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Medicine –
Feb 15,2018 Veterinary Medicine is a copyrighted publication of
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pain patients may also have expanded receptor fields,
which means they have areas that are sensitive well
away from the sore joint. Dr. Edwards states that in 20
to 40 percent of human patients with osteoarthritis,
their pain is coming from these CNS changes, not the
peripheral joints themselves. changes to posture, weight-bearing and gait. These
all can lead to activation of pain pathways.” She says
that, in people, myalgia is often described as aching or
cramping, and the chronic activation of muscle pain
sensors can activate areas in the brain associated with
depression.
“The nervous system has been hijacked,” she says.
“We have altered structure and function of the
nervous system. Because of that, there’s no magic
bullet from a treatment perspective. We have to think
about multimodal treatment strategies, targeting the
underlying neurophysiology and not just symptom
control.” A retrospective study revealed that 22 percent of cats
over 1 year old and 90 percent of cats over 12 years
old had radiographic evidence of degenerative joint
disease 3 .Therefore, for feline patients, history taking is
even more important. “We’re looking for very gradual
or subtle behavior or lifestyle changes rather than
overt lameness,” says Dr. Edwards. “Cats in general are
more agile than dogs. Most clients don’t take their cats
on walks, so they are not observing gait changes. The
fact that cats sleep 75 percent of the time can make
mobility changes difficult to recognize.”
Acute pain assessments have become a standard of
care for trauma, medical and surgical patients. The
same is not true for chronic pain, but Dr. Edwards
would like to change that. “Ideally, we need to evaluate
every patient at every visit for pain. It should be like
taking a vital sign,” she says.
It’s true that assessing pets for chronic pain is more
difficult. The clinical signs are hard to recognise. Pets
often don’t complain and can even try to hide their
discomfort. They slowly adapt to living with the pain
and change their activity patterns. Owner observations
are needed to help assess pets for chronic pain and
changes in mobility. Their feedback can help to identify
subtle behavior changes and clues about how the pet
is functioning at home. Dr. Edwards recommends
three online resources for assessing chronic pain in
pets: the Helsinki Chronic Pain Index, the Canine
Brief Pain Inventory and the ACVS Canine Orthopedic
Index. Keeping track of pain scores at regular recheck
appointments will help with evaluating the success of
drug treatments and gauge whether a pet’s fitness or
rehabilitation program is at the appropriate level.
Assessing Mobility
Mobility evaluations start with a thorough patient
history, followed by observations of the pet as it
stands, sits and transitions between different positions
and then thorough palpation. An overlooked source
of discomfort in veterinary patients is muscle pain or
myalgia. “Myofascial pain is often not recognised,
or we’re not looking for it. Pets can have primary
myofascial pain from a trauma or secondary myalgia,
where something else created the muscle pain. Our
veterinary patients are often dealing with secondary
myalgia,” she says. “They have altered kinetics and
She advises asking clients about reduced activity,
difficulty jumping, increased grumpiness, changes
in sleep patterns, dislike for grooming, avoidance of
interaction with people and housemates, appetite
fluctuations, weight changes and changes in litterbox
habits. She also recommends visiting the International
Veterinary Academy of Pain Management website for
handouts about common signs of pain to share with
clients.
Treatment Goals for Arthritis Patients
Arthritis treatment goals include improving the patient’s
ability to function and its quality of life. Dr. Edwards
states that these can be achieved by controlling pain
and inflammation, slowing the progression of arthritis,
improving joint function, maintaining muscle strength,
preventing injury and promoting physical fitness. She
says, “With respect to management, this is a lifelong
disease. These patients are going to have this disease
for the rest of their lives. So, we have to have good
client communication and client support.
Management is also dynamic. It needs to change over
time because the disease is progressive. It’s important
for these patients to come in for regular rechecks. One
of the main reasons for lack of success for arthritis
management is we’ve failed to adjust our treatments
over time.”
Dr. Edwards also states that, as with many areas of
practice, managing arthritis becomes more successful
with the involvement of the entire veterinary team.
Issue 01 | MARCH 2018 | 13