Feline Pain Management
Keeping Your Kitty Comfy after a Dental or Surgical Procedure
Dr. Fern Slack, UCVC Medical Director
Keeping your cat as comfortable and pain-free as possible is one of the most important goals we have when performing dental work or elective surgery. That’s why feline pain management (analgesia) is a crucial concern in any dental or surgical procedure. Pain management is necessary to basic humane medical practice; and, because pain impedes healing, pain management also helps with rapid and uncomplicated healing. A thorough pain management plan begins before your kitty’s elective surgical or dental procedure.
Premedication with Analgesics Helps Minimize Pain
Surgery, including dental surgery, no matter how beautifully performed, causes tissue trauma. Acute pain occurs after a surgical procedure just as it does after an accidental trauma. But – with surgical pain, we have an advantage! Premedication of your cat with analgesic drugs prior to a surgical procedure dampens the mechanism of pain upregulation, and thereby decreases both the total pain experienced and the dosages of postoperative analgesics needed.
The Two Facets of Pain: Nerve Injury and Inflammation
Acute pain has two facets: nerve injury, and inflammation in response to tissue injury. Untreated, inflammatory pain triggers a cascade of events that can lead to a number of undesirable outcomes, both short- and long-term. Anti-inflammatory medication included in the pre-surgical feline pain management plan can reduce the pain associated with elective procedures, and help optimize the prognosis for a good outcome.
A good option for pre-surgical anti-inflammatory medication for many feline patients is a drug called maropitant. Maropitant has the added benefit of anti-nausea activity. This can come in very handy if a patient is experiencing stress nausea. Nausea isn’t painful in the truest sense of the word, but it adds misery to an already stressful situation. Nausea can also be triggered in some patients as a side-effect of any opioid analgesic; maropitant is great at helping to cancel out that effect at the same time as providing anti-inflammatory activity.
Local Anesthetics in Feline Pain Management
Local anesthetics are an important part of the feline pain prevention approach. Everyone has had a local anesthetic shot at the dentist before a cavity is drilled. It keeps you from feeling the pain associated with the drilling. It also minimizes your discomfort even after the local anesthetic wears off, by having helped prevent pain, to begin with. Local anesthetics are used in feline dental work and in nearly all surgical procedures just as they are in human medicine.
Less Pain Means Safer Anesthesia
Effective feline pain management can reduce the dosage of anesthetic drugs needed, and thereby help minimize anesthetic risk. Most of the drugs used for general anesthesia have little or no pain-relieving activity themselves. Interestingly, unless there are analgesics on board, a cat under general anesthesia still feels and responds to pain, even if the patient is completely unconscious. This increases the dosages of general anesthetic drugs required to keep the patient unconscious, and thereby increases the risk of anesthesia.
Good Surgical Technique Minimizes Feline Pain
Surgical technique is very important when minimizing feline pain. A gentle surgical technique induces less pain than a rougher one. A technique that damages less tissue induces less pain. The proper surgical equipment, in the proper condition, can also influence the amount of post-operative pain experienced by the patient. Sharp tissue scissors are an excellent example of this; everyone knows that a cut from a very sharp edge hurts less than one from a blunt edge. The experience and expertise of the surgeon is very important in feline pain prevention, as is the choice and condition of the instruments used.
Preventing Infection Minimizes Feline Pain
Less obviously, maintaining sterility where indicated and possible is also an important consideration in minimizing postoperative pain because secondary infections from undesired contamination can cause pain ranging from mild to tremendous. Any surgery that involves opening a body cavity requires strict sterility. On the other end of the spectrum, surgeries such as tooth extractions are by definition not sterile. Risks of secondary infections in inherently non-sterile surgeries can be managed by being very clean, by rinsing and disinfecting as much as possible, and by other means.
Antibiotics Do Not Prevent Infections
Antibiotic therapy is almost never helpful in preventing infection, and is often actively harmful. Antibiotics do not prevent infections; neither do they cure infections in the commonly understood sense. The immune system defeats infections; outside help from antibiotics is not often needed, but may be in special situations.
Antibiotics Often Increase Pain and Discomfort
Antibiotic therapy can (and often does) cause pain. Antibiotics often cause far more harm than good, and often create exactly the opposite of the desired response. Antibiotics wipe out not only bad bacteria, but also the good ones, the ones that form part of the ecosystem that is our body. Removing the “good guys” can decrease the normal competition against the “bad guys,” which can allow the unwanted bacteria to propagate more easily. This effect is marked in the gut, where an antibiotic-induced reduction of microbial diversity, or “dysbiosis,” causes everything from mild diarrhea to severe inflammatory bowel disease. Antibiotic use may also lead to fungal infections in the mouth, vagina, and elsewhere (“thrush”) when the antibiotics decimate the population of “good guy” bacteria. Those fungi are a part of our normal ecosystem, and are always present, but only create disease when their competition is gone and the ecosystem is out of balance. Drug reactions, a common problem with antibiotics, can also cause great discomfort or outright pain.
All these potentially pain-inducing consequences are good reasons why antibiotics should be used only when indicated, and avoided when they are not. Your feline veterinarian will help determine if antibiotic therapy is necessary, and if so, which antibiotics will be the least likely to cause problems.
Post-Op Laser and PEMF Anti-inflammatory Therapy Reduce Feline Pain
Immediate post-operative anti-inflammatory treatment can minimize the inflammation which is inevitably induced by dental and surgical trauma. Post-operative cold laser therapy is standard at UCVC, except in cases of suspected or known cancers, for which laser therapy is contraindicated. Patients are treated during anesthetic recovery with PEMF (Pulsed Electromagnetic Field Therapy), an FDA-approved treatment which is potently anti-inflammatory. There are no known contraindications for PEMF therapy.
Thermotherapy Can Help Reduce Both Pain and Inflammation in Your Cat
Thermotherapy is an old-fashioned word and an old-fashioned treatment, but although it may lack the glamour of more technical therapies, hot-packing and cold-packing can help reduce both pain and inflammation. These techniques are appropriate for some situations and not others, but can be applied both in the hospital and at home as necessary. Your feline veterinarian can advise you in this area.
Feline Pain Management and the Protection of Injured Tissue
Another form of feline pain management that has selective applicability is physical protection of damaged tissue. Examples of this include a cast or splint to immobilize an injured leg, a bandage to cover a paw after a toe amputation, or a medical bodysuit to protect chest or abdominal tissue.
Elizabethan Collars Rarely Needed
Elizabethan collars are rarely needed in feline medicine, although there are situations that require them. In most cases, Elizabethan collars cause great stress and frustration without corresponding benefit. In fact, when a cat licks a wounded area, a natural form of removing damaged tissue, or “debridement,” takes place, and circulation to the area is stimulated. It is far more often beneficial to allow a feline patient to lick an injured area than to prevent it, Only when a patient is injuring himself is an Elizabethan collar necessary.
Feline Pain Management – Managing Post-Operative Discomfort At Home
Different surgical procedures induce different types, levels, and duration of discomfort. Your feline veterinarian can give you realistic expectations about how significant your cat’s discomfort may be, how long it may last, and what your best options are for pain management.
Post-operative analgesia for cats can be accomplished in many different ways. A variety of very safe opioid analgesics are available, most of which can be given very easily as an oral liquid. These are absorbed directly through the mucus membranes of the mouth; it is not necessary for the patient to swallow it. Gabapentin is often used for lesser or ancillary feline pain management. Anti-inflammatory treatment with PEMF (Pulsed Electromagnetic Field Therapy) technology can be given at home as well as in the hospital. In some cases, a patient’s comfort may be helped greatly with a series of laser treatments given at 2-3 day intervals post-operatively. This requires returning to the hospital, and can be done on an outpatient basis while you wait. Anti-inflammatory medications can also be very helpful in specific situations.
Monitoring Feline Pain – Your Cat’s Comfort During Surgical Recovery
While you are managing postoperative pain in your cat, always remember that cats hide pain extremely well. Instead of showing easily understood evidence of pain, such as whining or limping, they typically “meat-loaf” (a slang reference to the cat’s shape when she is on the ground from sternum to belly, but not lying on her side), or otherwise restrict their own activity. It can be very difficult to judge whether your cat is in pain, or just sleepy, so the best approach is to follow label directions. If in doubt, assume that if you would be hurting, your cat probably is, and medicate accordingly.
Feline Pain Management – What to Watch For at Home
Clear signs of discomfort include behaviors such as vocalization when touched, hypervigilance, violent reactions when handled, poor appetite, difficulty getting around, lameness, eliminating outside the litter box (often right next to it), hiding, decreased interaction with you, and sleeping or sitting in unusual places. Cats also have subtle facial expressions and body postures indicative of discomfort; we can help you to recognize those.
Feline Pain Management – Minimizing Emotional Stress Helps Minimize Pain
Another important part of managing feline post-operative comfort is minimizing emotional stress. Stress and fear enhance the sensations of pain. Simple measures such as keeping your home quiet, providing a safe recovery area not accessible by other pets or children, and avoiding other sources of household stress can help recovery greatly.
Keep Us in the Loop!
If your kitty is unexpectedly uncomfortable after surgery, please let us know immediately. Different patients respond differently to different drugs; your cat may not respond as well as most to “the usual drugs,” and may feel much better with a different one. If your kitty is not comfortable with the prescribed analgesic regimen, let us know! We can help.
If you have questions about pain management for your cat for elective dental and surgical procedures, we encourage you to make an appointment with one of our experienced feline veterinarians. After reviewing your cat’s individual health status and challenges, we can design an optimum pain management program for your cat. Call us for an appointment today!