Managing Chronic Pain: Our Ethical Responsibility

Shifting our perspective from healing to management

When we are working with chronic pain patients, we need to shift our thinking from curative to management. It is normal for us to work with our patients with the goal of eliminating pain – pain is the enemy, right? We want to do all we can to get rid of the pain. But in chronic pain patients, this is not realistic. We need to understand that, rather than completely removing pain from our patients’ lives, our goal is to manage and minimize the pain. ?In such cases, we’re seeking ways to help our patient and their owner to live relatively comfortably, even with some level of pain.

This may mean adjusting and evaluating our own beliefs around pain and length of life. Both we and the animal’s owner may have deeply ingrained perceptions about pain, specifically chronic pain, and an awareness of these beliefs may help us to see the issues more clearly. We know, for instance, that we have an ethical responsibility towards our patient and our patient’s owner to alleviate pain, but we also have to know our limits, and know when to recognise that further interventions will not help.

?

How beliefs shape the perception of chronic pain in pets

Every party involved in the care of an animal in chronic pain will have different beliefs about pain and the extent of intervention that should be offered to a suffering animal. Understanding the thinking of each party can help us to manage expectations more effectively, ensuring that all members of the team surrounding the patient are on the same page or pathway. This will reduce the risk of conflict or disagreements because of unmet expectations or fundamental differences in treatment approaches between different team members.

Chronic pain management will involve a series of compromises as treatment options are discussed and pursued. Understanding our beliefs can help to simplify these decisions when the time comes to make them.

?

Assess client goals and expectations.

While assessing client goals and expectations is important for every patient we see, this aspect becomes increasingly important for chronic pain patients, enabling us to help the owner set realistic goals and navigate challenging decisions on the pain management journey. Because chronic pain management involves many decisions where compromise or side effects are inevitable, it helps to know what is most important to the individual patient and client.

For some families, activity may be very important, while for others, physical activity is a much smaller part of their lives with their dogs. This simple differentiation can guide treatment decisions about the use of certain medications, some of which might control pain but reduce the dog’s ability to engage in physical activity. Together with the client’s goals, we need to consider the things that bring our patient the most enjoyment in life. Then we can figure out the best ways to retain as many of these elements in their lives as possible. ?

?

Navigating compromises

Every decision in chronic pain management will come with a compromise or a risk. Making home modifications can mean adding carpets or runners to the house that one or more family members do not enjoy, or that are inconvenient. Daily NSAIDs come at the risk of side effects to the GI system, and high-quality supplementation comes at a financial cost. Additional pain medications can affect mentation, balance and coordination, and can come at the cost of active participation in family life.

Helping our clients to fully evaluate their own beliefs around pain, and to understand what is most important to them when it comes to their dog’s quality of life, will help guide these decisions as they come into play.

Continue reading here