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Relieve Chronic Pain Using a Pyramid Approach

Dog looking sad, tired, sick


Managing chronic pain is complex. The goal of any pain treatment plan is to address all the treatable issues. It is recommended to apply a multimodal, balanced approach that incorporates restoration of normal body composition, pharmaceuticals, nutraceuticals, and physiotherapy. When creating a program, the most essential component to the whole program is pet parent buy-in. Without it, successful pain management in the patient in will be nearly impossible.

Since most animals that are in chronic pain are less active and overweight, restoring the animal to a normal body composition is the first step of the pain management pyramid. Creating an appropriate, long term nutritional plan and using physiotherapy are important steps in achieving this goal.

The mainstay of breaking the pain cycle from a pharmacological perspective is NSAID therapy. A multimodal approach to pain management should help facilitate the titration of NSAID use down to the lowest effective dose. Adding gabapentin is beneficial to address maladaptive pain. Amantadine, a NMDA receptor antagonist, may also have a role in chronic pain management, but is often cost prohibitive for many pet parents unless compounded.

Providing cartilage support through the use of nutraceuticals is another important, complimentary component of the pain management pyramid. Undenatured collagen type-II, as found in Flexadin Advanced with UC-II, works via oral tolerance to address pain from an immunologic perspective. Omega-3 fatty acids in the triglyceride form, such as is found in Triglyceride Omega, used at a therapeutic level can also benefit animals with arthritic pain.

Physiotherapy modalities such as therapeutic lasers (photobiomodulation), chiropractic manipulation, medical massage, hydrotherapy, and hot/cold packs, can all contribute to making patients more comfortable. These modalities are also an excellent way to involve the whole healthcare team in helping the chronic pain patient. Additionally, support staff can play an important role in reviewing and documenting all steps taken, scheduling follow up care, and helping pet parents stay on track with feeding and nutrition.

Using the pyramid approach, clinicians should succeed in getting chronic pain patients as comfortable, functional, and strong as possible prior to adjusting any part of the treatment plan. To learn more about this approach, as well as addressing fear in the chronically painful patient, check out this recent Fear Free webinar.


Chronic pain can be a challenge to diagnose and treat; successful management requires a multimodal approach involving the whole healthcare team and significant pet parent buy-in.

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.

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