Page 153 - BSAVA Guide to Pain Management in Small Animal Practice

p e

VetBooks.ir

Orthopaedic pain

Kinley Smith

Whether acute or chronic, orthopaedic pain can Chronic musculoskeletal
be severe and debilitating. Treatment should be disease
tailored to each individual patient and the use of
non-pharmacological therapies encouraged. Osteoarthritis is an incurable condition that is
painful, debilitating and progressive.
Acute musculoskeletal Understanding chronic pain is essential in
formulating a treatment plan for osteoarthritis.
injury While osteoarthritis may be the most commonly
diagnosed painful chronic orthopaedic disease,
Opioids provide a rapid, powerful and chronic pain from bone, muscle and tendons
relatively safe way to control pain in acute may exist in addition to joint pathology;
injury. Full mu agonists such as methadone are accurate diagnosis is essential to pain
preferred, ensuring continuity of analgesia management. Further details are provided in
through possible anaesthesia and Chapter 4.
postoperative pain control. A continuous rate
infusion (CRI) of opioids in combination with Treatment
lidocaine and ketamine should be used in
refractory cases. Non-steroidal anti- Drug therapy
in ammatory drugs NSAI s are valuable for igure 7.16 provides dose rates of selected oral
the trauma patient but must not be used drugs used in the management of orthopaedic
before the patient’s condition has been pain.
stabilized. Hypothermia (cold packing) of acute
orthopaedic injuries may reduce swelling as NSAIDs: NSAI s are usually the rst choice in
well as pain. While specialized equipment is the management of osteoarthritis. They are
available for delivery, typically a freezer ice e ective, easy to administer and have a
pack wrapped in a thin towel is applied relatively low incidence of side e ects.
to the area for 1 minutes three Long-term use may be associated with
times daily. improved analgesia without increased side

148 BSAVA Guide to Pain Management in Small Animal Practice. Edited by Ian Self. ©BSAVA 2019

Ch07g Pain Management.indd 148 19/12/2018 10:45