Laurie's Blogs.

 

24
Aug 2019

The Pain Dilemma!

Dog Pain

Have you had a surgery lately, or been to the emergency department or into hospital for anything pain-related?  Well, things have changed a bit.  At least here in Canada, health practitioners are taking the ‘opioid crisis’ seriously.  To the point that in many orthopaedic surgeries (bone repairs, ACL reconstructions), patients are just given Extra Strength Tylenol (paracetamol / acetaminophen) to address the pain.  As well, when we were in the hospital with my husband and his abdominal pain (which was diagnosed as cancer), he was only offered Tylenol for his pain as well.  Okay, so we're avoiding heavier pain medications... but is this always a good thing?  Yes and no!

 

So, the thought is that we don’t want people getting hooked on opioids and developing prescription drug addictions.  Okay, that’s great.  However, I don’t think that the system is really taking into account how they might be impacting or causing wind-up pain / central or peripheral sensitization.

 

Take for example my appendicitis from a couple of years ago.  My pain went on for 15 hours before I went into an Urgent Care Clinic.  I don’t take medications usually, so I had taken nothing.  When they gave me the morphine, it really helped.  I had surgery the next day, there was pain and discomfort afterwards, that the extra strength Tylenol’s weren’t touching.  So, one more round of morphine helped.  And then I was good.  Now, the lady across the room from me also had an emergency appendectomy but she had gone to the hospital right away and presumably had her pain controlled quickly.  (Maybe she was tougher… but I refuse to believe that!)  Anyways, the whole thing got me thinking about whether or not I’d have been ‘tougher’ if I hadn’t waited 15 hours to seek attention & had got some form of pain management on board sooner.

 

I once treated a dog that was only prescribed Tramadol after his TPLO.  He didn’t have any Metacam or other anti-inflammatory, or anything else and at 4 weeks he was still NWB!  A quick call to the regular vet clinic to plead the case that this dog needs more pain management, (to which they agreed and prescribed something else), and within a week he started using the leg!

 

Currently, the father of one of my staff members is having a great deal of pelvic pain.  He’s had surgery of some kind bladder surgery… but he’s still in pain.  His doctor actually told him, “I don’t want to give you pain medication because I think you’ll do too much!”  Oh, My Freaking Goodness!!!  What century are we in???  We used to hear that in veterinary medicine.  However, great strides have been made in fighting to change that mindset.  But for a human doctor to be so ignorant, when his patient can talk and tell him about the impact that the pain is having on his life, function, and well-being… I’m flabbergasted!  

 

What’s my point?  Primarily, we need to take the treatment of pain seriously, by whatever means possible.  That means multimodal care (which should include rehab) and a well-rounded approach!  We should be addressing sleep (see last week’s blog), and the timing of the medications for best effect.  We should be empowering owners with things they can do to help (i.e. massage, or joint compressions, or tail pulls, or appropriate walks…).  We need to treat pain as a disease in and of itself!

 

Secondly, it is important for all healthcare practitioners (in any discipline across the human or veterinary healthcare arenas) to stay up to date and current.  Kudos to you folks that follow Four Leg or any other platform that provides you with information to keep you current.  It might seem daunting, but I really feel that it’s our obligation as healthcare practitioners.

So, keep on learning!  And thank you for being a part of my tribe that strives for perpetual improvement and being the best that you can be!

 

Cheers!  Laurie

 



Top