Anesthesia and Pain
At Your Service: Pain Consultation and Referral Service
Who We Are
The Pain Consultation and Referral Service (PCRS) at Foster Hospital for Small Animals was created especially for patients with painful conditions that have proven difficult to manage using standard methods. Pain occurs in animals after surgery, after trauma, along with certain diseases (acute pain) and can persist (chronic pain) for long periods of time in some cases, as in the case with cancer, neurological, orthopedic or muscular disorders. We now recognize that undertreated pain may profoundly affect quality of life, and unrelenting pain can be a reason pet owners choose to euthanize their beloved pets. Pain may also compromise recovery from surgery or illness. A few analgesics for acute pain are approved for perioperative use in small animals, but more complex acute pain situations frequently arise. And with only one class of pain medication (the NSAIDS) specifically marketed for chronic pain in dogs, and none approved for use in cats, chronic pain therapy can be a challenge. Borrowing in large part from human medicine, pain specialists have adopted new techniques for management of both acute and chronic pain in animals. We provide expert and comprehensive pain management services, including non-conventional treatment regimens, all aimed to improve the comfort of companion animals.
Patients who may benefit from a consultation with, or referral to the PCRS include those suffering from osteoarthritis, prolonged post-surgical pain, pain resulting from medical conditions, major trauma, terminal disease (cancer, organ failure) or any other condition in which pain significantly impairs quality of life. This is especially important at the end of life, and our hope is that, together, we can enable pets to enjoy many comfortable days at home with their owners. We believe that no animal should experience pain as long as there are the means to treat or prevent it. When standard treatments fall short, a pain consultation can help.
Technology and Services Available
As part of an academic veterinary medical center, the Pain Consultation and Referral Service offers a multidisciplinary approach to pain, blending the expertise of anesthesiologists, surgeons, oncologists, neurologists, physical therapists and complementary medicine practitioners.
- Thorough patient assessment with emphasis on defining the cause, type and intensity of pain, while providing access to diagnostic or imaging as needed.
- Treatment options that combine traditional and non-conventional analgesic drug regimens, palliative interventions, complementary techniques, including acupuncture and trigger point dry needling therapies. We can also help refer to rehabilitation practitioners or for chiropractic evaluation.
- An individualized treatment plan that is developed in collaboration with the primary care veterinarian and is based on the owner’s capabilities and expectations.
Meet our Chronic Pain Specialist
A Diplomate of the American College of Anesthesia and Analgesia, Alicia M. Karas, DVM, MS, DACVAA, is also a pain specialist and animal welfare scientist. Dr. Karas graduated from Cummings School of Veterinary Medicine at Tufts University in 1989, returning to do a residency in anesthesiology after spending time working in small animal practice. She developed an interest in pain medicine at a time when the field was first developing and has remained on the faculty at Cummings School where she now teaches and practices. She has studied acupuncture at the Chi Institute in Reddick FL, Touch Balancing/Animal Bowen™, and canine trigger point therapy (Myopain Seminars) and is particularly interested in the role of muscle in instigating and maintaining pain. Her work also includes the development of methods to reduce the stress of clinic visits and hospital stays, and recognition and treatment of cognitive dysfunction in dogs and cats. She is dedicated to the promotion of comfort and mental well-being in all animals.
Referring a Patient
The most effective approach is for our pain specialist to conduct a thorough hands-on evaluation of the patient, while also engaging in an in-depth conversation with the owner to get a comprehensive history, goals and limitations. We ask about the pet’s daily activities, attitude, the extent of exercise and play, diet, and medications, including supplements. Many times there are assistive measures or household modifications that should be implemented. We encourage the primary care veterinarians to perform blood work and other routine follow-up so that we may take a team approach to manage the “whole” patient.
An initial consult will allow for six months of follow- up, where we check in regularly on progress and make any necessary adjustments. This is generally managed over the phone or by email with either you or the client. Please note: All diagnosis and prescribing must be done either by the referring veterinarian or by appointment with Dr. Karas. Therefore, pet owners must either make an appointment at the PCRS or seek consultation through their primary care veterinarian.
Dr. Karas sees chronic pain outpatients on Fridays at Foster Hospital for Small Animals, and also at Tufts Veterinary Emergency Treatment & Specialties on Thursday afternoons. Patients with severe pain may require immediate admission to Foster Hospital for Small Animals through the Emergency Service.
The option of email and telephone consultation services for veterinarians is also available when travel to our clinic is not feasible. If you have a patient under your care who requires, or is expected to require additional help with acute pain, you may call to see whether one of our anesthesiologists is available to advise you
To access the most state-of-the-art and integrative approaches to pain management, you can make a referral by contacting PCRS liaison, Kelly Reed, at 508-839-5395 or 800-736-8387.
Clinical Case Challenge:
- Trigger Point Dry Needling for Treatment of Myofascial Trigger Points
- PRE-TREATMENT: Ruby’s gait prior to being evaluated for trigger point therapy. She holds the leg close to her body and walks and runs on three legs with her body curved to compensate for the lameness. Watch now
- POST-TREATMENT: Ruby walks, runs and jumps using all 4 legs today, thanks to her trigger point dry needling therapy. She still had a mild tarsal instability but her active lifestyle keeps her muscles in shape. Watch now
Don’t forget to mark your calendars for our annual open house at Cummings School’s campus, set for September 20!
At Your Service
Pain Consultation and Referral Service
More than ever, pet owners are concerned about pain management in their four legged companions. Having a pet distressed by pain is a cause of worry and frustration for many owners. Learn more about the Pain Consultation and Referral Service.
Join the Discussion
The 7th Canine and Feline Breeding and Genetics Conference will bring together researchers, veterinary professionals, breed club representatives and breeders, to have serious, scholarly discussions on canine and feline genetics and genomics on September 11-12. Live streaming is also available. Please note that this is a high-level research conference. Read More
This article appeared in the August 2015 issue of our email newsletter – Progress Notes. Sign up for the newsletter and receive information on timely topics featuring our experts at Foster Hospital for Small Animals.