Neuropathic pain in dogs and cats
As a part of my series on pain management, I wanted to discuss the concept of neuropathic pain. Neuropathic pain is the type of pain caused by a problem with parts of the nervous system. The word “neuro” refers to nerves or the nervous system. The medical term “pathic” refers to being affected by a disease of a specified part. Helping to relieve chronic pain in dog and cats is one of my most important tasks in my mobile house call practice which provides pet hospice care, palliative care and geriatric patient evaluations.
Pain in general is basically divided into 3 basic categories:
1. Physiologic pain: Pain in response to tissue injury
2. Inflammatory pain: Pain as a consequences of tissue damage and the subsequent inflammatory process of the body
3. Neuropathic pain: Pain as a result of abnormal processing of signals by the nervous system.
Dogs and Cats like all mammals share a similar nervous system to that of humans. Unfortunately dogs and cats are not able to communicate that they are painful, nor able to describe the type and location of their pain. This makes diagnosis, research and treatment very difficult. However we as veterinarians can
gain insight or understanding by using human medicine to understand what can cause pain, how pain manifests and how best to treat pain. If humans feel neuropathic pain it is reasonable to assume that dogs and cats feel this type of pain.
The nervous system is a complicated system functionally and anatomically. It is beyond the scope of this article to describe the anatomy, function and variety of ways neuropathic pain develops. Suffice it to say that the nervous system contains many pathways than can malfunction and cause neurologic based pain.
Neuropathic pain is initiated or caused by an initial lesion or dysfunction in the various nerves of the body. Then nerves are damaged and then fire abnormally resulting in pain.
Again neuropathic pain is difficult to diagnose in veterinary patients, for it is best diagnosed via a description by the patient. The veterinarian and pet owners must rely on changes of behavior. Does the patient express dullness, aggression, difficulty in movement (See chart in my previous post on how to detect Acute and Chronic Pain) yelping for no reason, scratching motion without touching the skin, do they continually bite or attack an area?
Historical information about their pet’s past medical problems is an important part of the diagnostic tree. Where there events in the medical history which are known in human medicine to result in neuropathic pain?
Neuropathic pain-Associated Conditions
They also encounter similar diseases, traumas, inflammatory processes, infections, metabolic problems and surgeries as humans. Veterinary medicine has uses human medicine as a template
Limb nerve entrapment –thru surgery
Back problems which might cause nerve entrapment. Intervertebral disc herniation
Spinal cord injury
Feline interstitial cystitis
Inflammatory bowel disease
A Physical exam, including palpation and manipulation or the body helps to detect sites of pain usually in the musculoskeletal system. Observation of the behavior and gait of the pet can also provide clues to the existence of pain.
Lastly, a very important diagnostic test is a positive response to drug treatment. Since dogs and cats are unable to fully communicate their pain, a drug trial can end up being a valuable diagnostic tool.
For many older pets chronic pain is a real problem. It is one of the most important factors in living a life of quality. Unfortunately, it can be one of the most difficult disease processes to diagnosis and therefore treat. Most clients understand the concept of arthritic pain, but many do not understand neuropathic pain. Hopefully this blog with help owners understand neuropathic pain and the types of disease which are associated as primary causes. With this information owner can then help their pets by being a voice for historical information, a vital component is diagnosing neuropathic pain.
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