Canine Sports Medicine and Rehabilitation, Second Edition. Edited by Chris Zink and Janet B. Van Dyke.
© 2018 John Wiley & Sons, Inc. Published 2018 by John Wiley & Sons, Inc.

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Introduction

This chapter explores the fundamentals of
acute  and chronic pain management in dogs.
The  reader is directed to more comprehensive

resources for discussions of pain neurobiology,

neuropharmacology, and most drug doses. An

emphasis is placed on practical and evidence‐

based approaches, with attention to safe and

responsible drug use.

The Prevention and

Management of Pain

in Canine Patients

Mark E. Epstein, DVM, DABVP (C/F), CVPP

19

Summary

Undermanaged acute and chronic pain can lead to a cascade of negative physiologi-

cal, medical, and emotional consequences. Therefore, the imperative for the proper

recognition, assessment, prevention, and treatment of pain is not only an ethical one

but a physiological and medical one as well. Fortunately, there are a great many pain

management tools available to the veterinarian to mitigate these effects and improve

not only patient comfort, but overall recovery and quality (and in some cases, length)

of life. Unfortunately, it can be a challenge indeed to know which treatment plan can

best—and most safely—meet the needs of our patients, a matter made more difficult

for veterinarians since animals cannot self‐report their pain. This chapter is a succinct

overview of the multimodal approach to the prevention and treatment of pain in dogs,

utilizing evidence‐based veterinary medicine insofar as possible, and a consensus of

expert opinion otherwise. Drug classes and modalities discussed include: NSAIDs,

opioids, alpha‐2 agonists, locoregional anesthesia, subanesthetic ketamine, and a vari-

ety of other pain‐modifying analgesic drugs in common use (e.g., gabapentin, amanta-

dine, acetaminophen, tramadol, and others). This chapter also includes tips for practical

clinical use, with an emphasis on safe and responsible use of the various drug classes.

In addition, descriptions of other drugs possibly on the horizon for veterinary use

(some based on utility in human medicine) are included. Lastly, evidence‐based

approaches to managing postsurgical and varieties of chronic pain (osteoarthritis, oste-

osarcoma, and noninflammatory) are described, with sample cases to illustrate.