cumbency management, with special attention tobedding, bathing, nutrition,and walking aids for pa-tients whose recovery periodis prolonged.The postsurgical needs of animals with spinal corddisease can be time-consum-ing and frustrating. The re- wards, however, of im-proved neurologic functionand client satisfaction canbe significant.
Pain is an unpleasant sen-sory and emotional experi-ence associated with actualor potential tissue damage.
Surgical events, such aspain, hemorrhage, tissue damage, hypothermia, andhypoxia, initiate stress responses. These responses canbe metabolic, inflammatory, neural, or endocrine andresult in physiologic changes in the body.
Pain canlead to hypoxia, hypercalcemia, lung atelectasis, andpneumonia.Compensatory responses to the demands of damagedtissue include an increase in the release of cortisol, cate-cholamines, renin, and inflammatory mediators.
If these unfavorable physiologic changes become extreme,a delay in normal healing may occur. These changes areof particular importance in animals that have under-gone neurosurgery. Recovery is often prolonged as a re-sult of neurologic dysfunction, and unnecessary imped-iments to healing should be avoided.
In addition, thepsychologic impact of pain is to create a cycle of anxi-ety, fear, and sleep deprivation, all of which further ex-acerbate the delay in tissue healing.
The key steps to managing pain successfully are to(1) recognize the presence of pain and identify itssource and (2) provide the most appropriate form of analgesia. Good-quality nursing care must also beprovided. After surgery, animals should be placed ina quiet environment with warm, dry, and well-paddedcages.
Veterinarians must be able to determine whether ananimal is in pain. If behavioral changes or clinical signsthat are abnormal for the individual or for the speciesare observed, pain should be suspected. A stoic animalmay need to be assessed subjectively. For instance, if astimulus applied to a human is considered painful, thesame stimulus applied to ananimal should also be con-sidered painful. Treatmentbased on this anthropomor-phic view of pain shouldnot be considered inappro-priate
(Figure 1).The clinical signs andphysiologic effects of painseen in dogs after spinalsurgery are given in the box. All of these signs are notpresent in every patient, buta subjective diagnosis of pain can be made if severalof these signs occur concur-rently.
Because animals may notvocalize until pain is severe,vocalization is not a sensitive indicator of pain.
Also,many animals vocalize in the dysphoric phase of nor-mal anesthetic recovery, thus making vocalization evenmore difficult to interpret.
Analgesics should be a stan-dard component (unless con-traindicated because of under-lying cardiovascular or respira-tory disease)of the anestheticpremedications given to dogsundergoing spinal surgery.Opioids, nonsteroidal antiin-flammatory drugs (NSAIDs),and local analgesics are thepredominant types of drugsused for postoperative pain re-lief.
Although pain is mostcommonly reduced by phar-macologic methods, alterna-tive pain relief methods may be explored. Acupuncturehas long been recognized asan effective treatment forpain and has been used suc-cessfully in the conservativemanagement of interverte-bral disk disease in dogs.
Other available methods in-clude transcutaneous electri-cal stimulation (TENS) andacupressure.
A dachshund in its cage after spinal surgery. It isoften difficult to determine whether a dog is experiencingpain after surgery because signs of pain are varied and non-specific.
Clinical andPhysiologic Signsof Pain
Reluctance to move
Guarding of surgicalarea
Premature atrialor ventricularcontractions
Each animal responds dif-ferently to pain. The signs ofpain may be difficult to in-terpret.