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Survey of Pain Knowledge and Analgesia in Dogs and Cats by Colombian Veterinarians

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Survey of Pain Knowledge and Analgesia in Dogs and Cats by Colombian Veterinarians veterinary sciences Article Survey of Pain Knowledge and Analgesia in Dogs and Cats by Colombian Veterinarians Carlos Morales-Vallecilla 1, Nicolas Ramírez 1, David Villar 1,*, Maria Camila Díaz 1 , Sandra Bustamante 1 and Duncan Ferguson 2 1 Facultad de Ciencias Agrarias Universidad de Antioquia, Medellín 050010, Colombia; [email protected] (C.M.-V.); [email protected] (N.R.); [email protected] (M.C.D.); [email protected] (S.B.) 2 Department of Comparative Biosciences, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61802, USA; [email protected] * Correspondence: [email protected]; Tel.: +57-3178047381 Received: 6 December 2018; Accepted: 5 January 2019; Published: 10 January 2019 Abstract: A questionnaire study was conducted among 131 veterinarians practicing in the city of Medellin, Colombia, to assess views on pain evaluation and management in dogs and cats. When pain recognition and quantification abilities were used as a perceived competence of proper pain assessment, only 83/131 (63.4%, confidence interval (CI) 0.55–0.72) were deemed to have satisfactory skills, with the rest considered to be deficient. There were 49/131 (37.4) veterinarians who had participated in continuing education programs and were more confident assessing pain, with an odds ratio ( standard error) of 2.84 1.15 (p = 0.01; CI 1.27–6.32). In addition, the odds of using ± ± pain scales was 4.28 2.17 (p < 0.01, CI 1.58–11.55) greater if they had also participated in continuing ± education programs. The term multimodal analgesia was familiar to 77 (58.7%) veterinarians who also claimed to use more than one approach to pain control. Nevertheless, homeopathy was the preferred alternative approach in 71/77 (92%). There were major misconceptions on side effects and/or contraindications for use of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) by most veterinarians. In addition, the lack of multimodal analgesia by at least 40% of the practitioners, combined with heavy reliance on weak analgesics (i.e., tramadol) or those with no proven record of efficacy (homeopathic remedies), denotes major deficits in education at the undergraduate level and a need for additional continuing education designed to fulfill the gaps in knowledge identified in this study, and overcome ideological convictions not supported by scientific evidence. Keywords: analgesia; dogs; cats; epidemiological survey; Colombia 1. Introduction The effective management of pain relies on the ability of veterinarians to recognize and measure it in a reliable manner. Pain continues to be largely measured based on subjective measurements of behavioral signs. However, numerous advances have been made in the last two decades in the ability to accurately diagnose and treat painful conditions, based on a better understanding of how pain develops and is perpetuated. These have been put together in guidelines such as those of the World Small Animal Veterinary Association (WSAVA) for the recognition, assessment and treatment of pain [1]. Similar and more contemporary documents developed by a collaborative effort of the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) have been published [2], incorporating into earlier versions of the same document improvements reflecting continuing developments in research, technology, and expert opinions [3]. Vet. Sci. 2019, 6, 6; doi:10.3390/vetsci6010006 www.mdpi.com/journal/vetsci Vet. Sci. 2019, 6, 6 2 of 11 Despite all advances and attempts to develop global guidelines, standardization efforts are often limited by differences in attitude, education, and analgesic modalities available in different geographical regions and nations. In many developing countries, including Colombia, common analgesic drugs may be unavailable or hard to acquire by veterinarians. When availability is not an issue, expense and/or regulatory legislation guidelines may limit use of certain, particularly non-generic ones. In addition, education at the undergraduate level in Colombia is usually provided by professors that have not had many opportunities to receive education abroad in more advanced veterinary institutions. Epidemiological surveys have been helpful at identifying factors limiting the development and application of new analgesic techniques and treatments. Such studies have been published in different countries from the early 1990s, including in the USA [4], Canada [5,6], UK [7], France [8], Finland [9], and Brazil [10]. Through repeat surveys, some of these studies revealed important positive changes and trends in pain management over time. For example, the Canadian studies showed that the percentage of dogs and cats receiving analgesia after castration and ovariohysterectomy was increased about 3-fold from 1994 to 2001 [5,6]. A more recent survey conducted among UK veterinary surgeons also showed that analgesic prescriptions had increased from previous surveys [11]. A variety of reasons were attributed to these changes, including greater awareness of pain, greater knowledge of how to treat pain, more opportunities for continuing education, and greater availability of non-steroidal anti-inflammatory drugs (NSAIDs). At present, there is no information on the attitude and knowledge of veterinarians working in Colombia towards providing adequate analgesia in small animal practice. Thus, the objectives of this study were to assess the attitudes of veterinarians on the topic of pain relief and to identify gaps in knowledge of analgesic usage that should be addressed to increase the well-being of animals undergoing surgical procedures. The information gathered serves to guide future research and continuing education in this area. 2. Materials and Methods 2.1. Questionnaire A questionnaire was developed based on the one designed previously by the French Group of Clinical Research on Veterinary Analgesia (GRCAV) and kindly provided by Dr. Marine Hugonnard [8]. In order to increase responses and reduce bias due to question ambiguities or difficulties in completing the questionnaires, veterinarians practicing in the city of Medellin were personally interviewed by two of the veterinary investigators during 2017. Ethics approval was granted by the University of Antioquia Ethics Review Board and the participants were assured of the confidentiality of the results. We propose that compared to mailed questionnaires, personal interviews should reduce personal bias of the respondents. The sample size of 131 veterinarians was randomly chosen from a finite population of about 400 listed small animal practitioners working in Medellin. The dates for the interviews were scheduled according to the veterinarians’ personal agenda with 100% response rate. Their names and institution would remain anonymous at the completion of the study and if it became publishable. The practitioners were surveyed to assess their views on pain evaluation and control in dogs and cats. Briefly, the questionnaire consisted of 5 sections to collect information as follows: (1) demographics; (2) pain assessment (level of concern, ability to recognize and quantify pain, and type of pain indicators used); (3) competence to control pain and reasons for the use of analgesics; (4) extent of use of different analgesic classes (opioids, non-steroidal anti-inflammatory drugs, dissociative agents, α2-agonists); and (5) depth and quality of veterinary teaching on the topic of pain and interest on continuing education on the subject. As the ability to manage pain adequately cannot be assessed properly through this type of study, for the purpose of statistical analysis, the term “pain assessment” was arbitrarily deemed adequate when both “recognition” and “quantification” were judged to be excellent or good, and inadequate if Vet. Sci. 2019, 6, 6 3 of 11 one of these abilities was deficient, poor or mediocre. In order to rank what veterinarians considered to be the most useful pain indicators, they were asked to choose three options from a list of nine possible descriptors, for both dogs and cats separately. However, it must be emphasized that in a clinical setting, most pain score scales use a composite of the descriptor options provided here, and these are usually ranked numerically according to their associated pain severity. Consequently, a question on whether pain scales were used to assess acute pain was also included in the questionnaire. Participants were asked to rank a list of 5 general reasons for initiating pain treatment in order of decreasing importance, with 1 considered the most important and 5 the least important. The extent of use of different classes of analgesics (including adjuvants) was also recorded separately for dogs and cats, by inquiring about the frequency at which individual drugs from a list of 52 were used. Although corticosteroids are not considered as primary analgesic drugs, they were also included as they can exert a pain-modifying effect by reducing inflammation. To narrow the type of medications used for surgical procedures, they were asked to name the most common type of analgesics used in the pre- and postoperative stages. This was followed by asking whether they have heard and read about the use of “multimodal analgesia”. When opioid use was acknowledged, the participant was then asked to select two out of 12 likely side effects, with some misleading/confounding descriptors, considering dogs and cats separately. The responses were used to evaluate knowledge
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