PAIN SCORING in DOGS: an OBJECTIVE ASSESSMENT PAIN SCORING in CATS: an OBJECTIVE ASSESSMENT (Combined)
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PAIN SCORING IN DOGS: AN OBJECTIVE ASSESSMENT PAIN SCORING IN CATS: AN OBJECTIVE ASSESSMENT (Combined) Kirk Munoz, DVM (Hons), PgCert BA, MRCVS, cVMA, DACVAA Board Certified Specialist in Veterinary Anesthesia and Analgesia Assistant Professor, Anesthesia Fear Free Certified Professional College of Veterinary Medicine- Michigan State University 784 Wilson Rd, East Lansing, MI 48824 [email protected] Maggie (Pratt) Bodiya BS, LVT, VTS- AVTAA Veterinary Technician Specialist (Anesthesia/Analgesia) Veterinary Nurse III (Anesthesia Dept.) Academic Instructor (MSU Veterinary Nursing Program) Fear Free Certified Professional College of Veterinary Medicine- Michigan State University 784 Wilson Rd, East Lansing, MI 48824 [email protected] Pain is a multifactorial experience involving both sensory and emotional components. There have been many definitions of pain but the most recent and accepted one has been stated by The International Association for the Study of Pain which states that, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Cats tend to display many of the signs associated with pain in dogs, but they may vary from dogs in the sense that they can also appear very grumpy and remain in a quiet crouched position. In some cases, cats will purr when they are happy and also in pain, so this cannot be relied on to determine if a cat is painful or not. This goes to prove the point that no one sign can be used to determine if an animal is painful and the extent of the pain that animal is experiencing. Animals that are painful may become very reserved and quiet, i.e. lay quiet at the back of the cage and not move or they may become very aggressive and attack their site of pain and or persons that are trying to care for them. Assessment of pain has historically been performed in a very subjective manner. Pain can be difficult to evaluate especially in non-verbal animals and humans. Certain factors such as genetics, breed and age of animals have been shown to affect the way animals respond to pain. It has been reported that red-heads, for example are less sensitive to the effects of some drugs and thus higher dosages of analgesics may be needed to manage pain in these animals. Factors such as heart rate, blood pressure and cortisol levels have also been used to assess pain in animals, but it is important to remember that other conditions such as fear, anxiety, stress, anesthesia, pharmacological interventions, etc. can also contribute to an increase in these values. On their own, they are therefore not good evaluators of pain. A study which involved veterinary professionals found that 8.1% used a pain scoring system, while 80.3% thought that it was a useful tool. Pain that is left untreated can lead to delayed recovery, a decrease in quality of life and it also disrupts the human–animal bond. There are a few simple and quick pain scoring scales available, such as the vertical analog scale (VAS), descriptive and numerical rating scales. These are unidimensional scales and have been shown to have high variability, as high as 35%, in pain scoring among veterinary staff looking at the same patient. This variability has been found to be even more significant when there are many care givers for the same patient. When choosing a pain scoring system, it helps to have a user-friendly system. One should consider those who will be scoring the animals; such as veterinary staff, students and perhaps owners. A chronic pain scoring system that has proven to be valid and reliable is the Helsinki chronic pain scoring system. It is easy to use, and owners can be trained and asked to use it to assess the level of pain in the dogs at home. Ideally, especially if using unidimensional pain scales, if used by the same individual each time pain is assessed in a single patient there is a decrease in variability in pain scoring but it is still not as accurate as when a composite scale is used. Scores from the pain scoring system should be part of the patient record. The patient should be assessed pre and post-operatively, this also helps to give the veterinary professional a baseline pain score of the animal on presentation. The animal should be assessed at regular intervals (depending on the patient, procedure, score obtained at each scoring, etc.). The Glasgow composite measure pain scale is a validated and widely used pain scoring system. It is designed for acute musculoskeletal and acute surgical pain. There are two short forms available that have been used for both dogs and cats which has helped to considerably speed patient assessment. The scales consist of numerous descriptors designed to minimize bias and interpretation by observers. The total CMPS-Feline score has been shown to be a useful indicator of analgesic requirement and the recommended analgesic intervention level is 5/20. The feline grimace scale is another scoring system that can be used in a practice or hospital environment. Recommended analgesic intervention level is 6/24 or 5/20, when using this scoring system. References Coleman DL, Slingsby LS. (2007) Attitudes of veterinary nurses to the assessment of pain and the use of pain scales. Vet Rec. 21;160(16):541-544. Hielm-Björkman AK1, Rita H, Tulamo RM. (2009). Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. Am J Vet Res. 70(6):727-734. Kongara K. (2018). Pharmacogenetics of opioid analgesics in dogs Journal of Veterinary Pharmacology and Therapeutics banner, (41) pp 195-204. Marina C. Evangelista, Ryota Watanabe, Vivian S. Y. Leung, Beatriz P. Monteiro, Elizabeth O’Toole, Daniel S. J. Pang & Paulo V. Steagall. (2019). Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Sci Rep. 13;9(1):19128. Reid, J., Nolan, A., Hughes, L., Lascelles, BDX., Pawson, P, Scott, EM. (2007). Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score. Anim Welf Suppl. 1. Reid, J., Scott, EM., Calvo, G., Nolan, A. (2017). Definitive Glasgow acute pain scale for cats: Validation and intervention level. Veterinary Record. 180. vetrec-2016. 10.1136/vr.104208. Treede RD. (2018). The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain reports, 3(2), e643. .