Pain and the Rehabilitation Veterinarian

As a rehabilitation veterinarian, I am frequently sought out (by clients, and vets) to help manage pain from a variety of conditions.  Physical modalities, including some of the ‘toys’ of rehab can certainly help, including (just to name a few examples, and a few of their benefits): 

-Manual therapy (help restore function, manage joint and soft tissue abnormalities, spinal therapy)

-Laser therapy (aids healing, addresses inflammation, direct pain control, laser acupuncture)

-Acupuncture (local areas of pain to cause muscle relaxation or cause endorphin release – endorphins are the body’s natural pain killers)

[as an aside, I do not consider myself a “modalities” based veterinarian, and find my skills of assessment, and manual therapy skills the biggest asset].

Getting back to pain.  Pain is often a very misunderstood thing.  We know that humans have pain clinics because humans can suffer from long-standing chronic pain from many conditions.  These clinics have a range of staff from regular doctors, to physiotherapists, massage therapists, acupuncturists, chiropractors, osteopaths and naturopaths.  Animals also suffer from pain, including chronic pain, with no exception.  Here is a bit of a run down on some of the basic concepts of pain encountered in veterinary medicine:

-Acute Pain – You stub your toe, it hurts.  You ice it, and the pain subsides after a few days or so (nothing broken, nothing torn).  For dogs and cats, this can be a sudden ligament tear, cut to the toe pad, you get the picture.

-Chronic Pain – You stub your toe, it hurts.  You broke a tiny bone in your toe, and it remains painful for a long time (you may or may not have sought treatment), it hurts to walk some days (when it is cold out), or if you have a tight fitting shoe, you begin to walk differently.  You get pain in your opposite hip from compensating.  For dogs and cats, chronic pain usually results from acute paint that lingers.  Chronic pain can result because that ligament tear that tore initially (acute pain) is now lingering after a few weeks (or months).  The tear was partial, and surgery was not sought right away, and medication is intermittent.  Osteoarthritis is starting to settle into that joint (the sac surrounding the joint is angry, the joint fluid is full of inflammatory chemicals and messengers).  Your dog is now putting more weight on their opposite hind leg (off weighting the sore one), their pelvis is also compensating and they have sacro-iliac joint pain – this is the joint that attaches the hind limb to the pelvis, and gets cranky for a variety of reasons).  Medical professionals (vets) recognize some of the most important causes of chronic pain – including dental pain, arthritis pain, otitis (inflamed ears), and cancer pain.

-Cancer pain – This type of pain deserves it’s own heading.  In my practice, cancer involving the bone (like osteosarcoma) or cancer involving nervous tissue/nerves can be the most painful.  There may or may not be a bone swelling or extremely painful response of initial palpation but bone tumours can progress rapidly (ie. in days/weeks).  If a patient sees me for the first time, and I suspect cancer, I really like to rule it in or out before we really get going with a program.  I feel this is an ethical decision, that gives you, the guardian the best choices and options for care.  You may not want to know that cancer is affecting your dog, and you may not go to heroics (with chemo or amputation) if your dog has cancer, but ignoring it puts your dog in jeopardy of being in more pain than is necessary, and keeps you from altering their activity level in a way that protects them (ie. bone tumours are at greater risk of fracturing).  Often, dogs with cancer are so painful, just touching a bone or area near a joint affected by osteosarcoma can send them into an anxious, and terrifyingly painful episode.  Some dogs (many dogs) are also stoic, and may hide their pain better than others.  Cancer pain, left untreated, can lead to pain that is “hyper” (the brain, nerves and feedback mechanisms are working double time), including neuropathic pain or hyperalgesia (simple touch is very painful).  Although some of the modalities we offer can help relieve the patient of some discomfort from cancer pain (compensations, dysfunctions, etc), they need to stand alongside effectively chosen pain management with appropriate drugs.  Additionally, the modalities we use in practice are generally not recommended for application over an area suspected of being a tumour.  We can avoid the area, but by ignoring the possibility this is cancer or delaying diagnosis creates an ethical concern.

Palliative care, for me means addressing the whole dog and their quality of life.  As a rehabilitation veterinarian I have sworn an oath to address pain and suffering in animals.  I do not consider rehabilitation therapy an “alternative” to what your regular veterinarian or specialist can provide in terms of pain control.  In many situations, my therapy is very appropriate for managing pain on it’s own (for acute, and chronic pain that responds to these modalities).  More severe or long standing chronic pain requires more help, including drugs (and there are many to choose from, with their pros and cons, with some dogs responding better to some than others).  Sometimes modalities like acupuncture are not enough.  Neuropathic or cancer pain, well….it needs very special attention and a coordinated effort between your vet and myself.

If you have concerns regarding pain and it’s management in your furry friends, be sure to have a conversation with your veterinarian.  Pain is one of the most important symptoms we manage on a daily basis, and it certainly deserves our attention.

Here’s to pain free living!

~Dr. Shannon Budiselic, DVM, CERT, CVA, CCRT

Copyright 2014.  Equilibrium VRC. Ltd.  This document may not be published in part or in whole by anyone other than it’s author.