Chronic pain in dogs

The management of chronic pain in companion animals is an area in which there is a significant therapeutic void. In many cases professionals are unaware of the appropriate approach to manage chronic pain, despite the wide range of pharmacological, surgical and physical therapeutic options that act directly on the pain pathways. Recent discoveries in the area of pain pathways have opened many avenues for the management of chronic pain. The goal of this book is to present this new knowledge in the context of the small animal clinic.

Contents

1. What is chronic pain?
 Introduction
 Nociception
 Transmission
  Anatomy of nerve pathways
 Transduction: neurotransmitters involved in chronic pain
  Cellular metabolic mechanisms of chronic pain
 Perception and classification of chronic pain
 Pain modulation process
  Spinal control
  Supraspinal control
  Cortical control
 Pain chronification
2. Diagnosis of chronic pain syndrome
 Introduction
 Stress
 Behavioural changes in states of continuous pain
 Diagnostic approach for a patient with pain
  Detailed anamnesis
  Physical examination
  Blood test
   Orientative analytical parameters
  Complementary diagnostic techniques
   Thermography
   Techniques for assessing neurophysiological function
  Pain scales used in animals
3. Treatment of chronic pain
 Introduction
 Pharmacological therapy
  Anti-inflammatories
   Nonsteroidal anti-inflammatory drugs
   Corticosteroids
  Opioids
   Mechanism of action of opioids
   Routes of opioid administration
   Opioids used in veterinary medicine
  Antidepressants
   Tricyclic antidepressants
   Selective serotonin reuptake inhibitors
   Selective serotonin–noradrenaline reuptake inhibitors
  Anticonvulsants
  Amantadine
  Growth factors
  Local anaesthetics
   Routes of administration
   Most commonly used drugs
  α-adrenergic receptor agonists
   Medetomidine
   Dexmedetomidine
  Cannabinoids
  Capsaicin
  Ketamine
   Routes of administration
  Experimental drugs
4. Types of chronic pain
 Introduction
 Visceral pain
  Chronic pancreatitis
  Chronic renal failure
   Uraemic polyneuropathy
   Osteoarthritis: joint pain
 Pain due to cancer
  Analgesic drugs in oncology
   Anti-inflammatories: NSAIDs and corticosteroids
   Analgesics
   Local anaesthetics
   Antiemetics
   Anticonvulsants
   NMDA receptor antagonists
   Bisphosphonates
   Other drugs
 Geriatric pain
  Analgesic drugs in geriatric patients
 Diabetic neuropathy
  Treatment of diabetic neuropathy
 Joint pain
  Treatment of joint pain
   Joint stress stage
   Bone inflammation phase
   Bone reorganisation stage
   Degenerative stage
 Radicular pain
  Treatment of radicular pain
   Corticosteroids
   Opioids
   Muscle relaxants
   NSAIDs
   Local anaesthetics
   Neurolytic agents
   Adjuvant analgesics
   Other therapies
5. Interventional therapies
 Introduction
 Ablative techniques
  Peripheral neurectomy
  Rhizolysis
  Facet rhizolysis
  Cordotomy
  Dorsal root entry zone (DREZ) lesion
 Decompression techniques
  Discolysis
 Neuromodulatory techniques
  Neurostimulation
  Spinal infusion
 Electrotherapy
  Transcutaneous electrical neurostimulation (TENS)
  Interferential currents
  Ultrasound
  Shockwave therapy
  Diathermy
  Neuromuscular therapy
6. Functional recovery of a painful limb. Case descriptions
 Introduction
 Case 1 Shiba. Golden Retriever, aged 14 years
 Case 2 Terry. A mixed breed, 30-kg dog with leishmaniasis
 Case 3 Pepa. Yorkshire Terrier, aged 5 years
 Case 4 Admiral. Labrador, aged 2 years
 Case 5 Terry. Golden Retriever, aged 10 years
 Case 6 Miko. Dachshund, aged 6 years

Belén Ruano Puente, Degree in Veterinary Medicine specialising in pain and rehabilitation. Member of the Spanish Pain Society (SED), the International Association for the Study of Pain (IASP), and the Madrid Association of Companion Animal Veterinary Medicine (AMVAC). Head of the Pain and Rehabilitation Unit of the Pulso Animal Clinic (Manzanares el Real, Madrid). Pulso Animal is a group of professionals who, in their respective specialities and fields of expertise, seek to develop a method of treating animals with pain using an approach that considers all associated aspects and manifestations.