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Orthopedic Pain Management in Pets: Multimodal Approaches

Orthopedic Pain Management in Pets: Multimodal Approaches

Best Practices

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Learn how multimodal pain management improves recovery in pets after orthopedic surgery using meds, rehab, and at-home care

By 

Sustainable Vet Group

Updated on

April 22, 2025

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Why Pain Management Needs a Multimodal Approach in Orthopedic Cases

Orthopedic pain in pets can be complex. It often involves both acute pain (right after surgery or injury) and chronic pain from long-term joint damage or arthritis. Managing this pain with a single drug, like an NSAID alone, is often not enough to keep pets comfortable.

A multimodal approach uses a combination of medications and therapies that work on different parts of the pain pathway. This can include NSAIDs, opioids, local anesthetics, gabapentin, and non-drug options like cold therapy or laser treatments.

Using multiple methods allows for better pain control with fewer side effects, since lower doses of each drug can be used. It also helps prevent pain from becoming long-lasting or harder to manage. Overall, this approach supports faster recovery, improved movement, and better long-term quality of life for orthopedic patients.

Preemptive Analgesia: Managing Pain Before It Starts

Preemptive analgesia means controlling pain before it begins—not just treating it after surgery or injury. This approach helps prevent the nervous system from becoming over-sensitized, a condition known as central sensitization or “wind-up” pain. Once this happens, pain can become harder to manage and may continue even after the tissue has healed.

Why timing matters:
Giving pain medications before surgery or trauma reduces the brain’s response to painful signals. This leads to better pain control during and after the procedure, with less need for high-dose medications later.

Common drugs used for preemptive analgesia include:

  • NSAIDs (e.g., carprofen, meloxicam) to reduce inflammation
  • Opioids (e.g., morphine, fentanyl) for strong pain relief
  • Local anesthetics (e.g., lidocaine, bupivacaine) as nerve blocks or incisional line blocks
  • Gabapentin to calm nerve-related pain, especially in chronic cases

Using preemptive analgesia as part of a multimodal plan helps pets wake up more comfortably after surgery and reduces the risk of lingering pain. It sets the foundation for faster healing and smoother recovery.

Core Pharmacologic Strategies for Orthopedic Pain

Orthopedic pain often involves both inflammatory and neuropathic components, requiring multiple drug classes for effective management. Here’s how each group contributes to a comprehensive pain control plan.

1. NSAIDs for Inflammatory and Joint Pain

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of defense against orthopedic pain. They work by blocking prostaglandins, which cause inflammation, swelling, and pain after injury or surgery.

Common choices include:

  • Carprofen
  • Meloxicam
  • Firocoxib
  • Deracoxib

Usage tips:

  • Best used in otherwise healthy pets with no kidney, liver, or GI issues
  • Start before surgery when possible (as part of preemptive analgesia)
  • Monitor hydration, appetite, and stools during treatment
  • Avoid combining with corticosteroids or other NSAIDs to prevent GI damage

NSAIDs are especially effective for managing post-op inflammation, joint disease, and chronic arthritis pain. They’re typically used for several days post-surgery and may be continued long term for degenerative joint conditions.

When used correctly and monitored closely, NSAIDs provide reliable pain relief and are essential to any orthopedic pain protocol.

2. Opioids for Acute Surgical Pain

Opioids are powerful pain relievers used mainly for short-term pain control during and immediately after orthopedic surgery. They work by binding to receptors in the spinal cord and brain to block pain perception.

Common opioids include:

  • Morphine
  • Hydromorphone
  • Fentanyl (CRI or patch)
  • Buprenorphine (for mild to moderate pain)

Key uses:

  • Administered before, during, or just after surgery
  • Often delivered as an injection, IV constant rate infusion (CRI), or transdermal patch
  • May be combined with sedatives for comfort and restraint

Opioids are highly effective in controlling acute post-op pain, especially in the first 24–72 hours. Their use in hospitals allows close monitoring for side effects like sedation, nausea, or slow breathing.

They are not typically used long term but are critical in the perioperative window to keep pain levels low and prevent pain sensitization.

3. Local Anesthetics and Nerve Blocks

Local anesthetics provide targeted pain relief by temporarily blocking nerve signal transmission. They’re used both intraoperatively and postoperatively for regional anesthesia, particularly in limb surgeries.

Common agents:

  • Lidocaine – fast onset, short duration
  • Bupivacaine – slower onset, longer duration (4–8 hours)

Common applications:

  • Nerve blocks (e.g., femoral, sciatic) for hindlimb procedures
  • Incisional line blocks during or after surgery
  • Joint injections in arthroscopic procedures

Local blocks can significantly reduce the need for systemic drugs, lowering side effects and improving comfort. They are especially helpful in orthopedic cases involving the limbs, where nerves can be easily targeted.

Surgeons may repeat local blocks post-op or use soaker catheters for ongoing delivery. When used as part of a multimodal approach, local anesthetics improve pain control and shorten recovery times.

4. Ketamine and NMDA Receptor Antagonists

Ketamine is a dissociative anesthetic that also acts as an NMDA receptor antagonist, which helps block “wind-up” pain and central sensitization. This makes it useful not just for anesthesia, but also for preventing chronic pain.

How it's used:

  • Often given as a low-dose CRI during surgery
  • Can be combined with opioids or lidocaine in multimodal infusions
  • May reduce opioid requirements and improve overall comfort

Benefits in orthopedic cases:

  • Helps manage severe surgical pain
  • Prevents long-term changes in the spinal cord’s pain response
  • Useful for repeated orthopedic surgeries or animals with long-standing pain

Ketamine is especially helpful in patients who have shown poor response to standard pain meds or are at risk for developing chronic pain post-surgery. It’s rarely used as a solo agent but is highly valuable in perioperative pain protocols.

5. Gabapentin for Neuropathic or Chronic Pain

Gabapentin is an anticonvulsant that also works well for nerve-related pain. It’s often used in dogs and cats with chronic orthopedic conditions like arthritis, degenerative joint disease, or spinal issues.

How it works:

  • Modulates nerve activity in the spinal cord and brain
  • Reduces the overfiring of pain signals caused by chronic or neuropathic conditions

When to use:

  • As part of a post-op protocol, especially in pets already experiencing chronic pain
  • In long-term management of arthritis or intervertebral disc disease
  • Often paired with NSAIDs or opioids for better control

Gabapentin is well tolerated but can cause mild sedation or wobbliness, especially when starting treatment. Dosing should be adjusted based on the patient’s weight, age, and kidney function.

As a non-opioid option, gabapentin is a key component of long-term pain management plans and is particularly effective for older dogs with joint degeneration or neurologic pain following orthopedic surgery.

Postoperative Pain Control and Monitoring

Effective postoperative pain management is critical to recovery in orthopedic patients. Pain can change quickly in the hours and days after surgery, so frequent monitoring and adjustments are necessary to keep patients comfortable and healing well.

Pain reassessment frequency and methods:

  • Reassess pain every 2 to 4 hours in the first 24 hours after surgery
  • Use a consistent pain scoring system (e.g., Glasgow Composite Measure Pain Scale)
  • Watch for signs like increased heart rate, vocalization, reluctance to move, or changes in posture and appetite

Adjusting drug combinations based on response:

  • Increase or adjust doses if pain signs persist
  • Add or rotate drugs such as gabapentin or local anesthetics when needed
  • Reduce medications gradually as healing progresses and pain decreases

Role of early mobilization and comfort:

  • Encourage light, controlled movement as recommended by the surgeon
  • Use soft bedding, quiet spaces, and low-stress handling
  • Monitor limb use and behavior closely to track progress

By reassessing regularly and customizing pain plans, veterinarians can reduce complications, speed up recovery, and improve the overall well-being of orthopedic patients after surgery.

Non-Drug Therapies to Support Recovery

In addition to medications, non-drug therapies play a major role in improving comfort, reducing complications, and speeding up recovery in orthopedic patients. These methods are especially helpful in managing both acute and chronic pain.

Cold and Heat Therapy

Cold therapy is most useful in the first 72 hours after surgery or injury. It helps reduce inflammation, swelling, and pain by slowing blood flow to the area. Apply a cold pack wrapped in a towel for 10 to 15 minutes, 2 to 4 times daily. Always monitor the skin for signs of irritation or discomfort.

Heat therapy is more appropriate after the initial swelling has gone down—usually 4 to 5 days post-op. It helps relax tight muscles, improve blood flow, and ease stiffness. Use a warm (not hot) compress for short sessions, never on swollen or inflamed areas.

Both methods are simple and effective ways to manage pain, especially when combined with other treatments. They also help prepare the muscles and joints for gentle rehab exercises.

Physical Rehab and Exercises

Physical rehabilitation is a key part of any orthopedic recovery plan. It helps restore strength, joint motion, coordination, and balance. Rehab also reduces stiffness and muscle loss that can occur from inactivity after surgery.

Rehab programs may include passive range-of-motion exercises, controlled leash walks, balance training, and hydrotherapy. These exercises are introduced gradually and must be tailored to the specific surgery and the dog’s comfort level.

Starting rehab too early or too aggressively can cause setbacks, so it's important to follow the surgeon’s timing and guidelines. Rehab sessions may be done at a vet rehab center or supported at home with guidance.

Consistent, gentle rehab promotes faster recovery, better mobility, and a reduced risk of long-term lameness. It’s especially important in procedures like TPLO, joint replacements, and fracture repairs.

Acupuncture and Integrative Options

Acupuncture is gaining popularity as a supportive treatment for orthopedic pain, especially in dogs with chronic joint issues or slow-healing post-op discomfort. It involves inserting fine needles into specific points on the body to help regulate pain signals and improve circulation.

Veterinary acupuncture can reduce inflammation, ease muscle tightness, and enhance the effects of other pain control methods. It is often used alongside medications, rehab, and laser therapy for a more complete recovery plan.

Other integrative options include therapeutic laser, massage therapy, PEMF (pulsed electromagnetic field) therapy, and chiropractic care. These non-invasive techniques may be especially helpful in senior pets, those with multiple orthopedic issues, or when drug use must be limited.

These therapies should be used under the supervision of a trained professional. When integrated into a multimodal pain management plan, they can improve outcomes and quality of life for both surgical and non-surgical orthopedic patients.

Chronic Pain Management in Orthopedic Conditions

Chronic orthopedic pain often develops from long-term joint diseases such as osteoarthritis (OA), previous injuries, or complications like implant failure. These conditions are progressive and can significantly impact a pet’s mobility, comfort, and overall quality of life.

Common causes of chronic orthopedic pain:

  • Osteoarthritis in hips, elbows, or knees
  • Malunion or nonunion fractures
  • Joint instability or failed surgical repairs
  • Long-term strain on compensating limbs

Multimodal pain protocols for aging pets:

  • NSAIDs for inflammation control (as long as organ function allows)
  • Gabapentin or amantadine for neuropathic or sensitized pain
  • Joint supplements such as glucosamine, chondroitin, and omega-3 fatty acids
  • Weight management to reduce joint stress
  • Regular, low-impact exercise and physical therapy
  • Periodic acupuncture, laser therapy, or PEMF

Managing flare-ups and progression:

  • Adjust medications during pain flare-ups or cold weather
  • Use heat therapy to ease stiffness
  • Monitor activity level changes and signs of discomfort
  • Schedule regular checkups and radiographs to reassess progression

Chronic pain management requires ongoing care, flexible treatment plans, and regular communication with pet owners to adjust strategies over time.

How to Assess Pain in Orthopedic Patients

Accurately assessing pain in dogs and cats with orthopedic conditions is essential for effective treatment. Since pets can’t verbalize pain, veterinarians must rely on behavioral cues, physical exams, and structured tools to evaluate discomfort levels.

Common behavioral signs of orthopedic pain:

  • Limping or uneven weight-bearing
  • Reluctance to jump, climb stairs, or go for walks
  • Difficulty rising or lying down
  • Changes in posture or gait
  • Reduced appetite or interaction
  • Vocalizing, restlessness, or licking painful areas

Pain scoring tools used in practice:

  • Glasgow Composite Pain Scale
  • Colorado State University Canine Acute Pain Scale
  • Feline Grimace Scale
  • Numeric or visual analog scales (1–10 scoring)
  • Daily pain and mobility checklists for owners to track at home

When to adjust treatment:

  • Escalate therapy if the pet’s activity level decreases, pain signs worsen, or response to current medication is poor
  • Taper treatment when pain is well-controlled, mobility improves, and side effects emerge
  • Reassess regularly, especially after surgery or during disease progression

Consistent pain assessment allows timely adjustments in medication and helps improve outcomes in both acute and chronic orthopedic cases.

Guiding Pet Owners Through At-Home Pain Monitoring

Helping pet owners understand how to monitor pain at home is key to successful orthopedic care. Many signs of pain appear outside the clinic, so owners play a big role in early detection and long-term management.

What signs to watch for:

  • Limping or uneven movement
  • Reluctance to rise, walk, or play
  • Whining, restlessness, or hiding
  • Decreased appetite or change in normal behavior
  • Guarding or licking at the surgical or painful area

Owners should be encouraged to keep a simple daily log of their pet’s activity, appetite, mood, and any mobility changes. This helps track progress and catch setbacks early.

When to contact the vet:

  • Increased limping or discomfort
  • Swelling, redness, or discharge near a surgical site
  • Changes in medication response
  • Signs of adverse effects like vomiting, diarrhea, or lethargy

Importance of treatment compliance:

  • Skipping medications or rehab sessions can delay healing or worsen pain
  • Clear communication about timing, dosage, and activity limits helps ensure success

Ongoing support and education empower owners to participate actively in their pet’s recovery and long-term comfort.

Collaborative Team Approach in Ortho Pain Management

Managing orthopedic pain effectively requires a team-based approach. Collaboration between the general practitioner, orthopedic surgeon, rehabilitation specialist, and clinic staff ensures continuity of care from surgery through long-term recovery.

Key team roles:

  • General Practitioner (GP): Often the first to diagnose and manage early pain. GPs also handle post-op monitoring, adjust medications, and support owners with at-home care.
  • Orthopedic Surgeon: Designs the surgical and immediate post-op pain plan, selects advanced pain control methods, and oversees surgical healing.
  • Rehabilitation Vet or Therapist: Helps restore function through tailored rehab plans including exercises, cold/heat therapy, and manual techniques.
  • Support Staff (Technicians, Nurses): Deliver daily pain scoring, administer medications, and educate pet owners consistently.

A shared care model ensures all team members follow the same pain protocols and communicate changes clearly. This prevents under- or over-treatment and keeps pain control well-coordinated.

Benefits of a team approach:

  • Faster adjustments to pain management
  • Better tracking of progress across appointments
  • Increased client confidence and compliance

When the full team works together, pets receive safer, more effective care—leading to better recovery outcomes and improved quality of life.

Final Thoughts

Pain management is a critical part of orthopedic care—not just for comfort, but for healing, mobility, and long-term quality of life. When pain is well controlled, pets move more, recover faster, and experience fewer complications after surgery or injury.

Today, multimodal pain strategies are essential, not optional. Combining drug and non-drug treatments helps target pain from different angles, reduces reliance on any one medication, and lowers the risk of side effects. From preemptive analgesia to long-term rehab, every stage of care benefits from a thoughtful, layered approach.

Veterinarians, technicians, and pet owners must work together to monitor pain, adjust treatment plans, and support recovery at home. With the right tools and communication, we can make a real difference in the lives of orthopedic patients—ensuring they heal well and stay active, comfortable, and happy.

FAQs

What is multimodal pain management in veterinary orthopedics?

Multimodal pain management uses a combination of medications and therapies to target different pain pathways. This approach provides more complete relief, reduces drug doses, and minimizes side effects. It often includes NSAIDs, opioids, nerve blocks, physical rehab, and supportive care for both surgical and chronic orthopedic conditions.

Why is preemptive analgesia important before orthopedic surgery?

Preemptive analgesia controls pain before it starts. Giving pain medications before surgery reduces central sensitization, or “wind-up” pain, which makes pain harder to treat later. It leads to smoother recovery, lower drug needs post-op, and better comfort for pets during and after orthopedic procedures.

How do NSAIDs and opioids work differently in pain control?

NSAIDs reduce inflammation and block pain at the injury site by targeting prostaglandins. Opioids act in the brain and spinal cord to block the perception of pain. Used together, they address different levels of the pain pathway and provide more effective control during orthopedic recovery.

Is it safe to combine multiple pain medications in pets?

Yes, combining medications is safe when done correctly by a veterinarian. Each drug targets a different mechanism of pain, allowing lower doses and better control. Careful monitoring is essential to avoid side effects, especially with NSAIDs, opioids, or nerve-targeting drugs like gabapentin.

What non-drug therapies help with orthopedic recovery in dogs and cats?

Non-drug therapies include cold and heat therapy, physical rehabilitation, hydrotherapy, acupuncture, laser therapy, and massage. These methods reduce pain, improve mobility, and support healing. They are especially helpful in chronic pain cases or as part of a post-surgery recovery plan.

How can I tell if my pet is still in pain after surgery?

Signs include limping, reluctance to move, changes in appetite, vocalization, restlessness, or avoiding contact. Some pets may also lick the surgical site or isolate themselves. If any of these signs appear, contact your veterinarian to reassess pain control and adjust the treatment plan.

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