PAIN JM / Pain Line
A serious problem for the pet and its family.
Pain in pets should be avoided. Thinking that pain in a pet is a lesser evil, a consequence of the illness, and something temporary that the animal will overcome without help, because it does not complain, is a mistake. If not treated properly, the suffering caused to the pet by pain may get worse in time.
IMPLICATIONS OF PAIN FOR THE PET AND ITS FAMILY: An animal in pain is a potentially aggressive animal, it does not eat appropriately and it can compromise its recovery. Behavioural changes imply alterations in the relationship between pets and their owners and produce distress in both of them. Recovering the well-being of the animal, and, consequently, of its family, is essential.
Pain can be recognized and effectively managed in most cases. Pain assessment should accompany every patient assessment.
GENERAL CONSIDERATIONS ON PAIN: The ability to experience pain is universally shared by all mammals, including companion animals. It is our moral and ethical duty to give our best to mitigate this suffering. However, and despite advances in the recognition and treatment of pain, there remains a gap between the ability to accurately diagnose pain and the limitations in the analgesic modalities available. Decades of research into pain management indicate that pain is best managed early. Combating pain is more difficult once it is well established. Clearly, this is not always possible but when it is, prevention should be the focus of the analgesic plan. In the treatment of any pain, the main aim is to remove it, or, if that is not possible, to reduce it to a minimum.
2
Treat predictable pain -for example, post-operative pain. Perioperative pain extends beyond 24 hours and it should be managed accordingly. Practice pre-emptive pain management -start an appropriate treatment before a procedure to prevent the onset of pain and continue said treatment as long as necessary. Response to treatment is the proper way to measure the presence and degree of pain.
Acute and chronic PAIN
Acute pain is initiated by a traumatic, surgical or infectious event. It begins abruptly and should last a certain amount of time, depending on the seriousness of the injury. Acute pain varies in its severity from mild-to-moderate, and from severe-to-excruciating. It stops when healing is complete. Examples of acute pain include those associated with a cut or wound, elective surgical procedures and acute onset illnesses -such as: acute pancreatitis, among others.
CHRONIC PAIN This is pain of long duration, in principle, pain that lasts “beyond three months” is considered chronic. In human beings, chronic pain is often accompanied by fear, anxiety, depression and rage, which can aggravate pain and its negative impact on the patient’s quality of life. It is estimated that at least 30% of the dogs and cats that are seen by veterinarians can be classified as “senior” and this population may have a high prevalence of chronic pain. However, chronic pain is not diagnosed because it is often confused with “getting old”. Even in the absence of immediately obvious signs, the potential of chronic pain should be considered in order to improve the quality of life of the pet in its old age. The therapeutic approaches to pain management should reflect these different profiles. The therapy of acute pain is aimed at treating the underlying cause and interrupting the signals at a
range of levels in the nervous system, while treatment of chronic pain must rely on a multidisciplinary approach and a comprehensive management of the patient’s quality of life. Many cats and dogs suffer from a long-term chronic disease; and because of this, they are in a permanent state of pain. During the lifetime of the animals, exacerbations of pain (breakthrough pain) may occur or new sources of acute pain may occur regardless of the underlying chronic pain state (“acute on chronic pain”). For these animals, pain management is required to restore comfort.
Acute and chronic PAIN
ACUTE PAIN
“Chronic pain may be considered a permanent sate of illness”.
3
Types of PAIN
SEVERETOEXCRUCIATING
“Pain may vary depending on the patient and the condition. Each patient should be assessed individually”
MODERATE-A-SEVERE
MODERATE
(varies with degree of illness or damage)
Types of PAIN
Central nervous system infarctions and tumours. Fracture repair where extensive soft tissue injury exists. Ear canal ablation. Articular or pathological fractures. Necrotizing pancreatitis or cholecystitis. Bone cancer. Aortic Thrombosis. Neuropathic pain (nerve entrapment/inflammation, acute disc herniation). Extensive inflammation (e.g.: peritonitis, fasciculitis, cellulitis, especially streptococcal). Meningitis. Spinal Surgery. Burn injury. Limb amputation. Thrombosis/ Ischemia. Hypertrophic osteodystrophy.
4
Immune-mediated arthritis. Early or resolving stages of soft tissue injuries/inflammation/pathology. Panosteitis. Intervertebral disc disease. Capsular pain due to organomegaly. Mesenteric, gastric, testicular, or other torsions. Hollow organ distension. Peritonitis with septic abdomen. Traumatic diaphragmatic rupture. Mucositis. Pleuritis. Oral cancer. Trauma (e.g.: orthopaedic or head, with a great amount of soft tissue damaged). Mastitis. Injuries caused by frostbite. Dystocia. Ureteral/ urethral and/or biliary obstruction. Extensive resection and reconstruction for mass removal or corrective orthopaedic surgery (osteotomies, cruciate surgery, open arthrotomies). Glaucoma, ulceration or corneal abrasion. Uveitis.
SEVERETOEXCRUCIATING MODERATE-A-SEVERE
Soft tissue injuries (less severe than the previously mentioned ones). Diagnostic arthroscopy and laparoscopy. Urethral obstruction. Cystitis. Ovariohysterectomy. Osteoarthritis.
D
MILD-TO-MODERATE Dental disease. Chest drains. Otitis. Abscess lancing. Superficial lacerations. Male castration. Mild cystitis.
MODERATE MILD-TO-MODERATE
Data from Mathews, K. (2000) Vet Clin NA, Sm Anim Pract. 30,729-752.
Reassess analgesia plan
Reassess analgesia plan
Reassess analgesia plan
Comfortable when resting. Happy, content. It does not bother the wounds or the surgical site. Interested in or curious about its surroundings.
Happy. Slightly unsettled. Easily distracted by its surroundings.
Looks uncomfortable when resting. It whines and it licks or rubs the injury site. Floppy ears, troubled face. It does not respond to stimuli. It does not wish to interact with its surroundings.
Uncomfortable, it cries and bites its wounds. It cares for the wound and it protects it altering the distribution of body weight. It may be unable to move a part of the body.
It may be very rigid so as to avoid moving. Constant groans. It can bite the wound, even though it is unable to move. It does not respond to its surroundings. It is difficult to distract it from pain.
Not bothered by palpation of surgery site, or palpation elsewhere.
Reacts to palpation of wound or surgery site by whining or looking around.
It cries, shouts or cares for the injury site.
It can be subtle if it is in too much pain or if it cannot move. It can be dramatic, with shouts or bites.
It cries when palpated gently (allodynia or fear that pain can become more intense). It can be aggressive.
PAIN escale
MILD-TOSEVERE
4
MODERATE
MILD
3
MILD-TOMODERATE
MINIMAL
PAIN escale BODY TENSION
2
BEHAVIOUR
1
RESPONSE TO PALPATION
0
5
PAIN misconceptions
PAIN misconceptions
6
“We cannot always know whether our patient hurts but we can do our best so that it does not”.
“Non-steroidal anti-inflammatory drugs are toxic in dogs and cats”
“If we alleviate pain, the animal will move and disrupt its suture line or its fracture.”
“New-born and infant animals do not feel pain”
- FALSE -
- FALSE -
- FALSE -
As most pain is associated with inflammation, NSAIDs are the mainstay of analgesia for both acute and chronic pain in dogs and cats, and are widely and safely used in many other species around the world. The analgesic benefits far outweigh the potential risks. Nevertheless, it is essential that the patient is screened individually for potential risk factors prior to administration and monitored during treatment. Many of the NSAIDs licensed for use in human beings have a narrow safety margin in animals and should be used with caution.
The use of pain to control movement after surgery is not ethical. Other means should be adopted (e.g.: cage confinement, controlled leash walking) when activity needs to be controlled. Moderate walking exercise is essential for postoperative orthopaedic repair and for bone consolidation, maintaining muscle mass to support the limb. Non-use of the bone results in muscle atrophy. Without analgesic administration, movement may be very painful. Non-treated abdominal pain associated with thoracic incisions hinders normal ventilation/oxygenation.
Animals of all ages feel pain.
“Analgesics mask signs of patient deterioration”
- FALSE Appropriate pain relief does not eliminate a potential cause for signs of patient deterioration (e.g.: tachycardia).
Source Guidelines for recognition, assessment and treatment of pain (WSAVA 2014).
Alleviating PAIN PRODUCT
Treatment of pain in acute trauma, chronic-type pain, pain refractory to other treatments, cancerous conditions, osteoarticular and muscular pain, visceral pain in general and urological syndrome in different species and post amputation syndrome, “phantom limb�. Used to treat postoperative pain (due to its low cardiorespiratory depression, it can be recommended for first-line management of postoperative pain instead of morphine).
Tramadol
Treatment of pain and inflammation associated with osteoarthrosis, myositis, tenosynovitis, musculotendinous pathologies, ligamentous pathologies, panosteitis and for the treatment of myalgia. Indicated for the treatment of inflammation and postoperative pain (orthopaedic and soft tissues). In its injectable presentation, it reduces surgical stress and the amount of anaesthesia needed during surgery. In general oncology and metronomic oncological therapy.
Meloxivet
Inflammation is a primary cause of pain. The use of steroidal anti-inflammatories reduces pain by attacking its cause. It can be combined with other analgesics and anti-inflammatories, as long as the side effects this may have, especially at the gastrointestinal level, are considered.
Line
(Analgesic)
Line
(Non-steroidal Anti-inflammatory)
Colotrin Line
(Chrondroprotector)
Dexa Line
(Steroidal Anti-inflammatory)
PAIN
Treatment of primary and secondary osteoarthritis and other inflammatory processes of joints- such as tendonitis, synovitis and non-infectious arthritis. Treatment of chondropathies, hydrarthrosis and degenerative arthropathies. Combined treatment with NSAIDs: synergic effect in the treatment of some kinds of acute pain. Since the anti-inflammatory activity of Glucosamine is different from that of NSAIDs, it is possible that the combined action of both lowers the required dose of NSAIDs to produce an anti-exudative result.
PRESENTATION
Alleviating
TYPE OF ILLNESS
A JM product for each need.
7
Tramadol John Martin
Tramadol John Martin
tablets
20
Analgesics / TRAMADOL Line
TABLETS
8
FORMULA: Tramadol Hydrochloride 75 mg CSP formulation agents 350 mg INDICATIONS: Indicated for the treatment of moderate to severe pain in different etiologies, acute traumas, chronic pains, refractory pain to other treatments, in cancerous states, and muscle pain. ROUTE OF ADMINISTRATION: Oral DOSING AND USAGE: The dose for canines and felines is of 1-3 mg/kg bw twice or three times a day, the maximum being a total of 10 mg/kg bw per day. The dose is equivalent to a tablet every 25-75 kg of the animal’s weight. PRESENTATION: 2 Blisters of 10 tablets each.
oral drops
10 ML
FORMULA: Tramadol Hydrochloride 100 mg CSP formulation agents 1 ml INDICATIONS: Indicated for the treatment of moderate to severe pain in different etiologies, acute traumas, chronic pains, refractory pain to other treatments, in cancerous states, and muscle pain. ROUTE OF ADMINISTRATION: Oral DOSING AND USAGE: The dose for canines and felines is of 1-3 mg/kg bw twice or three times a day, the maximum being a total of 10 mg/kg per day. In animals whose weight is inferior to the mentioned ones, for the desired dose, the product can be diluted in saline. The length of the treatment is at the discretion of the veterinary physician in charge. PRESENTATION: Dropper flask with 10 ml
Tramadol John Martin
solution for injection
25 50 ML
ML
FORMULA: Tramadol Hydrochloride 50 mg CSP formulation agents 1 ml INDICATIONS: Indicated for the treatment of moderate to severe pain in different etiologies, acute traumas, chronic pains, refractory pain to other treatments, in cancerous states, and muscle pain. As analgesic in the anesthetic premedication and for the treatment of post-surgery pain. ROUTE OF ADMINISTRATION: Subcutaneous, intramuscular, and intravenous. DOSING AND USAGE: The product is administered via subcutaneous, intramuscular or slow intravenous routes. The dose for canines and felines is of 1-3 mg/kg bw twice or three times a day, the maximum being a total of 10 mg/kg per day. PRESENTATION: Vial flask with 25 ml
John Martin
Meloxivet John Martin
tablets
10
COMP
FORMULA: Meloxicam 4 mg CSP formulation agents 150 mg INDICATIONS: Indicated for the treatment of pain and inflammation associated with osteoarthritis, myositis, tenosynovitis. Musculotendinous and ligamentous pathologies, panosteitis, and for the treatment of myalgia. ROUTE OF ADMINISTRATION: Oral DOSING AND USAGE: Canines: Attack dose of 0.2 mg/kg bw the first day. Then administer a dose of 0.1 mg/kg bw every 24 hours. Felines: Dose of 0.1 mg/kg bw every 24 hours during 3 to 5 days, and then 0.1 mg in total every 24-72 hours. PRESENTATION: 1 Blister with 10 tablets.
oral drops
10 ML
FORMULA: Meloxicam 0.5 mg. CSP formulation agents 1 ml. INDICATIONS: Indicated for the treatment of pain and inflammation associated to osteoarthritis, myositis, tenosynovitis, musculotendinous and ligamentous pathologies, panosteitis, and for the treatment of myalgia. ROUTE OF ADMINISTRATION: Oral DOSING AND USAGE: Canines: Attack dose of 0.2 mg/kg bw the first day. Then administer a dose of 0.1 mg/kg every 24 hours. Felines: Dose of 0.1 mg/kg bw every 24 hours during 3 to 5 days, and then 0.1 mg in total every 24-72 hours. PRESENTATION: Dropper flask 10 ml.
Meloxivet John Martin
solution for injection
10 ML
FORMULA: Meloxicam 5 mg CSP formulation agents 1 ml INDICATIONS: Indicated to prevent or treat the pain and inflammation intra and after-surgery. It can be used in the premedication with a high margin of safety. For the treatment of inflammation and pain associated to osteoarthritis, musculotendinous pathologies and myalgia, among others. ROUTE OF ADMINISTRATION: Subcutaneous, intramuscular and intravenous. DOSING AND USAGE: Canines: 0.2 mg/kg bw the first day and then 0.1 mg/kg bw the following days, it can be continued with tablets or drops. Felines: To avoid after surgery pain and inflammation, apply as premedication 0.3 mg/kg bw and after 24 hours apply injection of 0.1 mg in total or continue treatment with drops. PRESENTATION: Vial flask 10 ml.
Non-steroidal Anti-inflammatory / MELOXIVET Line
Meloxivet
9
Dexametasona John Martin
solution for injection
50
Steroidal Anti-inflammatory / DEXA Line
ML
10
FORMULA: Dexamethasone Sodium Phosphate 2 mg Excipients CSP 1 ml INDICATIONS: Indicated in inflammatory processes, allergic reactions, replacement therapy, pruritus, and autoimmune illnesses. ROUTE OF ADMINISTRATION: Subcutaneous, intravenous, intramuscular. DOSING AND USAGE: In all the species: 0.05 to 0.15 mg per kg bw. PRESENTATION: Vial flask 50 ml
Dexa 4 John Martin
solution for injection
50 ML
FORMULA: Dexamethasone Sodium Phosphate 4 mg Excipients CSP 1 ml INDICATIONS: Atopic dermatitis, Arthritis, Bursitis, Synovitis, spondylitis, allergic conjunctivitis, congenital adrenal hyperplasia, brain edema, systemic lupus erythematosus, hypersensitivity to drugs, shock treatment, rheumatic conditions, nonsuppurative thyroiditis, autoimmune hemolytic anemia, and the general indications for corticoid anti-inflammatory. ROUTE OF ADMINISTRATION: Subcutaneous, intravenous, deep intramuscular, intra-articular. DOSING AND USAGE: Dosage of 0.25 to 4 mg/kg bw depending on the symptoms and on the discretion of the Veterinary Physician in charge. PRESENTATION: Vial flask 50 ml.
Dexashock20 John Martin
solution for injection
25 ML
FORMULA: Dexamethasone Sodium Phosphate 20 mg Excipients CSP 1 ml INDICATIONS: Indicated in shock, anaphylaxis, bronchospasm, neurological disorders after traumatism. Anti-inflammatory. Treatment of metabolic illnesses (ketosis in Ruminants). Autoimmune illnesses. ROUTE OF ADMINISTRATION: Subcutaneous, intramuscular, intravenous. DOSING AND USAGE: Dose of 2.2 to 4.4 mg/kg bw depending on the symptoms and on the discretion of the veterinary physician in charge. PRESENTATION: Vial flask 25 ml.
Colotrin
Colotrin
®
palatable®
48
60
TABLETS
FORMULA: Glucosamine Hydrochloride Chondroitin sulfate Methylsulfonymethane Excipients CSP
300 mg 200 mg 500 mg
INDICATIONS: Supplement for prevention, therapeutic, restorative. Indicated for the treatment of primary and secondary osteoarthritis and other articulation inflammatory processes, such as tendonitis, synovitis and non-infectious arthritis, cardiopathies, hydrarthrosis, and the degenerative joint disease. ROUTE OF ADMINISTRATION: Oral Chrondroprotector / COLOTRIN Line
TABLETS
11
Healthy pet, happy family.
JOHN MARTIN S.R.L. Timoteo Gordillo 2460 (C1440EEX) Buenos Aires - Argentina Telephone/Facsimile: (011) 4687-6128 info@john-martin.com.ar
john-martin.com.ar pipetablock.com.ar
f
ICADO OFI TIF
NA
P
V
SE
AL CI
CE R
Laboratoriojohnmartin pipetablock
SA / BPF