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Pain!
How can I keep my pet comfortable following surgery?

      Pain can be caused by a lot of means, including trauma, inflammation, nerve stimulation, stretching, etc.

How do I know if my pet is in pain?

How can I prevent pain in my pet?

      Generally speaking, animals are very tough, and they have a much higher tolerance for pain than people do. However, animals' body systems are similar to people's, and they experience pain in much the same way that people do...even if they don't show it.

      Pain has a number of negative effects, including stress (and potentially stomach ulcers), decreased appetite (leading to decreased energy and protein available for healing), failure to move around (potentially leading to pressure sores, increased risk of pneumonia), etc. The idea of not giving pain medication so that pain will inhibit a pet from being too active is too simplistic.

Though no system is anywhere close to perfect, pain can be measured/estimated by evaluating a combination of objective and subjective parameters, combined with knowledge of what would be causing pain and how the pet's pain has been treated.

  • Objective parameters
    • Elevated heart rate
      • Can also be elevated with excitement, activity, or hypovolemic shock (usually differentiated by prolonged capillary refill time and/or low blood pressure)
    • Panting 
      • Can also be caused by excitement, being hot, narcotic pain medication, and various metabolic issues
    • Elevated blood pressure
      • Can also be elevated by stress, excitement, etc.
  • Subjective parameters
    • Behavior
      • Decreased interaction with owner
      • Hiding
    • Crying out when handled
      • This is hard, because sometimes animals will anticipate pain and cry out before something hurts. Monitor for repeatability
    • Reluctance to move about or use an injured limb
    • It is an EXTREMELY COMMON MISCONCEPTION that pets are only in pain if crying out. If an animal is not using a limb, or not using it fully, it is either because of pain or because the animal physically cannot use the limb.
  • What would be causing pain
    • Primary problem - the initial problem that led to the surgery (fracture, infection, tumor, etc.)
    • Surgery
      • Incision and the closure of the skin, fat, and muscles, as well
      • Drilling into bone, placing implants into bone
    • Compression or injury to nerves
    • Inflammation
    • Biochemical reactions
    • Reaction to suture material or other implants as foreign
  • How has the pain been treated
    • Pain management 
      • In hospital
        • Peri-operative anti-inflammatory medications
          • Generally non-steroidal
          • Steroids are sometimes used when more severe inflammation is present, or in some cases of neurological pain/inflammation
        • Peri-operative narcotic medications
          • Oral
          • Injectable (IV)
            • intermittent dosing
            • continuous rate infusion (CRI)
          • topical
            • Fentanyl Patch
            • Recuvyra (topical gel)
        • Local anesthesia/analgesia
          • Epidural analgesia
          • Local nerve blocks
          • Wound infiltration
        • Gabapentin - like Neurontin, it treats neuropathic pain (arising from nerve damage)
        • Stabilization of injured bone or soft tissue
      • At home
        • Oral anti-inflammatories
        • Oral narcotics
        • Topical narcotics
        • Gabapentin
  • Things that can be confused with pain
    • Dysphoria - narcotics especially can disorient a pet
      • Repetitive vocalization can sound a lot like a pet whimpering in pain. If the pet is staring off into space and vocalizing over and over again, but when stimulated the pet "snaps out of it" and is much more calm, that's often dysphoria.
    • Excitement - animals will often vocalize when excited, especially if they care confined to a crate or a room away from everyone else
    • Attention seeking - if your pet is whimpering in the crate or room in which he or she is confined, but then seems fine when being held, attention-seeking and/or dysphoria may be involved.

Preventing pain in your pet

  • Appropriate medication
    • You have been sent home with a pain management plan Dr. Christiansen has put together based on the surgery and anticipated need. Please use those medications as directed.
    • Please review your notes carefully
      • You are to provide certain medications as needed to control pain.
      • Your are to provide other pain medications on a regular basis until directed otherwise. This is particularly true with orthopedic cases.
      • Your aftercare notes should clarify this. If not, please either call the hospital or e-mail Dr. Christiansen for advice.
    • For example: 
      • It is very important to give the pain medications (Previcox, Tramadol) to promote early and consistent weight-bearing of the affected limb.
      • Pain after surgery is a common reason as to why pets do not use the affected leg.
      • The more that the leg is not used the greater the muscle atrophy. 
      • Please continue the pain medications until your pet is fully weight-bearing and walking without a limp. ______
  • Appropriate exercise restriction
    • You have been instructed to restrict your pet to a crate or small room so that your pet cannot run, jump, or play. 
    • In many cases, pets are so comfortable very soon after major surgery that they won't feel any need to restrict their activity, and may try to jump up or down (and possibly fall), or perhaps try to run or play on a broken limb.
    • Even with soft tissue surgery, like an abdominal wall closure, initially the suture material is all that is holding your pet's abdomen shut and preventing your pet's intestines from falling out.
      • After 2 weeks, your pet's abdominal wall may have healed to 50% of its original strength, and it generally takes 12 weeks for complete healing.
      • Suture material will break if it is stressed too hard. If this happens before the body has healed sufficiently, your pet will need to have additional surgery to repair the "hernia," and/or may even undergo life-threatening complications. Patients have died from such problems. Don't let this happen to your pet.
    • With an orthopedic surgery, your pet may be comfortable enough to walk on the limb long before the fracture, etc. as fully healed, which may take 12 weeks. 
      • There is no repair that is strong enough that your pet cannot destroy it if not appropriately restricted.
      • Metal plates, cages, pins, and screws will function just like the metal in a coat hanger, and if it is cycled too many times, it will break. 
      • If this happens before the tissue has healed, your pet may need additional surgery, or the surgical procedure may fail completely.
      • In some cases, your pet may need a limb amputation.
  • Using the E-Collar
    • The E-Collar is the only thing that can prevent your pet from reaching the incision and causing infection that can be painful, may require further surgery, or may result in total failure of the surgical procedure and/or limb- or life-threatening complications. Please don't let this happen to your pet!

If you have further questions or concerns, please e-mail Dr. Christiansen.