Pain Management / BONDED CLIENT
49
deserve to hurt—they need and deserve to have us (the veterinary profession) “watch their backs” and “allow them to live as comfortably as they can for as long as their lives last.”
Effective techniques There is a mix of methods that veteri-
narians can use to manage pain; tools can range from drug therapies, acupuncture, massage, physical therapy, ultrasound and hydrotherapy to E-stimulation, laser therapy, myofascial trigger point therapy, shock wave therapy and more. Some of the techniques have been in use for decades, while others are emerging. Experts agree that the important thing
to remember is that there is no one perfect technique that will work for every case. Brown says, “A lot of what I do is multi-
modal pain management. An animal may go home on two drugs, if there are mul- tiple drugs that can work instead of one. We will then use ancillary techniques; acu- puncture, which was on the ‘outside’ a few years ago, is now a mainstream therapy. We offer laser, massage, ultrasound, E-stim and acupuncture; because of the kind of practice that we are, we do that. Some practices will refer those out. The point is, there are ways to get those things done.” For McPeek, it’s important for the vet-
erinarian to know what’s available, how it works with other modalities, and then assess each case. “A drug may be our first line of
defense,” she says. “Then, we may put an animal in rehab therapy, suggest mas- sage or laser, then reduce the therapy that was used in the initial phase, in order to use something more long-term. Some [therapies] are more common than oth- ers, and you have to manage the financial impact. If you can educate the client and help them understand where they’re get- ting to, you will have better compliance.” Downing says, “The most effective
pain management technique is to rec- ognize that there is no single ‘best’ way to manage pain. Clinicians now under- stand that, following the human pain
“Veterinarians seem unwilling to use a network of pain management sources, when they could look at it
as using someone else’s skill set for a specific issue.” —Mike Petty, DVM, president of the IVAPM
management model, our animal patients do best when we manage pain from a multi-modal perspective. Each of the pieces of a multi-modal pain management plan work synergistically together better than any one piece works on its own.” She cites examples such as an NSAID,
which targets inflammation in addition to providing analgesic effects; acupuncture as an effective tool for neuromodulation that has been demonstrated to offer pain relief in many settings and therapeutic laser, a modality that is currently under investigation. “We now know that therapeutic laser
speeds healing and mitigates tissue dam- age following a rattlesnake bite,” she says. There is an ongoing laser study in northern Colorado, where she practices. Petty has a similar outlook. “There is no one pain treatment that
is most effective and herein lies the prob- lem,” he says. “Ten years ago, the buzz phrase was ‘multi-modal drug therapy.’ Today it should be ‘multi-modal thera- peutic modalities.’ I find most issues take at least three different modalities to work for any given pain issue. For exam- ple, an arthritic dog with hip dysplasia should be on drugs like NSAIDs along with Gabapentin or other drug choices, but he should also be receiving acupunc- ture for the hips, rehabilitation for mus- cle strengthening and myofascial trig- ger point therapy for muscles that have become too painful to function properly.” Petty warns practices to be cautious
about any new therapy they consider adopting or referring. “It’s a matter of ‘buyer beware,’” he says. “You have to be careful with fad treatments.” He advises becoming a member of the IVAPM, which provides access to experts
Trends magazine, April 2013
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68