Addressing multimodal pain management with 3 new approaches

At the frontiers of science, research and medicine, new treatment modalities are constantly emerging. When considering treatment options for multimodal pain management in small animals, clinicians should have the appropriate tools in their toolbox. Here are 3 techniques that are starting to grab attention:

Fearless Techniques

Steve Dale, CABC, and Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, presented their session “Pain Can Be Eased: Multimodal Now Includes Dog Training”1 at the Fetch dvm360® 2022 conference in Charlotte, North Carolina. The pair drew parallels with research in human medicine showing how stress, anxiety, depression and other negative moods can increase the perception of pain.2 In studies examining chronic low back pain, total hip replacement, and total knee arthroplasty, fear and anxiety surrounding pain worsened outcomes in terms of pain perception and function.2.3 Conversely, they said, a positive attitude led to lower levels of pain and disability in one study.4 Results from another study showed a significant reduction in pain over 12 months when antidepressants were combined with a pain management plan.5

The presenters said this evidence suggests a link between state of mind and pain perception, pointing to cognitive pain management strategies in humans as a guideline for reducing fear, stress and anxiety. anxiety in animal patients. They recommended investigating Fear Free Certification, a program that educates veterinary professionals on techniques for preventing and mitigating negative emotions in their patients. The goal is to reduce the animal’s stress, anxiety and fear as part of a multimodal approach to pain management.

2. Behavioral training

Dale and Alvarez explained that the behavior can lead to chronic soft tissue damage. “I see, especially in small dogs, jumping on and off furniture all day…. They land on slippery surfaces, break down that carpal cartilage, and it presents to me as carpal hyperextension injuries,” Alvarez said.

The animal can recover from or prevent such injuries by undergoing personalized behavioral training designed to eliminate or modify the offending behavior. The patient can achieve this with in-home or virtual visits from an animal behaviorist or a care plan from a veterinarian. “We not only want to prevent the injury from recurring [but also] also prevent further injury,” Dale said.

3. Hyperbaric oxygen therapy

For years, doctors have widely used hyperbaric oxygen therapy (HBOT) in human medicine to treat patients with many conditions, including decompression sickness, serious infections, non-healing wounds, and anemia. Its use in veterinary medicine is relatively new, with research still emerging and a limited number of veterinary hospitals in the United States. using modality.

During HBO, the animal is placed safely and comfortably in a chamber with an atmosphere of 100% oxygen and a pressure 1.5 to 3 times higher than normal atmospheric pressure, allowing more oxygen to tissues throughout his body. According to the University of Florida College of Veterinary Medicine Small Animal Hospital, this treatment typically results in “reduction of swelling, stimulation of new blood vessel formation in the scarring/swollen tissue, reduction of pressure caused by injuries to the head or spinal cord, an improvement [wound] healing and improved infection control.6 Although currently limited to a small number of veterinary hospitals, HBO presents a possible new pain management modality on the horizon pending further research.


  1. Dale S, Alvarez L. Pain can be eased: multimodal now includes dog training. Presented at: Fetch dvm360® Conference; April 22-24, 2022; Charlotte, North Carolina.
  2. Koechlin H, Coakley R, Schechter N, Werner C, Kossowsky J. The role of emotion regulation in chronic pain: a systematic review of the literature. J Psychosome Res. 2018;107:38-45. doi:10.1016/j.jpsychores.2018.02.002
  3. Sorel JC, Veltman ES, Honig A, Poolman RW. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone joint J. 2019;101-B(1):7-14. doi:10.1302/0301-620X.101B1.BJJ-2018-0672.R1
  4. Martinez-Calderon J, Zamora-Campos C, Navarro-Ledesma S, Luque-Suarez A. The role of self-efficacy on the prognosis of chronic musculoskeletal pain: a systematic review. J Pain. 2018;19(1):10-34. doi:10.1016/j.jpain.2017.08.008
  5. Kroenke K, Bair MJ, Damush TM, et al. Optimized antidepressant treatment and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009;301(20):2099-2110. doi:10.1001/jama.2009.723
  6. Hyperbaric oxygen chamber. University of Florida Small Animal Hospital. Accessed June 15, 2022.

Irene B. Bowles