Pain Management Tips for the Veterinary Technician

Vet Tech content is sponsored by Elanco for the month of October.

There were several firsts at Fetch dvm360®conference at home this week in Atlantic City, New Jersey. One of them was renaming the event to be called Fetch Coastal and another was the launch of an afternoon keynote speaker.

Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), founder of Veterinary Anesthesia Nerds, took the stage in a dress with black cats and with great enthusiasm to discuss her favorite topic: management of veterinary pain. In this presentation,1 Sponsored by YuMOVE, she inspired attendees to become other advocates for pain management, shared her ideas on how to help animals stay pain-free, and described how technicians can be used to their fullest potential. potential in the process.

Pick up Coastal’s first-ever afternoon keynote speaker, Tasha McNerney, BS, CVT, CVPP, VTS (Anesthesia), smiling on stage.

“I know there are letters after my name, that I’m a certified pain veterinarian. But I will also say that all of you in the audience are probably as passionate about pain management as I am,” McNerney said. “I think we all (sought) veterinary medicine because we wanted to relieve the pain and suffering of animals in some way. You are the advocates for these animals, you are their voice when they cannot have a voice, especially if you are the veterinary technicians in the audience.

Multimodal approach

According to McNerney, when she first began practicing, the focus was primarily on the use of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs). However, she now knows that a multimodal approach is most effective and that in addition to these traditional painkillers, physical therapy, nutraceuticals and supplements can help manage pain.

“I do a lot of things with opioids and NSAIDs,” she explained. “But when we talk about pain management, especially chronic pain management and long-term pain management, it’s no longer just about opioids and NSAIDs. We can do many things non-pharmacologically for our patients and we can use the technicians we have in our office to ensure that we receive as much comprehensive care as possible.

She added that in human medicine, patient recovery outcomes have been improved by reducing opioids and increasing regional anesthesia.2 “(It causes them) to start eating again and feel much better. Back when I started and it was all opioid, NSAID, opioid, NSAID, I’m taking a step back from opioids and trying to introduce more local and regional anesthesia.

Different types of pain

McNerney pointed out that depending on your field of work in veterinary medicine, you might encounter patients experiencing different types of pain. For example, those who perform surgical procedures are likely to face acute pain in their patients, those who work in a rehabilitation center often face chronic pain, and professionals working with elderly patients may face severe pain. arthritic animals. Each type of pain should be treated separately, McNerney advised: “We need to make sure everyone on our team understands the differences and how we treat acute pain versus chronic pain, as well as some subtle differences and elements to monitor. And that goes for not only observing the animal, but also some things that we can train our staff members on how to communicate with the owner so that we can detect signs of pain.

In addition to treating the specific pain the animal is suffering from, incorporate an individualized approach. Be aware of the anticipated level of pain you are about to inflict during surgery and the level of fear, anxiety and stress the patient arrives at the hospital with, McNerney added. These factors can help determine the analgesic medication protocol.

Postoperative monitoring

Postoperative monitoring is particularly important in cases of acute and surgical pain. McNerney recommended that practices have a dedicated recovery technician, if possible, to regularly check the patient for signs of pain and advocate if additional analgesia is needed. “(Having a dedicated recovery tech) is fantastic because instead of having to take care of 6 surgery patients, and ‘oh, by the way, between your surgery, go see this patient,’” McNerney said, they can focus- you only on recovering patients and make sure they are as pain-free as possible.

Alternatively, if a dedicated recovery technician is not a viable option, McNerney suggested purchasing a small kitchen timer. This can be placed on a patient’s cage to remind them to check on them periodically and make sure they have received their medications and are doing well. McNerney suggested asking, “Did they get the opioid when they were supposed to?” » If they did, how did they react? Do I see signs of acute pain? Should I consult my clinician and advocate for more analgesia? ” Things like that.”

Pain scales

It doesn’t matter which pain scale is used in your practice, whether it is the Glasgow Composite Pain Scale, the Colorado State University Canine or Feline Acute Pain Scale, or the feline grimace scale, it is especially important that technicians are trained in how to use them.

She highly recommended participants download the Feline Grimace Scale app on their phones to help determine feline pain as well. This free and validated tool was developed by researchers at the University of Montreal and “it examines several different elements such as the position of the ears, the position of the eyes, the whiskers, the position of the head in relation to the shoulders. This helps show where this cat is on an acute pain scale,” McNerney explained. She supports this application because it has been validated by various studies3.4 and it can be extremely helpful to inform technicians monitoring postoperative patients if the patient requires additional analgesia.

The references

  1. McNerney T. The 5th vital sign: pain management as the key to purpose, profit and possibility. Presented at: Fetch Coastal; Atlantic City, New Jersey; October 9-11, 2023.
  2. Soffin EM, Lee BH, Kumar KK, Wu CL. The prescription opioid crisis: role of the anesthesiologist in reducing opioid use and misuse. FJ Anesth. 2019;122(6):e198-e208. doi: 10.1016/j.bja.2018.11.019
  3. Evangelista MC, Watanabe R, Leung VSY et al. Facial expressions of pain in cats: development and validation of a feline grimace scale. Scientific representative. 2019;9(1):19128. doi: 10.1038/s41598-019-55693-8
  4. Monteiro BP, Lee NH, Steagall PV. Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A major bilingual global survey. J Feline Med Surg. 2023;25(1):1098612X221145499. doi: 10.1177/1098612X221145499

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