Overview of the New AAHA and AAFP Pain Management Guidelines
Multimodal Approach to Pain Management
Effective pain management is crucial to the practice of veterinary medicine, the client-doctor relationship, and the quality of life of veterinary patients. In 2015, the American Animal Hospital Association (AAHA) and the Association of Feline Practitioners (AAFP) expanded upon their guidelines from 2007. These guidelines emphasize a multimodal and team approach.
The guidelines help create a continuum of care that includes anticipation of pain, early intervention, and individualized evaluation of response to therapy. The authors of the AAHA/AAFP guidelines believe that effective pain management generally involves a multimodal strategy using several classes of pain-modifying medications. This approach targets multiple sites in pain pathways potentially allowing lower doses of each drug and helping to minimize side effects associated with single-drug therapy. The choice of medication should be based on expected pain levels and individual patient needs.
NSAID use for the management of degenerative joint disease (DJD) pain in dogs is strongly supported.[1] NSAID safety and efficacy data suggests an overall benefit from long-term use at labelled dosages and intervals provided the patient has no evidence of additional risk factors.[2] NSAIDs studied for chronic use (between 28 days and 1 year) demonstrated satisfactory safety profiles in dogs, with 95–97% of dogs able to receive their NSAID at labeled doses and intervals without adverse effects for the duration of their study.[1] There is no evidence to date that a higher risk for adverse effects from NSAID use exists as the duration of treatment increases.[1] Some dogs may require several weeks of NSAID treatment before clinical improvement is noted.[3] The AAHA/AAFP Pain Management Guidelines also provide multiple ways to help minimize the risk of NSAIDs including routine laboratory monitoring, multimodal strategies, use of washout periods, gastroprotectants, and dose optimization for lean body weight.[1]
[1] Epstein M, Rodan I, Griffenhage G, Kadrlik J, Petty M, Robertson S, et al. 2015 AAHA/AAFP pain management guidelines for dogs and cats. J Am Anim Hosp Assoc (2015) 51:67–84.10.5326/JAAHA-MS-7331.
[2] Innes JF, Clayton J, Lascelles BD. Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Vet Rec 2010;166(8):226–30.
[3] Autefage A, Palissier FM, Asimus E, et al. Long-term efficacy and safety of firocoxib in the treatment of dogs with osteoarthritis. Vet Rec 2011;168(23):617.
