The Use of NSAIDs in Pain Management Protocol
A double-boarded veterinarian in anesthesia and pharmacology provides insight into the use of NSAIDs for patients with either acute or chronic pain.
Most of the time patients are in pain, it’s due at least in part to inflammation. That’s why nonsteroidal anti-inflammatory drugs (NSAIDs) are such great tools in managing chronic pain as well as for perioperative use.
In this Quick Cup of Knowledge interview, Dr. Kristen Messenger of North Carolina State University shares her thoughts on NSAIDs and their many uses. Being double boarded in anesthesia and pharmacology, this topic hits on both of Dr. Messenger’s areas of interest and research.
How Can NSAIDs Be Controversial?
According to Dr. Messenger, NSAIDs should be a part of the pain management protocol for almost every patient. They have such beneficial uses with relatively minimal risk that they can be used to treat things from chronic osteoarthritis in dogs and fevers in larger animals to inflammation due to soft-tissue surgery.
One area of NSAID use can be controversial, however, and that is using NSAIDs as a pre-emptive or preventive treatment for postoperative pain. This has to do with the fact that NSAIDs help with inflammation because they block the production of prostaglandins.
Prostaglandins, while they cause inflammation, also do beneficial things in the body such as in the auto-regulation of renal blood flow. Prostaglandins protect kidneys and prevent low blood pressure, which is one of the most common complications with anesthesia. Blocking the body’s ability to auto-regulate increases the risk of kidney injury.
The problem is that we want to have the NSAID before the pain happens, but we also want to reduce risk. That is why it is important to tailor our anesthesia plans to the individual patient and to always plan ahead for possible complications.
The Feline Grimace Scale
Part of determining a pain management plan is knowing about how much pain the patient is experiencing. When it comes to cats, Dr. Messenger and Dr. Marks admit the veterinary industry hasn’t always been great at assessing pain in cats. It’s difficult, and we often rely on clients or staff to know how the patient is doing.
Exciting news for Dr. Messenger comes in the form of the Feline Grimace Scale—a new tool to assess acute pain in cats from Dr. Paulo Steagall of the University of Montreal. This scale gauges pain levels by feline facial expressions from things like ear, whisker, and head position. Using this scale could change the way we determine pain management plans for cats.
Is Age a Factor?
Another factor Dr. Messenger addressed while discussing NSAIDs is the question of age. Clients and even some veterinary professionals might think, “This patient is too old to undergo anesthesia.”
Dr. Messenger’s simple response is that age itself is not a disease. “If we can help an animal by doing some sort of intervention that might require anesthesia,” she says, “there is always a risk.” Age does not necessarily increase or decrease that risk.
Age is relative—some 16-year-old cats, for example, might be sprightly and active, while another 10-year-old is sickly and immobile. We should use NSAIDs relative to pain levels, not the patient’s age.
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