Severe degenerative joint disease (DJD) in a dog’s stifle. Most of us will reach for pain medications to treat pain. That’s logical enough. In some situations (see the box on the opposite page), it is important to be resourceful and to be able to offer nonpharmaceutical pain relief, in addition to or instead of traditional chemical help. Bob Stein, DVM, pain management guru and founder of the Veterinary Anesthesia and Analgesia Support Group (vasg.org), shares some modalities to treat pain without medication.* Weight control Weight control is critical when trying to alleviate pain. Not only for the obvious reasons (extra weight puts extra pressure on joints), but also because adipose tissue releases cytokines that can exacerbate a multitude of inflammatory processes, including degenerative joint disease (DJD), which can also contribute to discomfort in the presenting patient. When discussing a pain management protocol, keep weight maintenance or a weight loss plan in mind. Regular weight checks and follow-ups are critical. Supplements Some nutritional supplements have been used to help with pain control. Omega-3 fatty acids, glucosamine and chondroitin, injectable “arthritis” supplements, methylsulfonylmethane (MSM), boswellia, bromelain, probiotics, curcumin, and many others have also been touted to have certain analgesic properties. Environment Small environmental changes can help in a big way. Ramps going over a few steps and “steps” to climb on and off furniture can help patients with limited mobility to maneuver more easily. It may also be useful to prevent dogs from going up or down stairs, or to limit access to certain parts of the house. Elevating food and water bowls may help some pets who have trouble bending down to eat or drink. With cats, “accidents” in the house may not be due to behavior or cystitis, but rather to difficulty getting in and out of the litterbox. Advise clients to provide a litterbox with a lower edge. Although the benefits of “orthopedic” beds remain to be proven, providing clean, thick, soft bedding is important for pets with limited mobility. Traction ToeGrips, invented by our colleague Julie Buzby, are small rubber tubes that go over dogs’ nails. They prevent them from slipping on surfaces, such as hardwood floors and tile, and can help a dog get better traction while moving around the house. Carpets, area rugs, and runners should be placed on slippery areas to prevent injury. Confinement Keeping a patient confined after surgery is an easy way to prevent unnecessary pain. “Ground zero” is a much safer place than lying on a bed or on the couch. Activity Owners of patients recovering from surgery should be given a detailed protocol for outdoor activity regarding use of a leash, number of outings, duration of walks, use of a sling, etc. Harnesses A harness or a sling is an easy way to assist a dog with weak or painful back legs. Some devices can even help a patient get up from a laying position. For many dogs, a two-part harness like Help ’Em Up is more comfortable and useful than a simple belly sling. Rehab Inactivity is detrimental, both in the hospital and at home. Rehabilitation is a set of personalized exercises designed to regain strength and function while reducing pain. The least you can do in-house—and a pet owner can do at home—is passive range of motion (PROM), both on affected and unaffected limbs. Massage Massage therapy, performed before PROM or independently, can help alleviate soreness and elevate mood. It also can decrease edema that may accumulate in immobile limbs. Owners can be trained to perform massage therapy at home. Cryotherapy Ice packs of various types decrease pain and swelling. Place over the area for 10 to 15 minutes every few hours. A thin towel should be placed between the cold source and the skin to avoid burns. Some veterinarians only recommend cold for a few days after an injury, followed by heat therapy. Human chiller units like the Cryo/Cuff and Breg Polar Care are very useful tools that can be adapted easily to the canine stifle. Heat therapy Heat helps decrease pain and muscle spasms. It can be applied to the area for 10 to 15 minutes every two hours for as many days as directed. A thin towel should be placed between the heat source and the skin to avoid burns. Blocks Whereas local blocks can be used perioperatively, they can also be used in the home setting. Lidocaine patches can be applied along a surgical incision or over a painful area, but they must be fully protected, as ingesting a patch could cause fatal lidocaine toxicity. Acupuncture and myofascial trigger point needle therapy Acupuncture may be considered controversial to some, but there is evidence to show that, in good hands, it can alleviate pain. Pets seem to tolerate needle therapy surprisingly well. Laser Loved by some and questioned by others, laser therapy is rapidly growing in popularity. It reportedly alleviates pain by reducing inflammation and increasing circulation in a noninvasive way. While Class IV lasers have the potential to cause significant thermal injuries, laser therapy has no other known side effects. Laser therapy can be used as often as needed. Most companies have formulated dosing charts with frequencies of administration. Other modalities A multitude of other modalities, some a bit on the controversial side, also exist. This includes energy healing or reiki, various types of electromagnetic therapy (TENS unit, Assisi loop, etc.), and homeopathy. Of course, none of these modalities are a replacement for pain medications. They can and should absolutely be added to a reasoned pain medication protocol whenever possible. Five reasons to use nonpharmacological pain relief Medications are not enough Medications are no longer working Unavailability (e.g. opioids) Some pharmaceuticals are not an option (e.g. NSAIDs) Owner’s preference Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified, is a board-certified veterinary surgeon and author. His traveling surgery practice takes him all over Eastern Pennsylvania and Western New Jersey. You can visit his websites at www.DrPhilZeltzman.com and www.VeterinariansInParadise.com. AJ Debiasse, a technician in Stroudsburg, PA, contributed to this article.
