Integrated Pain Management
The Integrated Pain Management Service (IPMS) at NCSU Veterinary Teaching Hospital offers a wide range of diagnostic and therapeutic services to clients whose animals are suffering 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 Small Animal Surgery.
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 advice for veterinarians on the management of pain, and advice calls will be taken by Drs. Duncan Lascelles and Elizabeth Hardie (chronic pain) and Drs. Bernie Hansen, Cliff Swanson and Conny Gunkle. Veterinarians seeking advice on cases can call the service at 919.513.6500 when dealing with acute pain or 919.513.6588 for chronic pain questions. For referral of cases, veterinarians should call 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 also have considerable experience in clinical pain management, research in clinical pain management, have together written almost 100 papers on pain management, and have considerable experience in clinical pain management and teaching pain management to students and qulaified veterinarians. They are also playing a key role in the establishment of specialist training programs and certification in Animal Pain Management.
Advanced pressure mat diagnostics allow us to determine the distribution of pressure going through each of a cat's 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 emply as many non-drug treatments as appropriate for the individual. Such treatments are 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 types such as surgery, drug therapy, rehabilitation therapy, acupuncture, massage, hydrotherapy, and radiation therapy. Often the therapy involves liaison with sepcialist 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 you and your pet into an exam room and take a complete history while they perform a physical examination on your pet. 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 your veterinarian has sent with you or transmitted. The senior clinician will then introduce him or herself to you and examine your 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 your pet overnight.
- Diagnostic tests: for patients suffering pain often include specialized gait examinations, radiography, various blood tests, biopsies, and neurological examinations. Your 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 specialist services at the hospital will perform examinations and consultations (for example neurology, oncology).
- Discharge: At the time of discharge from the hospital (usually between 4 and 6 pm) the senior clinician will discuss your pet's painful condition with you and answer any questions you may have. 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 your pet's pain. A copy of these instructions will be faxed to your regular veterinarian if you have been referred. If your pet has to be admitted to the hospital overnight for any reason, the NCSU-VTH requires that you leave a deposit for half of the estimated total charges. Any form of payment (cash, check, or major credit card) is acceptable for this purpose.
- Treatment: The treatment recommended will very much depend on the reason for the pain. Sometimes, your pet will be transferred to another service if there is a treatable condition that is best managed by a specialist in that area. Treatments thay 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 specialist centers or specialist therapists (physical therapy/rehabilitation, massage, acupuncture).
- Follow-up: If the best results are to be aachieved in pain management, patients need to be re-evaluated. We will keep in contact with you by telephone and at re-examination visits. At these visits, specialized monitoring and assessment will be performed, and your treatment discussed. You, as the caregiver of your pet, have a very important role to play in the assessment of treatment outcome, and you will be integrally involved in the assessment and treatment process. Often, re-visits and procedures such as blood sampling can be performed by your local veterinarian. Your local veterianrian will be kept informed of all treatments and progress updates.