Contents

Section 1 Pain Terminology, Physiology, Recognition, and Clinical Strategies
for Management
Pain Terminology 2
Physiology of Pain
The Sensory Nervous System and Pain 4
Nociception 6
Consequences of Pain 8
Pain Recognition 8
Pain Assesment 9
Strategies for Pain Management
Preemptive Analgesia 10
Multimodal Analgesia 10
Placebo Effect 12

Section 2 Analgesic Drugs
Opioids 15
Local Anesthetics 17
Alpha2 Adrenergic Agonists 19
Nonsteroidal Anti-inflammatory Drugs 21
Analgesic Adjuvant Agents 25
Preemptive Analgesic Drug Combinations 27
Transdermal Analgesic Preparations
Fentanyl Patch 29
Buprenorphine Patch 29
Lidocaine Patch 30
Pluronic Gel Medications 30
Topical Local Anesthetic Preparations 31
Dispensable Oral Medications
NSAID Preparations 32
Opioid Preparations 33
Opioid / Acetaminophen Preparations 33

Section 3 Analgesic Techniques
Epidural Analgesia/Anesthesia 35
Epidural Catheter Placement 38
Brachial Plexus Block 42
Radial/Ulnar/Median Nerve Block 45
Intra-articular Analgesia 48
Dental Nerve Blocks 50
Infiltrative Blocks 54
Intravenous Regional Analgesia/Anesthesia 58
Intercostal Nerve Block 61
Interpleural/Intraperitoneal/Intraincisional
Analgesia/Anesthesia 63
Intravenous Constant Rate Infusion 66
Transdermal Opioid Delivery 68
Adjunctive Analgesic Techniques 71

Section 4 Pain Management for Specific Conditions and Procedures
Initial Pain Management of the Trauma Patient 76
Head Trauma 78
Acute Pancreatitis 79
Canine Procedures
Dental Cleaning with Extractions 81
Ovariohysterectomy 82
Castration 84
Exploratory Laparotomy 85
Forelimb Amputation/Fracture 88
Thoracotomy 90
Intervertebral Disc Disease 92
Cruciate Ligament Repair 94
Hind Limb Amputation/Fracture 96
Degloving Injury 98
Perianal Fistula 100
Ear Canal Ablation 101
Feline Procedures
Declaw 104
Ovariohysterectomy 105
Castration 107

Section 5 Managing Chronic Pain
in Dogs and Cats
Chronic Pain 109
Treatment of Chronic Pain 111
Guidelines for Chronic Pain Management 114
Common Chronic Pain Syndromes
Osteoarthritic Pain 115
Osteosarcoma-related Pain 117
Central Neuropathic Pain 118
Chronic Otitis Pain 119Section 6
Implementing a Pain Management
Program in Clinical Practice
Components of a Successful Pain
Management Program 121
Recommendations for Assessment and
Management of Pain in Clinical Practice 121

Appendix
Drugs and Sources 123
Index 131
Recommended Readings 150