Chronic pain in humans is defined as pain persisting longer than three months. There is no universally accepted definition of chronic pain in animals, however, which have shorter life spans than humans. While the terms ‘acute’ and ‘chronic’ are often used colloquially, this is not the only way to categorize pain and indeed, is not always the most useful way, as it doesn’t describe the pathophysiological mechanism underlying the patient’s pain. The terms ‘nociceptive’, ‘neuropathic’, and ‘nociplastic’, as defined by the International Association for the Study of Pain (IASP), describe the pathophysiological mechanism responsible for a patient’s pain, which helps guide treatment.

Comparative Pain Program faculty working at the Cornell University Hospital for Animals (CUHA) believe that long-term pain should be managed by multiple hospital services working in collaboration, each offering their expertise to provide the best possible outcome. The longer pain goes untreated, the more difficult it can be to manage; it also may not respond as well to commonly prescribed analgesic drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Our relationships with colleagues at Weill Cornell Medicine Pain Management treating people with chronic pain ensure that the CUHA remains at the cutting edge of pain management. We offer many of the same techniques used in people – treatments that few other hospitals provide. Most of these are interventional techniques – minimally invasive procedures performed under the guidance of an imaging modality such as ultrasonography. Read more about some of the specific techniques we offer below.

Epidural Injection

Epidural injection of various drugs, such as steroids, can be performed in patients suffering from pain due to intervertebral disk disease, lumbosacral stenosis, post-amputation neuropathic pain, cancer, and more.

Peripheral Nerve Blocks

Peripheral nerve blocks, usually performed using ultrasonography with or without nerve stimulation, can be used to treat neuropathic pain – pain caused by a lesion or disease of the somatosensory nervous system. Steroids are often injected around nerves, but other drugs are used as well. Peripheral nerve blocks may also be used to relieve joint pain.

Musculoskeletal Injections (Joint, Myofascial/Trigger Point, Tendon)

A variety of drugs (e.g., steroids), viscosupplementation, and orthobiologic therapy (mesenchymal stem cell therapy, platelet-rich plasma, etc.) can be used in musculoskeletal injections, which are usually performed under ultrasonography. Joint injections are most common, but attention to other tissues such as muscle and connective tissue as sources of pain is growing. For instance, trigger points (palpable, irritable, taut bands or knots within a muscle – usually neck or core muscle – that causes pain that radiates into a specific reference zone and sometimes causes muscle twitch when pressed) may be treated using dry-needling or injection of certain drugs. These techniques can be used in all species but are most commonly performed in dogs and horses, with use in farm animals increasing. Learn more about orthobiologics use in the Companion Animal Hospital here and in the Equine and Nemo Farm Animal Hospital here.

Non-Pharmacological Therapeutic Modalities

Electro-acupuncture, shock wave therapy, class IV laser therapy, transcutaneous electrical nerve stimulation, therapeutic ultrasound, and cold compression therapy/ cryotherapy are offered by the Companion Animal Hospital Sports Medicine and Rehabilitation Service and by the Equine and Nemo Farm Animal Hospital Sports Medicine and Rehabilitation Service.

Investigational Treatments

Thermal radiofrequency (TRF) and pulsed radiofrequency (PRF)

These interventional pain management procedures, which utilize radio waves, have been performed since the 1970s in human pain management centers to treat pain that does not respond to more conservative management. However, these have not yet been studied in dogs. We are conducting a clinical trial of combined TRF of the saphenous nerve and PRF of the sciatic nerve in dogs with stifle (knee) pain. In dogs, this is usually caused by cranial cruciate ligament rupture with or without meniscal injury. For more information, click here or visit the Clinical Trials website.

Cryoneurolysis

The Comparative Pain Program is conducting pre-clinical studies of cryoneurolysis in multiple species with the goal of beginning clinical trials in patients soon.

Chemoneurolysis

Chemicals such as alcohol and phenol have been injected perineurally (around nerves) in people to cause nerve degeneration that relieves pain. The Comparative Pain Program is in the early stages of research on chemoneurolysis which may prove to be effective against long-term pain from diseases such as end-stage osteoarthritis or cancer.