Preemptive pain management starts with keeping our patients calm and reducing stress as much as possible.  Pets with severe hospital anxiety will be given appropriate tranquilizers before coming to the hospital.  Stressed patients will be given a sedative/analgesic combination as soon as possible after arriving at the hospital in a quiet, darkened exam room. Preemptive use of oral or injectable anti-inflammatories (i.e. Rimadyl) will be used in appropriate patients to enhance overall pain management.
    Multi-modal pain management involves the use of a combination of NSAIDS (Non-Steroidal Anti-Inflammatory Drugs), opioids, alpha-2 agonists and local anesthetics to diminish pain and inflammation. Micro-doses of multiple agents will be used to control pain at multiple locations in the pain pathway, while reducing the total amount of anesthetic delivered to our patients to help avoid unwanted side effects.
    Other pain management techniques may involve the use of narcotic pain patches, epidural anesthesia, and constant rate infusion of drugs to block pain. Although surgical pain can likely never be completely eliminated, it can be greatly reduced.  In addition, we will use lasers for a variety of surgeries, to decrease bleeding, swelling and pain.  Post-operatively, we will use local cold therapy, appropriate bandaging, warmed cages, and lots of TLC.

Riverview Animal Hospital requires that all patients undergoing potentially painful procedures receive appropriate preemptive and multi-modal pain management.       
Chronic Pain
    Recognition and treatment of chronic pain is fast becoming another cornerstone in compassionate veterinary care.  As with acute pain, pets experience chronic pain and hide their pain response by a variety of behaviors.  Chronic pain can have multiple sources including osteoarthritis, dental disease, back pain and cancer pain.  Chronic pain differs from acute pain in that over-stimulated receptors in the spinal cord actually become a source of the pain, making chronic pain more difficult to treat.  As such, a multi-modal approach to chronic pain management is essential.
    In order to recognize chronic pain, our veterinarians will take a thorough history, taking note of subtle behavior changes, perform a complete physical exam, including an orthopedic and neurologic exam, and observe your pets posture and ability to ambulate on flat surfaces and stairs.  Radiographs of affected joints and dental x-rays will help identify potential sources of pain.  Screening blood tests help identify underlying disease, and serve as a baseline to monitor possible changes in function associated with therapeutic drugs.
    Treatment of chronic pain should be directed at correcting the underlying cause if possible i.e. surgical repair of an unstable joint.  Aggressive dental intervention can have a profound effect on a pet’s pain level and overall quality of life. For more on dentals CLICK HERE

At Riverview Animal Hospital multi-modal management of chronic pain will include the following:

• Weight management – many pets are overweight and our vets can help you slim down your petwith some of our percription foods.
• Lifestyle changes – regular, moderate exercise.
• Identification of underlying disease conditions with bloodwork, radiographs etc.
• Diets and supplements that have proven Glucosamine, anti-oxidants, free radical scavengers and Omega-3 fatty acids – Our vets can help you find the supplement or food that is right for your pet.
• Non-steroidal anti-inflammatory drugs or (NSAIDS) – Rimadyl etc.
• Tramadol – synergizes with Rimadyl for relief of chronic osteoarthritis pain
• Amantadine – great for wind-up pain and neuropathic pain
• Gabapentin – can be used long term for chronic pain
• Intra-articular steroids – especially for stubborn elbow pain
• Acupuncture 

 Our goal is to keep our patients as comfortable as possible and improve their quality of life.  This can be done safely with proper monitoring and continuing communication with you, our clients.  Chronic pain is treatable!  Old age is not a disease.  Some pain is inevitable, silent suffering is intolerable.