August 23, 2017

Educating Pet Owners About Identifying Pain

Panelists B. Duncan X. Lascelles, BVSc, PhD, DACVS; Mark Epstein, DVM, DABVP, CVPP; and Bryan T. Torres, DVM, PhD, DACVS-SA, DACVSMR, discuss strategies that veterinary staff can use to educate clients about identifying pain in their pets.


B. Duncan X. Lascelles, BVSc, PhD, DACVS: Switching things up a little bit. Mark, we’ve talked about the science and we’ve talked about what we need. How about owners? What is the current state of owners? Are pet owners understanding pain and pain management? If we need to improve it, what can we do to improve it?

Mark Epstein, DVM, DABVP, CVPP: Well, owners are afflicted, just like veterinarians, in this way. On the one hand, it’s probably their most vigilant thing. If you would ask them what the one thing is that they would most want to control and prevent in their pet, it would be pain. On the other hand, we encounter chronic pain, especially osteoarthritis-related pain, casually. It’s in the exam room on a routine semi-annual or annual visit, either by volunteering information or being prompted for it.

The owners will report that the patient is not being really active in the morning, is stiff in the morning, is stiff after exercise, or is not jumping on the couch anymore. They may say that their pet doesn’t like the stairs. They say, “I had to help him in the truck to get over here, but, fortunately, he’s not in pain.” There’s a disconnect. They haven’t made that relationship between those limitations and activities of daily living and the pain that the patient is experiencing, the sarcopenia, and other things that will start to happen.

The hazard is in that exam room because the owners are not seeing vocalization or they’re not seeing limping even. If it’s a unilateral problem, maybe, but if it’s a bilateral hip dysplasia, then maybe not. They’re not picking up on the confirmation changes. We veterinarians, and primary care in particular, have maybe 10 to 15 minutes, I’m afraid, of contact time with that client. And if they are older, we’ve got to talk about lumps, bumps, teeth, ears, and half a dozen other things in the context of that time.

How do we get started with a discussion that really is going to impact this patient and that relationship—that bond with that family for the rest of its life? It’s a real hardship. It’s easy enough for the veterinarians to affirm that, “Well, he’s probably okay” and maybe say, “Here are some nonsteroidals” and pass it on and not do the kind of follow-up he or she should. So, it is incumbent upon the veterinarian and the veterinarian’s team to be aware, to prompt the right questions, and to pause when there’s either historical or physical exam evidence of osteoarthritis. It’s also incumbent that we somehow have that conversation, even if it’s after that particular visit. You have to follow up with an e-mail, a phone call, or in person to really set the course for what that patient is going to experience for the rest of their life.

Bryan T. Torres, DVM, PhD, DACVS-SA, DACVSMR: You’re absolutely correct with that disconnect between what they’re seeing and assuming it’s a normal aging change versus a clinical sign of osteoarthritic pain. We’ve all had those patients where we say, “This is what we think is going on. Can you try a nonsteroidal for a few weeks and see what you think?” And they come back to you saying, “He’s like a puppy.”

So, clearly, those clinical signs were of pain, with the nonsteroidals helping in those osteoarthritic patients.

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