Patient Pain Gets VIP Treatment at Teaching Hospital
Anesthesiologists Organizing Global Pain Management Academy
by Julia Foster Gawley

Every day in every veterinary practice, managing patients’ pain is a challenge. Anesthesiologists and acupuncturists, homeopathic practitioners and general veterinary practitioners alike address this problem, and yet no definitive protocols for treating pain have been established. What’s more, some treatments currently practiced lack scientific backing.

Dr. Kurt Grimm (left) and Dr. William Tranquilli confer on a case.

Drs. William Tranquilli and Kurt Grimm, anesthesiologists at the Veterinary Teaching Hospital, are trying to change that. Tackling the issue both globally and locally, they are working to create an international consortium on pain management and at the same time coordinating the efforts of a diverse group of clinical specialists within our hospital to manage patients’ pain.

The need for cohesive pain management protocols has arisen because pets are living longer and medical technology is improving. A larger population of older pets means veterinarians treat more chronic conditions, such as cancer and osteoarthritis.

“As a referral hospital, we see older, sicker patients and perform more invasive surgeries,” explains Dr. Grimm. “Owners are expecting more, and we can offer more, but pain management becomes an important part of the treatment plan.”

At present, though, pain detection in veterinary patients is more an art than a science. “What we understand now about the perception of pain in animals is just the tip of the iceberg,” says Dr. Grimm. Judging from what is known about humans, it is believed that animals’ pain is individual and changes over time, depending on the environment and on mental and physiological state. Behavior changes, though they are the best indicator of pain in veterinary patients, often vary.

Developments in veterinary pain management parallel a trend in human medicine.

“There have been significant changes in pain management for humans in the last decade. In this area veterinary medicine is evolving at the same rate as human medicine,” says Dr. Grimm.

VIP
Within the Veterinary Teaching Hospital, this evolution has taken the form of monthly meetings that involve 10 to 15 clinicians. Called the Veterinary Interdisciplinary Pain Service, the group shares experiences in treating pain in patients.

“Our hospital has a good history of pain management,” notes Dr. Grimm, “but in the beginning we were all doing our own thing. We’re now trying to create a more comprehensive strategy for pain management, which is multidisciplinary and seamless throughout the patient’s stay at the hospital. The goal is to constantly anticipate and assess pain in our patients.”

Contributing expertise from areas such as radiology, orthopedics, ophthalmology, and oncology, each specialist in the group brings a distinct viewpoint on the effects of pain in the patient.

For instance, Dr. Dianne Dunning, an orthopedic surgeon, may see pain as a functional problem, resulting in lameness. Dr. Steven Marks, who specializes in internal medicine and critical care, is more concerned with pain interfering with the general well-being of the patient. An anesthesiologist focuses on the pharmacodynamics involved with the perception of pain.

By pooling their knowledge, these specialists create a clearer, more comprehensive picture of pain in veterinary patients.

“The goal is to have a multi-doctor team managing every patient,” says Dr. Dunning. “A patient that comes in with an eye problem may see both an ophthalmologist, to fix the primary problem, and an anesthesiologist, to provide analgesia. Orthopedic problems may involve consultations with an orthopedic surgeon, a physical therapist, and an acupuncturist. This way, no aspect of pain management will be missed.”

Dr. Marks believes that the goal of the VIP service is to improve the well-being of the patient. At its core the service reinforces the human-animal bond.

“People relate to pain,” says Dr. Marks, “and making comfort a priority for our patients legitimizes the importance of that relationship.”

The VIP service will sponsor pain-related research too. Currently researchers are working to create a pain-scoring system that will provide some objectivity to assessing pain.

“Pain management is a high priority of patient care,” notes Dr. Marks, “but only a few other universities are looking at it with this multidisciplinary team mentality.”

Global Efforts
Beyond the confines of the College, Drs. Grimm and Tranquilli are working toward the development of a new International Veterinary Academy of Pain Management. Still in its infancy, the academy aims to bring pain management to the forefront of veterinary medicine.

“The academy will open up lines of communication among different specialties, push for more research, and encourage the spread of information,” explains Dr. Tranquilli. “We want to serve as the parent organization that provides an appropriate level of administration and regulation to this issue, and perhaps eventually develop a boarded specialty in pain management.”

Membership in the academy is open to any veterinarian who feels he or she has a stake in pain management, such as anesthesiologists, private practitioners, and certified acupuncturists.

“Our goal is to bring together this splintered group of experts so we can exchange information, become a cohesive group, and push for more advancements in a variety of pain-related issues,” says Dr. Tranquilli. “We need to bring structure and a common voice to pain management and provide a scientific rationale for our treatments.”

Setting our own hospital clinical standards for pain management will help meet the American Animal Hospital Association’s new pain management guidelines. Pain management obviously has medical benefits for the patient in addition to being a humane approach to patient care. Prolonged, untreated pain can inhibit recovery.

“Ultimately, the patient will benefit from better pain management,” says Dr. Grimm.