Page 44 - BSAVA Guide to Pain Management in Small Animal Practice

4 | Chronic and osteoarthritic pain

VetBooks.ir CASE EXAMPLE 1 CONTINUED analysis should be considered in consultation

with the dog’s owner.
CLINICAL SIGNS AND SIGNS OF PAIN Pilot’s owner returns a week later and
reports that his appetite has improved, but
Pilot’s owner presents him to you for that he has been noticeably sti er and slower
examination. e is bright, alert and responsive to move out of his bed in the morning.
and you udge his body condition to be 6 9 he improvement in Pilot s appetite is
La amme, 1997 . Chest auscultation and encouraging, but presents a dilemma – his
abdominal palpation are unremarkable. is musculoskeletal pain appears to bene t from
heart sounds and peripheral pulses are NSAI treatment; however, this is potentially
synchronous with a rate of 1 bpm and he is causing gastrointestinal adverse e ects. In this
panting continuously. is mucous membrane circumstance, reintroducing the original
colour is pink and capillary re ll time less NSAID, whilst continuing omeprazole and
than 1 second. he range of motion of both monitoring closely for further gastrointestinal
hips is reduced and, during extension of his e ects, would seem reasonable; however, his
hips, Pilot stops panting. owner reported that Pilot was doing less well
Signs of pain during physical examination than previously on the original NSAID and
are rarely overt in trained dogs. Most therefore switching to an alternative licensed
commonly pain is inferred from resistance to NSAI could also be considered. o minimi e
movement of joints and mild changes in risks associated with concurrent administra-
behaviour lip licking, discontinuing panting tion of NSAIDs, a washout period without
in response to joint manipulation. NSAI treatment of 7 days is currently
recommended Epstein et al., 1 . here are
no current methods of predicting response to
INVESTIGATIONS AND INITIAL TREATMENT a particular NSAID. In the case of concerns
over e cacy in a patient, the authors would
In instances where there is concern about tend to replace non coxib NSAI s with coxibs,
treatment-related gastrointestinal adverse or vice versa. Monitoring response to treat-
events, consider assessing faecal occult ment alterations can be challenging. he
blood or serum urea creatinine severity of A associated signs can wax and
(disproportionate increase in urea may be wane over time. Owners are more likely to
related to gastrointestinal bleeding . present dogs when they become aware of an
Precautionary treatment for gastric ulceration exacerbation of signs; therefore, improve-
is appropriate, based on history, and the ments in the condition related to a natural
authors would discontinue NSAIDs and waning in signs regression to the mean may
administer omepra ole at 1 mg kg twice be erroneously attributed to treatment. Client
daily for 7 1 days olbert et al., 11 before completed questionnaires such as the
reinstating NSAID treatment. Inappetance elsinki Chronic Pain Index ielm B rkman
may also be associated with pain; during the et al., 9 or Canine Brief Pain Inventory
period of NSAID withdrawal the authors (Brown et al., 7 can be useful to track
would prescribe a licensed paracetamol- changes in levels of pain and disability. Quality
containing product at the datasheet of life questionnaires, such as that produced
recommended doses . mg kg three by Newmetrica www.newmetrica.com , may
times daily . NSAI including paracetamol be used to investigate how the dog’s disease
datasheets state that their prescription is is a ecting his experience of life. Collar
contraindicated in the presence of mounted accelerometers are increasingly
gastrointestinal disorders; therefore, a ordable and may provide ob ective data
prescribing NSAIDs or paracetamol in such on the amount and type of activity the
cases is o licence and a cost bene t dog engages in.

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