Part I: Veterinary Pain Management with Emphasis on Avian (Bird) Species

Part I: Veterinary Pain Management with Emphasis on Avian (Bird) Species

By Jeannine Miesle MA, AAV

Part 1: History / Introduction (Please scroll down)

Part 2: Pain Perception and Signal Reception

Part 3: Pain Signal Transmission and Pain Pathways

Part 4: Types of Pain, Long-term effects, Referred Pain, and Pain Memory

Part 5: Pain, Stress, and the Body’s Physiological Response to Them

Part 6: Pain in the Avian Species

Part 7: Anesthesia and Analgesia, Chronic Pain

Part 8: Quality-of-Life Issues

Part 9: Pain Assessment in Birds / Quality of Life

Part 10: Hospice and Palliative Care for Pets, Strategy for Comprehensive Care, & Conclusion


Part 1

History

In the past, very little concern was given to the discomfort and pain of animals. Horrible practices such as branding, negative reinforcement, and invasive treatment in research were tolerated because they benefitted man. But in the last 30 years the public has grown increasingly aware and intolerant of animal suffering, particularly for farm animals and those used in research. Laws which address animal pain and suffering have proliferated all over the world, particularly in the first-world countries. The social ethic of eliminating pain and suffering has emerged as people become more sensitive to the animals’ pain. The greatest changes have been in animal suffering due to lab testing, in which animals are placed in small cages and not given anesthesia or analgesia during testing. Today, the standard of testing has become a moral mandate to terminate the test when pain becomes severe, to provide analgesia/anesthesia during tests, and to provide better living conditions.

Veterinarians have not always concerned themselves with animal pain. In the 20th century, increased scientific advances made animal and human pain subordinate to scientific progress. Pain and suffering were considered unscientific, therefore less important than the scientific progress. Physicians and vets focused on prolonging life more than improving the quality of life; cure became more important than care. Quality of life is difficult to measure and impossible to quantify. Even today, in some countries and for some doctors and veterinarians, pain control is irrelevant and secondary to scientific progress.

Until the 1960’s most practitioners were involved mainly with agriculture, except for a small percentage of dog and cat veterinarians. Their owners did demand anesthesia and analgesia, but since the patient couldn’t talk, there was no way of determining if it were in pain. Some more-astute practitioners focused on discomfort and offered pain relief, but generally the patient’s pain was ignored. Even during the 1960’s and 1970’s, little-to-no reference to animal pain appeared in books and papers. Medications given for neutering included sedatives and tranquilizers, not pain-killers. As late as 1996, a study showed that limited knowledge of pain management was common, since it had not been taught in veterinary school. That attitude is rapidly changing in favor of pain control.

Current thought

Since then, a new ethic has emerged as society becomes more concerned about animal welfare. Realizing that uncontrolled pain and suffering cause the greatest harm that can befall animals, veterinarians have made their elimination a major moral imperative. People are dependent upon their pets as their bonded companions. The loneliness prevalent in today’s world, whether by senior citizens, singles, or the physically and emotionally ill, has created the need for bonded companions; their pets give them a reason to live. People’s sensitivity to their pets’ pain and suffering has risen to an unprecedented extent.

We now realize that animals have thoughts, mental states, and feelings. Even though such mental states are probably not exactly like ours (since animals cannot communicate verbally), we still must concern ourselves about their pain, fear, and distress. Their pain may actually be worse than human pain because, lacking language and sophisticated reasons skills and the ability to understand time, animals cannot understand the reasons for or causes of pain. Therefore, they lack the ability to hope for and anticipate pain relief and cessation.

Legislation

Laws have been and are being enacted concerning the treatment of animals. The 1985 U.S. laboratory animal laws made the control of pain and distress their major edict. Before this, no literature on animal pain control existed. Since then, though, new laws have been sought and some passed in the areas of research, farm, and companion animals. Now, thousands of papers exist on animal anesthesia and analgesia, and pain control is a major field of study in veterinary colleges. Originally, the laws focused on pain, but now that pain control is well establish, the USDA has begun to monitor distress in animals. This generic term covers the entire spectrum of noxious experiences animals can suffer: fear, loneliness, boredom, stimulational deprivation, and restricted movement. Although some practitioners doubt the existence or negative effects of these modalities, most are beginning to realize that they are part of pain and suffering.

Moral and ethical obligations

If we keep these animals as family members, love them and accept love from them, we are morally obligated, without question, to prevent and control their suffering. Not only is uncontrolled pain emotionally and mentally harmful, it is biologically deleterious; it is a major biological stressor which affects all aspects of the patient’s physical health and well being.

This new interest in providing pain relief for animals has fueled many therapies, both effective and ineffective—some even harmful. Owners have decided that if their veterinarians are not concerned about their pets’ suffering, they will find people who are. This has led to the development of many “alternative” therapies, most of which have not been tested or proven to alleviate pain. The animal may be cheated out of a proven modality for pain control during the time of alternative therapy use, making his situation even worse than it had been. If veterinarians will not manage pain, they risk loss of credibility among the public and loss of clients who will go elsewhere to find either another practitioner who will address the pain or an alternative therapy.

Animals do not fear death, since they lack the ability to understand the concept. But they do fear pain. The veterinary community today urges euthanasia as a merciful tool for relieving the animal of his suffering. Allowing an animal to live in unalleviated pain is the worst thing we can do for them. If indeed the health and well-being of the animals in his care is his top priority, he will seek to eliminate or at least manage the animals’ pain. There is now scientific proof that uncontrolled pain is a major stressor for the animal; it retards healing and increases the possibility of infection. It can even cause death.

A great number of treatment options have been developed in the last two decades in human medicine, and clinicians have turned to many of them for use in their practices. These areas include oncology, transplantation, dialysis, and pain relief.   Animal medicine is following in the path of human medicine by developing the concept of “pawspice”—a hospice for animals. These “state-of-the-art” care facilities and palliative care options promise to alleviate suffering, but they have created another set of ethical and moral dilemmas. Clients have shown a willingness to spend, in some cases, unlimited amounts of money on their animals. This may be beneficial for the veterinarian and in some cases, the animals, but it raises ethical challenges that both practitioner and client have not had to deal with in the past. For example, should the veterinarian pursue the management of the animals’ pain and suffering to the point that the more affluent clients will favor extending treatment well past the time when the animal would have died of the illness? Will he allow the animal to suffer through such extraordinary treatments because the clients cannot accept the death of their pets? Should the veterinarian encourage euthanasia because the client cannot afford treatment for a pet that might pull through with heroic efforts? These new developments in veterinary medicine have created a quandary for the practitioner; he must learn to balance the owners’ wishes with the needs of their animals. In the past, the practitioner would encourage euthanasia when there seemed little hope of recovery for both the wealthy and the poor clients since he had no other options. Now, the practitioner must convince the client that euthanasia is in the best interest of the animal, even when the client can afford more treatment and is not willing to discontinue treatment in the hopes the animal will pull through. In addition, he must weigh a potential life-saving treatment against the client’s ability to afford it and ask himself if he is willing to provide this care pro bono. These expensive treatments could make for financial difficulties if done even infrequently. This has indeed made the practitioner’s job much more challenging.

Reference:

Rollin BE. The Ethics of Pain Management. In: Handbook of Veterinary Pain Management. Ed: Gaynor J, and Muir W III, Mosby-Elsevier, 2009.

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