Pain is a problem that was not addressed adequately in the past in either human medicine or veterinary medicine. Humans and animals alike suffered pain after surgery and trauma, and few doctors concerned themselves with this aspect of patient care. Recently, however, the medical world has begun to focus on pain management, bringing new relief to patients of all species.

Dr. Kurt Grimm, a visiting assistant professor in anesthesiology at the University of Illinois Veterinary Teaching Hospital in Urbana, is a strong proponent of pain management, although he admits there is still a vast amount to learn about pain and its treatment.

"The topic of pain management can be complicated because we still have so many unanswered questions about the way pain is processed and perceived, " says Dr. Grimm.

An important first question is "what is pain?" Pain is an unpleasant sensory or emotional experience; therefore, by definition pain is difficult to evaluate clinically because it exists within the mind of the individual experiencing it. In veterinary medicine this problem is compounded by the fact that animals are non-verbal and have no way of describing their experience of pain.

For a long time, there was debate over whether animals actually felt pain in the same way that humans do. "It has been generally accepted that many domestic animals experience pain similar to the way that humans experience pain because their central nervous systems are anatomically very similar and they respond negatively to painful stimuli," says Dr. Grimm. "Many of the same neural pathways that are associated with pain processing in humans are also found in domestic animal species."

One of the biggest hurdles in trying to develop protocols for pain management is that the experience of pain can vary so widely from individual to individual. "For any given physical insult, there is a significant variation in response," says Dr. Grimm, "although there does seem to be a correlation between the degree of invasiveness and the degree of pain. For instance, a skin incision would probably be less painful than orthopedic surgery." Response to analgesic drug administration can also vary between individuals. Management of pain requires individualized patient care and follow-up.

Pain management has become important in veterinary medicine in order to relieve suffering after surgery or trauma. Extreme pain can invoke a stress response, which can alter immune function and interfere with coagulation (blood clotting). Stress can also interfere with wound healing and negatively affect the cardiovascular system. Animals that are already compromised may be adversely affected by excessive pain.

On occasion, extreme pain can cause neural pathways to become permanently altered, creating a neurological "memory" of pain. An individual that continues to experience pain long after the injury has healed may have developed a condition called "chronic neuropathic pain." Dr. Grimm says, "Because neuropathic pain is not caused by tissue damage, but rather altered nervous system function, it is very difficult to treat medically. It appears that prevention through early and effective pain management is really the best option."

At the University of Illinois Veterinary Teaching Hospital, most surgery patients get pre-operative pain medication as part of their anesthetic protocol. It has been shown in veterinary species that medication given before surgery provides more effective pain control than medication given afterwards in a large percentage of patients. Some pain medications can also reduce the amount of general anesthetic required during surgery, which can reduce negative side effects of the anesthetic.

Pain management is now taught in the curriculum at many veterinary schools and is a frequent topic of professional continuing education for veterinarians. Last year, the Companion Animal Pain Management Consortium was founded with the mission of educating veterinarians, technicians, and students on the clinical recognition and treatment of pain in companion animals. Dr. William Tranquilli, a professor of veterinary anesthesiology at the University of Illinois College of Veterinary Medicine, is one of its three regional directors and is also a nationally recognized leader in the efforts to educate veterinarians about pain management.

"Animal owners should know that there are veterinarians who are interested in and concerned about pain management," says Dr. Grimm. "A pet owner needs to look for a veterinarian who is willing to care for a pet's overall well-being, which includes effective pain management."

If you have any questions about pain management, please contact your local veterinarian or the anesthesiology/pain management service at the University of Illinois Veterinary Teaching Hospital at 217/333-5300.