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Choosing the right pain scale for feline dentistry

In this pain update, we detail the pain scales that are available for use in feline dental patients.



During the recent British Veterinary Dental Association conference, Matt used Slido to ask the audience which pain scales are they using. We had a total of 85 votes from 85 participants.

 

The focus of each of these pain scales is the presence or absence of normal or abnormal behaviours, so keep that in mind as you pain score your patients. Having a baseline understanding of that individual and their pain is really important, and in dental disease there may be a combination of both acute and chronic pain. Don't forget, when we're talking about pain scoring, if we consider the animal to be in pain, then that pet should receive analgesia. We can then reassess them at an appropriate time frame, considering the drug that we've used, and check that our analgesia intervention has had the desired effect. If the patient improves following analgesia, then the pain hypothesis holds up. On the converse side, if animals are repeatedly medicated with drugs without being in pain, then they may suffer adverse effects from those drugs.


Pain behaviours before and after a treatment of oral disease in cats using video assessment, a prospective blinded randomised clinical trial was conducted by Watanabe et al and published in 2020. It was an exploratory study that aimed to identify pain-induced behaviours in cats before and after treatment of oral disease using video assessment. The researchers conducted a prospective, blinded, randomised controlled trial involving 24 cats. Those cats were divided into two groups, one receiving minimal dental treatment and the other undergoing multiple dental extractions. This study utilised video assessments, which were reviewed by a behaviourist, to observe and analyse these specific pain-related behaviours before and after the dental procedure.


The findings from the study showed that certain behaviours such as pawing at the face, restlessness, and difficulties in grasping dry food are associated with cats in pain. These specific behaviours are really useful to incorporate into a modified version of a pain scale if you are considering adapting existing pain scales for use in your dental patients. That study highlighted the valuable insights into those feline pain behaviours related to oral disease and highlights the importance of recognising those behaviours for the effective management of pain in cats.


In this study, the researchers used the SFGPCS-F pain scale. And they recognised there are some limitations to this pain score for dental patients, which are really important for us to focus on. The section in the SFGCPS-F detailed ignoring wound or painful area, all cats in the study scored zero. Regarding the palpation of the wound section, if the observers had palpated that painful area, it would have biased the observer because they would have known that the cat was in the mild dental disease group or the severe dental disease group. They also said it was possible in all cats. These were cats that were shelter cats. And so you can understand that temperament was probably not amenable to examination in all of those cats. But in those cats where they did attempt to examine the mouth, escape behaviours were documented. Now that could be because the cats were in pain or it could be because they weren't habituated to examination.


What these researchers conclude is that it is possible that pain was underestimated in some cats when they're less active and reluctant to move. And the behaviours reported here may add additional information to feline pain assessment in dentistry. So, really good to see that in the literature.



In a separate paper (this data came from the same group of cats) they noted that in cats requiring mild or extensive dental work the pain scores were significantly increased in the cats with severe disease. The analgesic requirements in those cats with severe disease were significantly higher than in cats with minimal disease, and food intake was significantly lower. So really good findings to help us zoom in on what to consider in our cats with dental pain.

Now, in this study, they used the Short Form of the Glasgow Composite Pain Scale, and that has an intervention level of five out of 20. They concluded that it is possible that pain was underestimated in some cats when they were less active and reluctant to move. We've got to bear in mind that this is a clinical study, and so they have to have a set intervention point. This goes back to what we always say, if you think the cat is painful, you should provide analgesia and then reassess that patient.

So, if you think they're painful, they're scoring 3/20 on the SFGCPS-F by all means go ahead and give analgesia and then reassess that patient.You don't have to wait for them to hit that intervention level.

From this same group, when they focus on feeding, they document that the amount of dry and soft food intake when reviewed over a three-minute period and dry food over a two-hour period was significantly decreased in cats with severe oral disease. And that study concluded that cats with oral pain require longer periods of time to eat with a soft and dry feed. So that's really important. A useful thing to communicate to our pet owners.


Turning now to the Feline Grimace Scale. There was a study looking at the use of the Feline Grimace Scale and dental pain by Watanabe et al again. What they documented was that the FGS is a reliable tool for pain assessment in cats undergoing dental extractions. So it gives us a second option.

 

Our two options that we can use for dental pain in cats are, the SFGCPS-F and the FGS. That said, it's certainly worth adding in further observations;

-Is the cat pawing its face?

-How much time is the cat spending resting?

-Does the cat have difficulties in grasping dry food?


So, think about modifying those existing pain scales and incorporating those pain behaviours to give you a really comprehensive view of how painful those cats are.The big positive here is that we do have effective options for pain scoring cats undergoing dental disease, dental treatment.

 

In our podcast we talk to Prof Paolo Steagall about the development of the Feline Grimace Scale. Listen here.



An excellent resource which puts all of the pain scores in one place is the Vet Pain app. In this separate pain update, Professor Stelio Luna from University of São Paulo State describes the development of the app.



This post was written by Matt Gurney.


Matt & Carl established Zero Pain Philosophy to provide educational resources & telemedicine to veterinary professionals globally, enabling optimal management of pain.


Matt sees referrals in the pain clinic at Eastcott Referrals. You can also receive telemedicine advice from us here if you have a pain case where you need a helping hand.


Matt Gurney is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and works at Anderson Moores Veterinary Specialists. Matt is Past President of the European College of Veterinary Anaesthesia & Analgesia and works at Eastcott Referrals in the UK.


Carl Bradbrook is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and is Past President of the Association of Veterinary Anaesthetists. Carl works at Anderson Moores Veterinary Specialists in the UK.


The intended audience for this pain update is veterinary professionals. This pain update is based on clinical experience and independent opinion.

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