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There's so much more to chronic pain.....

Updated: Dec 25, 2023

As September is #AnimalPainAwarenessMonth I've just made it in time to explain how my service is expanding over the next few months.


The more I've learned about how chronic pain affects an individual biologically, emotionally and socially the more I've tried to incorporate my learning into my acupuncture visits.


For example, when I learned to assess pain in animals in vet school (over two decades ago!!) we were told to basically look for the lame leg and then palpate, bend and flex the limb to find the source of that pain. Once we thought we knew where the pain was we could direct our investigations and/or treatments to 'fixing' that injury or disease process.


A year or so after completing my acupuncture training I went on a course that blew my mind, run by an amazing veterinary rehabilitation and physiotherapy specialist. She described how (obviously) a dog is a unit of four legs, a trunk and a network of muscles, joints, bones, ligaments and fascia which are all working together to produce a moving unit. If any part of that system is disrupted it inevitably affects the other parts. For example, if a dog has sore hips it will throw its weight forward onto the front half of the body in an effort to take the weight off the back legs. The result? the front legs and shoulder and chest muscles are taking more load than they were designed to. If this animal was a suspension bridge, engineers would be putting measures in place rapidly to prevent stress damage to the overloaded areas. Too often in animals we wait until the damage has been done.


Now I try to do a full body musculoskeletal assessment and often find painful sites different from the area I've been asked to treat.


Here's another example. I've known for a long time that chronic pain affects the way the nervous system actually handles inputs and outputs: sensitivity is dialled up in the spinal cord so that a (for example) grade 1 painful event in a tissue, a minor injury such as a graze with a thorn or firm pressure might be 'translated' by the nerves taking that information to the spinal cord and up to the brain as a grade 4- i.e. significant injury.


Similarly, the part of the nervous system and brain centres involved in threat responses (fight or flight) are put on high alert so they might interpret a signal from the spinal nerves as more dangerous than it is, leading to heightened anxiety or apparent overreactivity to the situation.


These are unconscious biological adaptations which are not only unhelpful in coping with the pain but can also lead to withdrawal behaviours or aggression in our pets (one shocking study in the US found a high proportion of dogs euthanized for aggression had undiagnosed chronic ear disease on post-mortem examination).


Now, I take account of behaviour and reactivity in my assessments and pain scoring tools, ensuring that we see improvements over time, offering advice as to how to manage these changes or directing the client back to their primary vet for more support if required.


Another aspect of how an animal is coping with their pain is their home environment. If they predict pain or injury may happen (and remember this is often brain on high alert for danger so it may well overestimate such events) when leaving their bed to cross a slippy floor to eat, drink or reach the garden, they may try to delay or avoid those behaviours or become anxious or tense their body (leading to more physical changes in the musculoskeletal system) when they need to make that journey.


If they are a compulsive squirrel chaser and there is a 20cm drop out of the back door they will ignore the pain that comes from jarring their elbow joints multiple times a day until the cartilage has worn to nothing.


Now I mention suggested adaptations to the home environment that may help make that animal's life easier and reduce their anxiety and the progression of their disease.


I've also learned to appreciate so much more the burden of caring for an elderly or chronically ill pet. As clients allow me into their homes and sit with me for up to an hour while I treat their animals, conversations often happen that reveal the extent of the lengths such owners will go to to do the best for their pet: cancelling or rearranging long-planned holidays, getting up multiple times a night with a restless dog, countless hours spent researching supplements or therapies that might help ease their pet's symptoms. All this on top of the worry and anxiety of seeing their pet struggle on a daily basis despite their best efforts.


I try to listen empathetically and offer support and suggestions where I can.



In my next blog post I'll be spelling out how I aim to ensure these measures are assessed more thoroughly and consistently in order to offer a full all-round pain management support service for both pets and their owners....



(Photo credit: Samson Katt on Pexels.com)

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