly socializing them allows for happier and more predictable interactions with people and other pets. Having control of a pet through proper training reduces accidents and traumatic fights. It's very important in the goal of reducing pain.
- Proper dental care reduces damage to major organs such as the liver, heart and kidney and can reduce arthritis pain. Chronic inflammation can increase the chances of a patient developing other painful conditions that require more invasive surgery and treatment. Regular dental care reduces pain and disease.
- Judicious use of vaccination prevents severe diseases that cause pain and death. They also protect human health. Unnecessary vaccinations can cause adverse effects and increase a pet's chances for developing painful conditions, so it's important to evaluate each vaccination your pet receives to see if it is really necessary. A good veterinarian is happy to discuss such issues with owners during the annual health examination.
- Proper parasite management reduces the need for more serious medical and surgical therapies. If a pet is on heartworm control, then they don't need to take toxic and painful arsenic injections to control adult heartworms. This saves money, improves health and reduces financial, physical and emotional pain.
- Proper use of medications, insecticides and other drug therapies can reduce pain. Be sure you need to use each substance you put in or on your pet. Seek out more natural solutions when they exist and consider detoxification therapy on a seasonal basis. If we reduce toxins our pets absorb through various routes, then we may be able to improve their health and reduce pain.
Pain can occur even when we have done all things to the best of our awareness and ability, and it is important to be able to readily recognize the signs of pain in our animal friends. A major evolution in health occurred recently as people began to better recognize signs of pain in animals. Animals don't always cry when they are in pain. To do that would attract attention to their weakened state, and this could cause them to be easier prey for predators in the wild. Animals tend to hide pain. Some common signs of pain in animals include:
- A change in normal behavior. This can manifest in many differing forms including decreased appetite, decreased grooming, avoiding activity, avoiding stairs, a loss in ability to perform for longer periods of time (such as a dog that loves jogging suddenly wanting to stop and go home), not greeting you on arrival home, being less communicative or rubbing, licking or chewing on body parts.
- Expressing abnormal behaviors. This can be very subtle and can involve things such as inappropriate elimination (bowel or bladder issues), biting or aggressing, sleeping more, hiding, avoiding other pets or children in the home, or refusing to eat regular food in favor of something else (patients with dental pain often stop eating dry or hard food).
- Heat or sensitivity to touch in certain areas.
- Crying out suddenly in pain while sitting, walking, playing or sleeping. Resistance or abnormal responses to touch such as stiffness, soreness or pain.
- Changes in pulse, respiration or other physiological parameters.
Solutions exist for managing all sorts of pain. The best process is one that brings about healing as healing is the treatment for pain. When healing occurs, then pain vanishes. Suppression of pain without healing can and does lead to increased adverse effects, and while suppression is often needed, it is not the preferred way to bring about healing in most cases. Herbs, homeopathic medicines, anthihomotoxic medicines, drugs, surgery, acupuncture, chiropractic, physical therapy, massage, hot and cold packs, electromagnetic devices, lasers, prolotherapy and a wide variety of other tools can be used for pain management. In each case we must consider the reason for the intervention's use, its risks and adverse effects, its likelihood for cure, and its cost.
Your veterinarian can offer many different tools for health creation, disease prevention and for pain management. Integrative veterinarians have large toolboxes for pain management. In our hospital we have more than 70 agents that are useful for managing pain. If we properly diagnose our patients and then approach them with the best tools, we can do much to help them live longer, more pain-free lives.