1 Sept 2026
Emma Gerrard DipHeCVN, DipAVN(SA), BSc(Hons), CVN, NCert(SurgNsg), RAMA(KSQP), FHEA, RVN highlights the important contribution of VNs to achieving optimal analgesic outcomes for the patient.
Emma Gerrard
Job Title
Image: DragonImages / Adobe Stock
Effective pain management is a fundamental component of modern veterinary practice and an essential aspect of animal welfare. Pain is now widely recognised as the “fourth vital sign”, alongside temperature, pulse and respiration, and should be assessed, treated and reassessed throughout a patient’s care.
Advances in the understanding of animal pain have transformed veterinary medicine, with increasing emphasis on proactive analgesia and the use of multimodal pain management strategies.
Non-steroidal anti-inflammatory drugs (NSAIDs) were approved as safe and effective agents for veterinary use in the 1990s, and they remain among the most prescribed analgesics in companion animal practice, with robust evidence available for efficacy and safety (Monteiro et al, 2022). When used appropriately, they provide safe and effective pain relief for a wide range of conditions, from routine surgical procedures to long-term management of osteoarthritis.
However, their use requires careful patient selection, monitoring, and client education; therefore, veterinary nurses (VNs) are well positioned to support the safe and effective use of NSAIDs through patient assessment, pain scoring, perioperative monitoring and owner communication.
This article explores the role of NSAIDs in pain management and highlights the important contribution of the VN to achieving optimal analgesic outcomes.
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. This revised definition, introduced in 2020, reflects the complex nature of pain and recognises that painful experiences may occur even in the absence of obvious tissue injury. Furthermore, the IASP acknowledges that pain is influenced by biological, psychological and social factors, and that the inability to verbally communicate does not negate the possibility of experiencing pain. These principles are particularly relevant in veterinary medicine, where assessment relies on recognising behavioural and physiological indicators rather than patient self-reporting.
Although pain serves an important protective function by encouraging behaviours that minimise injury and facilitate healing, unmanaged pain has significant consequences for animal welfare and can negatively affect recovery, behaviour, mobility, appetite and overall quality of life.
Untreated pain has been associated with immune suppression, increased cardiovascular strain, behavioural changes and delayed recovery (Clancy, 2025). Current pain management guidelines emphasise that pain assessment, treatment and reassessment should be viewed as a continuous process (Gruen et al, 2022; Monteiro et al, 2022). This highlights the important role of the VN, who is often best placed to identify changes in patient comfort and evaluate the effectiveness of analgesic interventions.
Pain can be broadly categorised as either acute or chronic, and recognising the differences between these pain states is important when selecting appropriate analgesic and nursing interventions.
Early identification and effective management of pain can have a profound impact on patient welfare and clinical outcomes. Through careful observation, patient assessment and the use of validated pain scoring tools, VNs play a pivotal role in identifying pain and ensuring that analgesic strategies are implemented, monitored and regularly reassessed.
Acute pain develops following tissue injury, surgery, trauma or inflammation, and serves a protective role by encouraging rest and preventing further injury (Clancy, 2025). However, acute pain also triggers physiological stress responses including increased heart rate, blood pressure and cortisol release.
If inadequately managed, acute pain may delay recovery and contribute to peripheral and central sensitisation, resulting in increased pain perception and poorer patient outcomes (Gruen et al, 2022; Monteiro et al, 2022).
Chronic or maladaptive pain persists beyond the expected period of tissue healing and often becomes a disease process in its own right (Taylor et al, 2024). Common causes include osteoarthritis, degenerative joint disease, chronic dental disease and some cancer-related conditions. Chronic pain can be challenging to recognise because clinical signs are often subtle and may be mistaken for normal ageing. Reduced activity, reluctance to exercise and changes in behaviour or social interaction may all indicate persistent discomfort.
Pain is a complex physiological process involving multiple pathways and mediators. As a result, relying on a single analgesic drug is often insufficient to provide optimal pain relief.
Current pain management guidelines advocate a multimodal approach, whereby different analgesic techniques and drug classes are combined to target multiple points within the pain pathway. NSAIDs contribute to multimodal analgesia by acting primarily at the transduction and modulation stages of the nociceptive pathway, and may provide opioid-sparing effects when used in combination with other analgesic agents (Scales, 2021). Such protocols may incorporate NSAIDs, opioids, local anaesthetic techniques, alpha-2 agonists and adjunctive medications such as gabapentin.
By combining analgesic modalities, more effective pain control can be achieved while reducing reliance on any one drug and potentially minimising dose-related adverse effects. Within these protocols, NSAIDs form a cornerstone of analgesic therapy because of their effectiveness in managing inflammatory pain associated with both acute and chronic disease processes (Gruen et al, 2022; Monteiro et al, 2022).
NSAIDs produce their analgesic, anti-inflammatory and antipyretic effects by inhibiting cyclooxygenase (COX) enzymes, which are involved in the production of prostaglandins (Monteiro and Steagall, 2019). Prostaglandins play a key role in the development of pain and inflammation, increasing following tissue injury, surgery or chronic inflammatory conditions such as osteoarthritis. By reducing prostaglandin production, NSAIDs help alleviate pain, reduce inflammation and improve patient comfort.
Two main COX enzymes exist. COX-1 helps maintain normal body functions such as protecting the stomach lining, supporting kidney health and aiding blood clotting, while COX-2 is mainly associated with inflammation and pain.
Most veterinary NSAIDs are designed to act primarily on COX-2, reducing pain and inflammation while preserving the protective effects of COX-1. Nevertheless, some effects on COX-1 can still occur, which is why adverse effects affecting the gastrointestinal tract, kidneys and, less commonly, the liver remain possible.
Commonly used veterinary NSAIDs include meloxicam, carprofen, robenacoxib and firocoxib, all of which are available in a variety of formulations, including injectable, tablet and oral liquid preparations, allowing treatment to be tailored to individual patient needs (Monteiro et al, 2022; Taylor et al, 2024). NSAIDs are widely used in the management of acute pain, particularly in surgical and traumatic cases. Their perioperative administration has been shown to reduce inflammation associated with tissue trauma and improve postoperative comfort (Gruen et al, 2022; Monteiro et al, 2022).
Furthermore, administration before painful procedures may help reduce peripheral and central sensitisation, contributing to improved postoperative analgesia (Scales, 2021).
Consequently, NSAIDs are routinely incorporated into analgesic protocols for patients undergoing procedures such as neutering, orthopaedic and soft tissue surgery, as well as for patients recovering from traumatic injuries.
The role of NSAIDs is particularly important in the management of chronic musculoskeletal pain – especially osteoarthritis. Osteoarthritis is among the most common causes of chronic pain in ageing dogs and cats, and represents a significant welfare concern.
Progressive inflammation and degeneration within affected joints contribute to pain, reduced mobility and a decline in quality of life. Long-term NSAID therapy remains one of the most effective pharmacological interventions available for osteoarthritis and has been shown to improve mobility, increase activity levels, encourage exercise and enhance overall quality of life in many patients (Innes et al, 2010; Taylor et al, 2024).
However, successful chronic pain management requires a holistic approach that extends beyond pharmaceutical intervention alone. Weight management, appropriately controlled exercise programmes, environmental modifications, physiotherapy, rehabilitation and, in some cases, complementary therapies such as acupuncture, may all contribute to improved patient outcomes. VNs frequently play a central role in coordinating these interventions and supporting owners throughout the animal’s treatment journey (Gruen et al, 2022; Taylor et al, 2024).
Although NSAIDs are highly effective analgesics, their use is not without risk. Because prostaglandins also perform important protective physiological functions, inhibition of their production may result in adverse effects in susceptible patients.
The gastrointestinal tract is most commonly affected, with adverse reactions ranging from mild gastrointestinal upset to severe ulceration. Clinical signs may include vomiting, diarrhoea, reduced appetite, melena and, in severe cases, gastrointestinal ulceration or perforation (Monteiro and Steagall, 2019; Taylor et al, 2024).
Renal adverse effects are another important consideration. Because prostaglandins help maintain renal perfusion, NSAID administration may increase the risk of renal compromise in patients with dehydration, hypovolaemia, hypotension or pre-existing renal disease. Patients should, therefore, ideally be euvolaemic and normotensive before treatment (Scales, 2021; Monteiro et al, 2022; Taylor et al, 2024). This is particularly important during the perioperative period, when VNs play a central role in monitoring hydration status, blood pressure, recovery quality and postoperative pain. Maintaining cardiovascular stability during anaesthesia helps minimise the risk of NSAID-associated renal injury (Scales, 2021; Monteiro et al, 2022).
Although less common, hepatotoxicity has also been reported. Clinical signs may include lethargy, reduced appetite, vomiting and, in severe cases, jaundice. Patients receiving long-term treatment should be reassessed regularly, with monitoring protocols determined according to the individual patient’s risk factors and clinical status (Monteiro et al, 2022; Taylor et al, 2024).
VNs play a key role in the safe and effective use of NSAIDs. As patient advocates, they are uniquely placed to identify pain, monitor treatment response, educate owners and support analgesic decision-making through their close involvement in patient care (Clancy, 2025).
Prior to NSAID administration, VNs contribute to patient risk assessment by obtaining accurate bodyweights, evaluating hydration status, collecting a thorough medication history and identifying previous adverse reactions or concurrent therapies – particularly corticosteroids. They may also assist with blood and urine sampling for baseline and ongoing monitoring of patients receiving long-term NSAID therapy, helping to identify potential complications at an early stage (Taylor et al, 2024).
Pain should be viewed as a dynamic clinical parameter requiring continuous evaluation rather than a one-off assessment. Regular reassessment allows analgesic plans to be refined and helps ensure effective pain control throughout recovery and ongoing treatment.
Validated pain scoring tools, including the Glasgow Composite Measure Pain Scale, the Feline Grimace Scale and species-specific grimace scales used in other companion animals, support objective assessment, enabling VNs to monitor patient comfort, evaluate response to analgesia and communicate findings effectively within the veterinary team (Reid et al, 2007; Evangelista et al, 2019). Training in the use of these tools has also been shown to improve scoring accuracy and agreement between assessors, supporting more consistent pain recognition and management (Robinson and Steagall, 2024).
Client education is one of the most valuable contributions VNs make to NSAID safety. Nurse-led clinics provide opportunities to monitor mobility, body condition, quality of life and treatment compliance, helping to ensure long-term analgesic plans remain safe and effective.
Owners should receive clear guidance on dosing, administration, and potential adverse effects, and should never alter doses without veterinary advice. They should also be warned against administering human NSAIDs, such as ibuprofen or naproxen, which can be highly toxic to dogs and cats.
Owners should also be encouraged to monitor for and promptly report signs such as vomiting, diarrhoea, appetite changes, lethargy or alterations in drinking behaviour. Early identification of adverse effects allows timely intervention and can significantly improve patient outcomes. By empowering owners to become active participants in monitoring their pets, VNs strengthen patient advocacy, improve medication safety and, ultimately, enhance animal welfare.
In summary, NSAIDs remain a cornerstone of acute and chronic pain management in companion animals. While highly effective, their use requires appropriate patient selection, monitoring and client education to minimise risk.
VNs play a central role in assessing pain, monitoring treatment response, identifying adverse effects and supporting owners. Through these activities, VNs make a significant contribution to patient welfare and the safe, effective use of NSAIDs in practice.
Emma Gerrard began her veterinary nursing career in 2001 and qualified as a veterinary nurse in 2005. She has experience in mixed, small animal, and emergency and critical care practice. After more than 20 years in clinical practice, she moved into higher education in 2023. Emma is currently a veterinary nursing lecturer at Aberystwyth University. Alongside her academic role, she is a RAMA (SQP), chairperson of regions for BSAVA, a member of the BSAVA Cymru Wales regional and publications committees, and a tutor for ONCORE ePD. Emma is editor of the second edition of the BSAVA Pocketbook for Veterinary Nurses and a regular contributor to veterinary nursing publications.