By now there's no question that pain management is good medicine. For one thing, it's just plain miserable to see an animal
suffering—let alone to be the animal that's suffering. What's more, untreated pain can lead to a prolonged hospital stay,
mental distress, gastrointestinal lesions, disseminated intravascular coagulation, immunosuppression, arrhythmias, and decreased
As is so often the case, good medicine is also good business. When you implement a comprehensive pain management protocol
and charge appropriately for it, it can make a significant positive impact on your practice's bottom line. Here we'll discuss
two pillars of a comprehensive pain management program: preemptive and multimodal analgesia.
Preemptive analgesia refers to blocking the pain pathway before the painful stimulus occurs—in other words, getting pain-relieving drugs on board
before surgery or another painful procedure. This decreases the intensity and duration of postoperative pain and also reduces
the amount of induction and maintenance anesthesia necessary.
Multimodal analgesia refers to the use of analgesic drugs from several classes to achieve a synergistic effect. By doing this, you increase your
chances of successfully preventing and treating pain in your patients. These different drug classes include opioids, nonsteroidal
anti-inflammatory drugs (NSAIDs), local anesthetics, alpha-2 agonists, and N-methyl-D-aspartate (NMDA) antagonists.
The case studies on this page and the next demonstrate how you can employ comprehensive pain management in two common procedures
in cats and dogs and how you can charge for these medications profitably.
In these examples, the epidural should be performed by a veterinarian, but all the other procedures can be performed by a
trained technician. (Licensing and drug-administration regulations vary by state but, in general, technicians and assistants
can administer controlled substances under the supervision of a veterinarian.)
Canine fracture repair
These examples don't include the minimal costs of syringes and other supplies, but it's still evident that providing analgesia
for our patients and charging appropriately for it generates income for the practice. Implicit in the markup of the drugs'
cost is the reality that you are providing a service: The medical team is administering these drugs safely and effectively—so
you can continue to emphasize a service-driven, not product-driven, approach.
Setting up a pain management protocol
The first step: You must write it down. All doctors in the practice should give their input, and your final written protocol
should address your team's use of analgesic drugs, including doses, mechanisms of action, indications, and contraindications;
preemptive analgesic techniques; and methods for recognizing pain.