The Best Pain Medication Is the One Your Patient Never Needs.

By Steve Mehler, DVM, DACVS

For decades, pain management in surgery was largely reactive.

A patient woke up from anesthesia, showed signs of pain, and then received pain medication.

Today, veterinary medicine has embraced a very different philosophy—one supported by decades of research in both human and veterinary anesthesia:

The best pain management begins before the first incision is ever made.

It may sound counterintuitive, but one of the primary goals of modern surgery is to reduce the amount of pain medication a patient needs after surgery—not by withholding analgesia, but by preventing pain from becoming established in the first place.

Pain Changes the Nervous System

Pain isn't simply a message traveling from an injured tissue to the brain.

It's a dynamic process.

Every time a surgical incision is made, specialized nerve endings called nociceptors detect tissue injury and begin sending electrical signals toward the spinal cord.

If enough of these signals arrive, neurons within the spinal cord become increasingly responsive—a phenomenon known as central sensitization.

You can think of it like turning up the volume on a stereo.

Initially, a small pain signal produces a modest response.

But once the nervous system becomes sensitized, that same signal can feel much stronger.

This is why untreated pain can become progressively more difficult to control.

In some cases, even gentle touch near the surgical site becomes painful (allodynia), and normally painful stimuli become even more painful (hyperalgesia).

Once central sensitization develops, simply giving more pain medication afterward may not completely reverse it.

Preventing that amplification is often easier than treating it after it occurs.

Preemptive Analgesia vs Preventive Analgesia

Many people use these terms interchangeably, but they are not identical.

Preemptive analgesia refers to administering pain control before the surgical stimulus occurs.

Examples include:

• Opioids before induction

• Local anesthetic nerve blocks before incision

• NSAIDs given preoperatively when appropriate

The goal is simple:

Block pain transmission before the nervous system has a chance to become activated.

More recently, anesthesiologists have shifted toward the broader concept of preventive analgesia.

Rather than focusing only on what happens before the incision, preventive analgesia aims to minimize pain signaling throughout the entire perioperative period—from before surgery until tissue healing is underway.

This comprehensive strategy appears to provide greater benefits than any single intervention alone.

Why Local Anesthetics Are So Powerful

One of the most effective tools we have is also one of the oldest.

Local anesthetics don't merely numb tissue.

They block sodium channels in peripheral nerves, preventing pain signals from traveling toward the spinal cord.

If the signal never reaches the spinal cord...

The spinal cord cannot amplify it.

That's an important distinction.

Local blocks aren't simply masking pain.

They're interrupting the pain pathway before the nervous system can become sensitized.

Numerous veterinary studies have shown that regional anesthesia can:

• Reduce inhalant anesthetic requirements

• Improve cardiovascular stability during surgery

• Decrease postoperative pain scores

• Reduce rescue analgesic requirements

• Improve patient comfort during recovery

For many procedures, nerve blocks have become standard of care.

Multimodal Analgesia: Attacking Pain From Multiple Directions

Modern pain management rarely relies on a single medication.

Instead, veterinarians combine drugs that work through different mechanisms.

This is known as multimodal analgesia.

Depending on the procedure and patient, a pain protocol may include:

• An opioid

• A local anesthetic block

• An NSAID

• Acetaminophen (in dogs, when appropriate)

• Ketamine at subanesthetic doses

• Alpha-2 agonists

• Gabapentin for selected patients

Each medication targets a different part of the pain pathway.

Because the drugs complement one another, lower doses of each medication are often sufficient.

This reduces adverse effects while improving overall pain control.

Better Pain Control Doesn't Mean More Drugs

This is one of the biggest misconceptions owners have.

When they hear that their pet is receiving multiple pain medications, they sometimes assume the surgery must be especially painful.

In reality, the opposite is often true.

By using several medications strategically—each targeting different mechanisms of pain—we can frequently reduce the total amount of any one drug that the patient needs.

For example, a dog that receives:

• A regional nerve block

• An opioid before surgery

• An NSAID (when appropriate)

• Excellent anesthetic monitoring

may require significantly fewer rescue opioid doses after surgery than a dog that receives only postoperative analgesics.

The objective isn't to give more medication.

It's to give the right medications at the right time.

Does the Evidence Support This Approach?

Yes.

Both human and veterinary anesthesia literature consistently support multimodal, preventive analgesia.

Regional anesthesia has repeatedly been shown to decrease postoperative pain and reduce opioid requirements.

Preventing nociceptive input before and during surgery also reduces the development of central sensitization, leading to more comfortable recoveries in many patients.

No single drug eliminates surgical pain completely.

But combining multiple evidence-based techniques before pain becomes established provides the best opportunity for excellent postoperative comfort.

What This Means for Pet Owners

If your veterinarian discusses a detailed pain management plan before surgery, that's a good thing.

Modern anesthesia isn't simply about keeping a patient asleep.

It's about controlling pain before it starts.

That planning may include:

• Pain medications before anesthesia

• Regional nerve blocks

• Anti-inflammatory medications when appropriate

• Careful anesthetic monitoring

• Individualized recovery protocols

All of these strategies are designed to accomplish one goal:

Keep your pet comfortable while minimizing the amount of medication they need afterward.

The Bottom Line

One of the greatest advances in veterinary anesthesia hasn't been inventing a stronger pain medication.

It's understanding when pain medication works best.

Pain is much easier to prevent than it is to reverse.

By blocking pain before it reaches the spinal cord, minimizing nervous system sensitization, and using multiple complementary medications, veterinary surgeons can help patients recover more comfortably with less reliance on rescue analgesics.

In other words:

The best pain medication may be the one your patient never ends up needing because their pain was prevented from escalating in the first place.