Veterinary Ambulatory of Pain and Palliative Care, São Paulo University, Brazil
Submission: March 01, 2018; Published: April 19, 2018
*Corresponding author: Maira Rezende Formenton, Professor at Bioethicus Institute, Fisioanimal Rehabilitation Center, Veterinary Ambulatory of Pain and Palliative Care, São Paulo University, Brazil, Email: [email protected]
How to cite this article: Maira R F. Physiotherapy for Pain Control in Dogs and Cats. J Yoga & Physio. 2018; 4(5): 555646. DOI: 10.19080/JYP.2018.04.555646
Analgesia and pain control are essential issues in the area of veterinary rehabilitation. Considered as the fourth vital sign, acute or chronic pain requires early intervention, the anticipation of evolution, and assessment to achieve individualized treatment protocols. The acronym PLATTER (PLan, Anticipate, TreaT, Evaluate, and Return) , guides the professional for the establishment of analgesia, including in the area of physiotherapy.
Following the acronym, the first stage involves planning. In a rehabilitation program, it refers to the choice, within the methods available, those suitable for that patient’s condition. For example, laser therapy (Figure 1) may be the choice for a feline with spine pain, as it is an easy and non-invasive method with good acceptance of the species. But for a dog that accepts manipulation, acupuncture associated with massage therapy (Figure 2) can bring the result of analgesia as quickly and pleasantly treatment .
Anticipation refers to predicting the occurrence of pain and then prevent patient exposure to painful experience. A typical example is patients with osteoarthritis, which in the colder months tend to present hyperalgesia (Figure 3). It is possible, for example, to intensify physiotherapy sessions in the months before winter and thus anticipate the treatment, and allow a higher quality of life during this period for the animal. TreaT is the choice of methods for the treatment itself. We must remember that must always be multimodal, and the association of pharmacological methods with rehabilitation brings the best benefits. It should be considered from the disease of the animal to the financial conditions of the owners to establish the best treatment. Table 1 shows the primary methods of rehabilitation for the control of pain and analgesia.
Finally, the Evaluate and Return in physiotherapy should be done at each session, to adjust the protocols and methods applied. The evolution of the patient can be fast, especially in cases of acute pain, and the change of approach can occur each session. For chronic, recurrent, maladaptive or neuropathic pain, the improvement can happen within 4 to 6 sessions, so, reassessment can wait for this period. In this process of pain assessment, considering the anamnesis, it should take into account aspects reported by the animal’s tutor such as lameness, reluctance to move, decreased appetite, excessive licking and even self-mutilation. To assist in the identification and quantification of pain, it is recommended to use unidirectional scales such as the Verbal Numerical Scale associated with multidirectional scales such as the Helsinki questionnaires and the Glasgow pain scale, or quality of life such as Yazbek & Fantoni  questionnaires.
Inflammation is another pathological process directly related to pain. Physiotherapy has complementary means to control inflammation, in order not only to reduce pain but also to reduce the use of medications that may cause side effects in the long term [4,5]. The control of the inflammatory process has other benefits besides analgesia, among them: the improvement of functional limitations and increased mobility, reduced the time of recovery postoperatively, improvement in the quality of life [6,7].
As a result of this relationship between reduction of inflammation and pain, a study in dogs  showed that the use of the association between low power laser therapy and electrotherapy in the form of TENS confers reduction of pain scores and the lesser need for analgesic rescue. Two groups of dogs were established postoperatively for knee surgery, one group undergoing the therapies as mentioned above three times a week, for two weeks, the other was the control-placebo group. The evaluation was done by pain scales, baropodometry, and thermography. The animals submitted to the laser therapy sessions associated with electrotherapy obtained better pain scores and less analgesic rescue. When addressing chronic inflammation, physical therapy may benefit from better support and quality of life in patients with arthrosis, back pain, and even cancer patients [9-20].
The method for the pain control during physiotherapy should be established based on planning, assessment and multimodal choice of the treatment, to obtain the highest level of comfort for the patient, as quickly and efficiently as possible.