PAIN

Pain is a distressing sensation arising from stimulation of specific endorgans in particular

parts of the body and perceived in the thalamus and cerebral cortex. It is basically a protective
mechanism to ensure that the animal moves away from noxious (damaging) influences, but
endogenous pain, arising from internal pathological problems that require the veterinarian’s
intervention.
In animals the measurement of pain is by observation of actions and by measurement of
the psychological parameters of heart rate, blood pressure and so on.

Etiology
Pain sensation are aroused by different stimuli in the different tissues and the agents
that cause pain in one organ do not necessarily do so in another. In animals there are three
types of pain: cutaneous, visceral, and somatic (or musculoskeletal) and the causes of each are
listed below:
 Cutaneous or Superficial Pain
The agents that cause pain are those which damage skin, such as: burning, freezing,
cutting, and crushing. Thus, fire burns, frostbite, severe dermatitis, acute mastitis, laminitis,
infected surgical wounds, footrot, crushing by trauma, conjunctivitis, and foreign body in the
conjunctival sac, are familiar causes of pain.
 Visceral Pain
Causes are inflammation of serous surfaces including pleurisy, peritonitis, and
pericarditis, distension of viscera including stomach, intestines, ureters, bladder, swelling of
organs as in hepatomegaly, and splenomegaly. In the nervous system, swelling of the brain
caused by edema, or of the meninges caused by meningitis, are potent causes of pain. So is
inflammation (neuritis) or compression (neuralgia) of the peripheral nerves or dorsal nerve
roots.
 Somatic or Musculoskeletal Pain
Can be caused by tears and hematomas of muscle, myositis, and space-occupying lesions
of muscle. Osteomyeltis, fractures, arthritis, joint dislocations, sprains, strains, are also obvious causes
of severe pain. Among the most painful injuries are swollen inflamed lesions of the limbs caused by deep
penetrating injury or in cattle by extension from footrot. Amputation of the claw, laminitis, and septic
arthritis are in the same category. Ischemia of muscle also causes pain.
Pathogenesis of Pain
Pain receptors are distributed as endorgans in all body systems and organs. They are connected
to the central nervous system by their own sensory nerve fibers with their cell bodies in the dorsal root
ganglion of each spinal nerve and via some of the cranial nerves. Intracord neurons connect the
peripheral ones to the thalamus where pain is perceived and to the sensory cerebral cortex where the
intensity and localization of the pain are appreciated, and the responses to pain are initiated and
coordinated.
The stimuli which cause pain vary between organs. The important causes include:
 Skin – cutting, crushing, freezing, burning
 GI tract- distension, spasm, inflamed mucosa, stretching of mesentery
 Skeletal muscle- ischemia, traumatic swelling, tearing, rupture, hematoma
 Joint cartilage- by inflammation.

 The response to pain varies not only with the personality of the patient, some are more
stoic (stoical) than other, but also with other influences.

Clinical Findings

The general clinical signs of pain in particular organs and systems are dealt with in each of them.

Physiological Responses - manifested by the following signs, the severity of the pain determining the
degree of response: tachycardia, polypnea, pupillary dilation, hyperthermia, and sweating. These
cardiovascular responses may contribute to a fatal outcome, for example when dehydration, acid-base
imbalance and endotoxic shock are also present.

Behavioral Responses – These include abnormal posture and gait when the pain is musculoskeletal (i.e.
somatic). The gait abnormalities include lameness, a shutting gait, and rapid shifting of weight from one
leg to another. These are subjects of importance in orthopedic surgery.
Behavioral responses to pain may also include unrelated activities such as rolling, pawing,
crouching when the pain is visceral. In general terms, somatic pain is more localized and is therefore
more easily identified than visceral pain. Injuries to limbs are usually identifiable, with severe pain and
injury it shows non-weight bearing lameness, while lesser lesions with milder pain may show more
weight bearing activity.
More general behavioral responses to pain include failure to take adequate food (anorexia) and
water, adoption of anxious expression, and disinclination to be examined. Moaning, grunting, and
grinding of the teeth (ondontophorosis or bruxism) are generally agreed to be indicative of pain.
 If the vocalization occurs with each respiration, or each rumination, the pain appears
likely to arise from a lesion in the thoracic or abdominal cavities.
 When teeth grinding is associated with head pressing it is thought to indicate increased
intracranial pressure such as occurs with brain edema, or lead poisoning.
 Grinding of teeth as a sole sign of pain is usually associated subacute distension of
segments of the alimentary tract.
  More extreme kind of vocalization caused by pain include moderate bellowing by cattle,
bleating in sheep, and squealing in pigs.
Elicitation of Pain
This is essential part of a clinical examination. The techniques used are also generally
surgical and are listed briefly below:

1. Pressure by palpation, including firm ballottement with the fist and the use of pole to
depress the back in the horse, or to arch the back upwards by pressure from below in
the cow, or by percussion, e.g. hoof tester/hammer.
2. Movement by having the animal walk actively or passively flexing or extending limbs or
neck.
3. Stimulation of pain which is related for example to coughing, by stimulating the animal
to cough.
4. Relief of the pain by correction of the lesion.

Diagnosis
The objective in the clinical examination of an animal presented because its problem is
thought to be one of pain is to:

1. Ensure that pain is the cause of the signs observed,

2. Locate the site of the pain,
3. Determine the nature of the lesion and relieve it if possible,
4. Treat the pain symptomatically as a supportive treatment for primary disease.

 The differential diagnosis of pain should include restlessness due to paresthesia as in

snakebite in horses, and to photosensitive dermatitis in ruminants, especially cattle.
 Locating the site of the lesion of pain is more difficult than in man because the animal is
unable to explain where it hurts. All of the techniques of observation and palpation and
movement as set out in clinical findings are essential to locate the lesion properly.

Treatment
In Farm Animals
There are a number of aspects to the problems of relieving pain in farm animals. Not the least is
the matter of cost. Relief of the causative lesion is number one priority as such should be one of the first
tasks of the attending veterinarian, providing the following principles are followed:

1. Relief of pain is a humane act.

2. Analgesia should not be used so as to obscure clinical signs which may be necessary to
observe, to properly diagnose or maintain surveillance of a case.
 3. It may be necessary to protect the animal from massive self-injury.
4. Analgesics for visceral pain are readily available and relatively effective.
5. A major problem in the clinical management of pain is for cases of severe, slowly
healing infected traumatic wounds of the musculoskeletal system in horses and cattle.

Note: For slowly healing injury where there is no suitable analgesics available & in
consideration with honest to goodness assessment with a very poor prognosis, it is
sometime more practical/economical to salvage the farm animal rather than letting
them suffer a lot with injury for a long period of time, and it is humane to subject them
for proper euthanasia. Anyway, euthanasia is acceptable in animals.

In Small Animals
Principles of Pain Management
 1. Assess the animal for pain using behavioral clues by watching whether normal behaviors
are present and whether any new behaviors have appeared.

2. Each patient should have a customized pain management plan based on anticipating the
type, severity, and duration of pain expected (for example, post-surgical pain
management).

3. Treatment for pain often involves drugs but should also include other physical treatments,
such as compresses, massage, physical therapy, and other methods.

4. Signs of pain can be subtle and difficult to recognize, so animals suspected of being in
pain may be treated with drugs and then watched for improvement.

5. Providing continuous (round-the-clock) administration of pain medication is often more

effective at relieving pain than giving drugs on an “as-needed” schedule. As-needed dosing
is often less effective because it requires that the caregiver be able to recognize pain
behaviors that are often difficult to appreciate..

6. Sometimes treatment with combinations of different pain-relieving drugs is more effective.

In these cases, smaller doses of each drug can usually provide pain relief.

7. Animals in pain can also have anxiety, so a veterinarian might prescribe an antianxiety
drug for use after analgesic drugs have been given.

8. Adequate pain relief after surgery or trauma allows the animal to rest. Dogs and cats often
sleep more than usual for a few days after surgery, but a caregiver should be able to wake
them up if the dosage of the analgesic drug is appropriate. If your pet cannot rest or cannot
be awakened, it might need reassessment in order to institute appropriate medication & or
veterinarian’s judgement.

Acute surgical, traumatic, and disease-related pain is generally treated with one or
more analgesic (pain-relieving) drugs. Selection of the most suitable drug or drug combination is
based on the anticipated severity of pain, the pet’s overall health, and the specific drugs helpful for
the species.

For more extensive injuries or disease-related tissue damage, analgesics from more than
one drug class are often prescribed. Reducing your pet’s stress and providing all-around good
care will maximize the benefit of the pain treatment regimen. Housing conditions, diet, and level of
interaction with other animals and people should be tailored to the individual animal. For example,
separating a pair of dogs that enjoy playing vigorously together might be stressful for the dogs
under normal circumstances. But temporarily separating the dogs after one has had surgery (to
allow the incision to start healing) is less stressful for the recovering dog if the human caregivers
spend enough time interacting with it.
 Managing animals that are under stress and in pain requires a combination of good
nursing care, nondrug methods (for example, bandaging, ice packs or heat, and physical therapy),
and drug treatments.