Integrated Pain Management
The Integrated Pain Management Service (IPMS) at NC State Veterinary Hospital offers a wide range of diagnostic and therapeutic services to clients whose animals are suffering from pain such as cancer pain and osteoarthritis.
For ongoing clinical research studies, go to Clinical Studies.
What is the Integrated Pain Management service?
The Integrated Pain Management Service (IPMS) is a comprehensive approach to pain management for cats and dogs. The IPMS operates on a referral basis run by Drs. Duncan Lascelles, Elizabeth Hardie, and Bernie Hansen, with animals being admitted through the Small Animal Surgery service.
The goal of the IPMS is to improve the welfare and quality of life of the individual pet by controlling pain. This is achieved by evaluating the pet concerned and tailoring a regimen to that individual pet. Following initiation of treatment, the efficacy of the treatment is constantly re-evaluated, and changes made as appropriate. The NCSU-IPMS works closely with the pet's referring veterinarian and owner.
The IPMS also offers consults for veterinarians on the management of pain. Veterinarians seeking advice on cases can contact the service at 919.513.6588.
Are the veterinarians board-certified in Pain Management?
As of yet, there is no formal training or board certification program in Veterinary Pain Management. It is likely that this will be established over the next few years under the guidance of the International Academy of Animal Pain Management. The IPMS at NCSU has been set up by board-certified specialists in surgery, intensive care and anesthesiology. These individuals have considerable experience in clinical pain management, research in clinical pain management and teaching pain management to students and qualified veterinarians. They are also playing a key role in the establishment of specialist training programs and certification in Animal Pain Management and have authored almost 100 papers together on pain management.
Advanced pressure mat diagnostics allow us to determine the distribution of pressure going through each cat or dog's paws, and help us to quantify certain types of pain, such as pain-causing lameness.
What therapies are used by the IPMS?
Chronic pain management is a rapidly expanding field of study in veterinary medicine. Pets, like people, are living longer due to advances in veterinary care, but with this longevity, these pets have to confront chronic pain associated with disease such as osteoarthritis and cancer. In line with the greater interest in treating pain, several pharmaceutical companies have produced new drugs in recent years, giving veterinarians more options in treating pain. These new drugs, as well as procedures and drug combinations evaluated at NCSU, will be utilized where appropriate. However, the IPMS will employ as many non-drug treatments as appropriate for the individual. Such treatments include physical therapy, radiation, neurosurgical procedures, acupuncture and massage, depending on each animal's needs. The CVM will be working closely with practitioners to provide services such as physical therapy, massage and acupuncture at a convenient location for owners.
What will happen during an appointment?
The IPMS formulates therapy plans tailored to the individual patient, usually involving a number of different treatments such as surgery, drug therapy, rehabilitation therapy, acupuncture, massage, hydrotherapy, and radiation therapy. Often the therapy involves working with specialty veterinarians and therapists outside the hospital. The IPMS monitors and adapts the therapy to ensure optimum outcome.
- Examination: Generally, a 4th-year veterinary student will escort the patient and owner into an exam room and take a complete history while they perform a physical examination. This will take approximately thirty minutes.
- Review: The student will then leave the room for about fifteen minutes to consult with one of the faculty (senior clinician). At this time, the student and the senior clinician will also review any diagnostic material that the primary veterinarian has sent or transmitted. The senior clinician will then introduce him or herself to the owner and examine the pet. New patients usually need to be left with us for the day to allow enough time to complete the diagnostic tests needed. Occasionally, it is necessary to leave the pet overnight.
- Diagnostic tests: For patients suffering from pain, these include specialized gait examinations, radiography, various blood tests, biopsies, and neurological examinations. The pet may need to be lightly sedated to complete our evaluation, since several of these tests require them to to be absolutely still for several minutes at a time. Often, other specialty services at the hospital will perform examinations and consultations (for example Neurology, Oncology).
- Discharge: At the time of discharge from the hospital (usually from 4pm-6pm), the senior clinician will discuss the pet's painful condition with the owner and answer any questions. At this stage, treatment options are discussed, and together we decide on the most appropriate treatment regimen. We will also send home detailed written information about the physical findings, diagnostic test results, diagnoses, medications, and recommendations for the ongoing care of the pet's pain. A copy of these instructions will be faxed to the primary veterinarian if the patient was referred.
- Treatment: The treatment recommended will very much depend on the reason for the pain. Sometimes, the pet will be transferred to another service if there is a treatable condition that is best managed by a specialist in that area. Treatments that may be discussed include surgery, established drug therapy, novel drug therapy, physical therapy/rehabilitation therapy, massage therapy, hydrotherapy, acupuncture, radiation therapy, neurosurgical procedures, joint blocks and joint injections. Some of these treatments are performed outside of the hospital by specialty centers or therapists (physical therapy/rehabilitation, massage, acupuncture).
- Follow-up: If the best results are to be achieved in pain management, patients need to be re-evaluated. We will keep in contact with the owner by telephone and at re-examination visits. At these visits, specialized monitoring and assessment will be performed, and ongoing treatment discussed. The owner, as the caregiver of the pet, has a very important role to play in the assessment of treatment outcome, and will be integrally involved in the assessment and treatment process. Often, re-visits and procedures such as blood sampling can be performed by the primary veterinarian who will be kept informed of all treatments and progress updates.