I wish the following statements were purely historical, but as shared by Dr. Michael Petty during a discussion of the business of pain management, they are being spoken in veterinary clinics today by some of our colleagues.
- “Pets don’t feel pain like we do.”
- “It will help my patients’ recovery if they feel some pain post-operatively.”
- “I’m nervous to use pain medication in this older or chronically ill patient.”
- “This dog isn’t vocalizing. He must not be in pain.”
- “The cat is just old.”
Sadly, those statements mean that many dogs and cats in acute or chronic pain aren’t getting the relief they deserve and that some veterinarians and veterinary nurses aren’t advocating pain awareness, a huge area for practice growth.
We can all agree that we see visibly painful patients every day — the acute abdomen in a beagle puppy, the chronically lame German shepherd and the sudden saddle thrombus in a Maine coon cat. We also see the potential for pain, an area not to be missed with the owners of young, high-risk breeds.
Instead of waiting and then reacting to the consequences of many genetically associated orthopedic diseases, we can proactively educate pet owners about what might lie ahead and explain how we can detect disease. Early identification of conditions such as hip dysplasia and a luxating patella, combined with a proactive approach to therapy, gives these patients the best chance for a long and good-quality life. Someone whose pet is living a good-quality life is a veterinary hospital’s ideal client, not only for the health of the practice but also for the generation of referrals.
A Whole-Hospital Approach
We must not forget the not-so-classic possible signs of pain that clients describe seeing at home: hyporexia or dysrexia, a lack of feline grooming, lick granuloma development, a change in sleeping patterns, and increases in fearful or anxious behaviors. These observations, paired with assigning a pain grade based on a physical exam and diagnostic tests, help us keep pain, and more importantly, the reduction or resolution of pain, in the forefront of our mind.
Just like with most successful hospital initiatives, recognizing pain in our patients and committing to appropriate pain-management therapy should be a whole-hospital approach. Given that so many clients think pets always vocalize when in pain, our first step should be to teach our teams the power of observation. We know that patients can act very differently in the hospital as compared to the home, and they might hide or minimize behaviors that can be key indicators to the medical team.
Keeping this in mind, educate team members about how dogs and cats exhibit pain as well as the differences in the two species. This could be as simple as having customer service representatives watch how a dog walks into the clinic or sits in the lobby. It could be training the team to ask important behavioral questions during phone calls made to schedule an appointment.
Yes, I know, when do we have time for such training in the midst of hundreds of other daily tasks? For practice owners whose plate is already overflowing with responsibility, we thankfully don’t have to reinvent the wheel. Pain management guidelines prepared by the American Animal Hospital Association and the American Association of Feline Practitioners — learn more at http://bit.ly/31PDAqP — should be required reading for every team member. Another wonderful resource is the International Veterinary Academy of Pain Management, of which Dr. Petty is a past president. For a fairly inexpensive annual membership fee, practitioners can access an online forum for questions and answers, advice on cases and new pain treatments.
Don’t Forget the Recheck
Once the hospital team’s messaging is aligned, we can be more open-minded to therapeutic pain protocols. While most practitioners commonly use nonsteroidal
anti-inflammatories and the opioid classes of drugs, keep in mind that through judicious use, these medications can be used preoperatively and to manage chronic pain. Remember to set client expectations from the start of these prescriptions and to perform routine blood and urine monitoring.
More importantly, understand that these are not the only options for helping patients at the practice. Make sure that floors and exam tables have nonslip surfaces. Don’t hesitate to sedate painful patients during diagnostic testing. Instead of only suspecting an orthopedic disease and trying empirical medical therapy, recommend radiographs or advanced imaging to get a definitive diagnosis, and tailor therapy to the patient and its needs.
One key aspect of a patient’s pain-management protocol that many practitioners miss is the recheck exam, something I’ve talked about in previous articles. It remains a very underutilized part of small animal practice.
Too often, we prescribe a non-steroidal anti-inflammatory trial or start a joint supplement or a new physical therapy, and then we don’t follow up appropriately with the client. We don’t call within 48 hours to check on the patient, and we don’t forward-book a recheck exam or schedule necessary bloodwork.
Instead of falling into this trap, let the client know that pain control, especially chronic pain management, is a journey and is most effective with frequent re-evaluations. The transparency builds client trust and reinforces the need for the owner to be an active part of the medical team.
For practitioners who want to elevate their pain-management skill set — it will help grow business — consider these four resources, which come with different time and financial investments.
- The United States has three schools for learning veterinary acupuncture. While the institutions train practitioners a bit differently, the end goals are the same. The modality can be offered to the classic orthopedic or neurologically challenged patient, and it might help manage many systemic and metabolic diseases.
- Interest in rehabilitation and physical therapy has risen rapidly. The Canine Rehabilitation Institute and the University of Tennessee offer certifications.
- Class IV lasers can be a wonderful adjunctive therapy for many pain conditions.
- The International Veterinary Academy of Pain Management has a two-year program on becoming a certified veterinary pain practitioner. It explores the physiology of pain and covers a wide array of pain-management strategies in veterinary medicine.
Spread the Word
Finally, I recommend promoting your practice’s pain-control focus. Use social media to showcase modalities like acupuncture, laser therapy and stem cell transfer and to share client success stories. September is Animal Pain Awareness Month, so use your digital platforms to teach clients to recognize pain in their pets at home. Not only will this messaging reinforce in clients that pain management is a priority, but it also can drive referrals and improve your website’s search engine optimization.
Take a fresh look at your practice’s mission and your messaging about pain control. Look at your teams and their roles in client education and awareness, both in the practice and in your digital presence. And most importantly, think about your patients and their quality of life.
You’ll find that improvements in all these areas will deliver better medicine to your patients, form better relationships with clients and improve your practice’s bottom line.
Author: NATALIE MARKS, DVM