Why NOT give pain control medicine?

In my last post, one might have a tendency to interpret my comments as being critical of the dog’s regular veterinarian.   While I do think there is some lapse of logic in sending home a barrier collar instead of (or without) pain medicine, you have to consider this in light of the back-story.  Don’t judge too harshly.

As hard as it may be for you to believe, routine pain management after surgery has not always been the standard for our profession.  As a reformed sinner myself, I must admit that our commitment to routine pain management is only about seven years old.  Prior to this, pain medication was only given when the animals were crying.  This was sadly inadequate, as it is a non-survival behavior to exhibit how weak you are.  Animals are not stoic out of some misguided sense of macho, but rather because the primeval ancestors who advertised themselves as helpless victims did not produce many descendants.  So "big girls don’t cry", and waiting for the animal to cry is waiting too long.

How could we have had such a callous attitude toward animal suffering?  I graduated from veterinary school in 1978.  When I took my surgical training, we were told to be very sparing with pain medication, if we gave any.  "If you get them feeling too good, they’ll run around and tear up your surgery."  We were paying good money for our education, and these professors were the best in the west, and so we believed them.

Now you might say, "Have you ever had surgery yourself?  Didn’t you need something for pain?" I’d answer yes, and yes.  HOWEVER, when I had my shoulder reconstructed about one week before starting veterinary school (I was in a sling for the first six weeks), they didn’t give me much pain medicine.  In those days, being a drug addict was considered "a bad thing".  If you got to liking those pain meds, you just might become a drug addict.  So, I lay there hurting like hell all day long, and then they’d give me some Demerol at bedtime so I could sleep.  That’s the way it went for three days, after which the pain had subsided greatly.  I don’t know whether I’d have become addicted if I had received medication during the daytime, too, but I was sure glad to drift away on my little pink cloud at night. 

Since they didn’t give people much pain medicine, and the instructors told us not to give pain medicine, it’s not so hard to understand how this attitude became pervasive.  Attitudes have changed greatly in the past few years.  In 1997,  Dr. Bob Paddleford talked about pain control, and spent half his time apologizing for recommending it.  He knew the old-timers would think he was a sissy.  Now we’re concerned with multi-modal analgesia (in other words,whether you are using enough different approaches to be sure the pain is under control).

If you have major surgery now, chances are good that you’ll have a little "pain pump".  If you start hurting, you just hit the button and get some more medicine.  In retrospect, I find that when I received post-surgical pain medicine, it hasn’t made me want to get up and run around — it let me rest. 

I don’t know how long it would take a pet to learn to operate a "pain pump".  I do know that I can’t wait for them hit their nurse’s buzzer.  Certainly, when you know a particular individual, you can be alert for changes in attitude, restlessness, and so forth.  For practical purposes in the hospital, we just have to look at what we’re doing with that animal.  Would this be painful if it were happening to me?  Then I’ll treat my patient as I would wish to be treated (not like I was treated in 1974).

3 thoughts on “Why NOT give pain control medicine?

  1. Karen says:

    The comment about the vet not wanting to be seen as a “sissy” is an unprofessional one, and surprising coming from a vet. “Sissy” is a derogatory term from “sister” and is ultimately meant to put down females. Not being a “sissy” means not being weak, and obviously females are strong, as we are the ones who give birth. So I would appreciate the analysis without the derogatory terms. If animals were denied pain medication, with vets full-well knowing they were in pain, it only shows how much we have benefitted from vet medicine becoming more female-dominated, which in this case means more compassionate. There’s nothing “sissy” about that.

  2. doc says:

    If you will note the context, I said “he was afraid the old-timers would think he was a sissy.” I am specifically referring to an out-moded and un-informed mindset. The whole point of the post is how wrong this was. I am sorry that you have zeroed in on one word and misconstrued this as a slam toward feminism. None was intended, and, in my opinion, none was present. Our profession now has more women than men and they are good veterinarians.

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