The aim of the research roundup is to provide vet professionals with an easy-to-read digest on three items of research in pain management which focus on one common subject area.
This research roundups provide a single point of reference for the reader. In this edition, the three papers come from the same group of researchers which is great to see how their research has progressed in this area.
Subject
Pain assessment in cats before and after dental extractions
Title of the paper
Pain behaviors before and after treatment of oral disease in cats using video assessment: a prospective, blinded, randomized clinical trial.
Aim of the paper
In the author’s words, the aim of this exploratory study was to identify pain-induced behaviors in cats before and after treatment of oral disease using video assessment.
Summary of the work
This study aimed to identify pain-induced behaviours in cats before and after treatment of oral disease using video assessment. It involved 24 cats divided into two groups: one receiving minimal dental treatment and the other undergoing multiple dental extractions. The cats were filmed before and after treatment, and their behaviors were analyzed. Pain scores were performed using the Glasgow Composite Measure Pain Scale (CMPS-F)
Key findings include:
Cats with severe oral disease showed significant changes in behaviors such as standing, laying, and pawing at different time points after treatment.
Cats with minimal treatment showed less walking and standing, and more immobility post-treatment.
Pain behaviors like difficulty grasping dry food and head shaking were more frequent in cats with severe oral disease.
New behaviours appeared after treatment associated with post-op pain
The Zero Pain View
Behaviours documented in this study can help differentiate between painful and pain-free cats in clinical practice. The information from this study is valuable to use when we are discussing the need for dental work in cats. The work clearly shows that cats with mild dental disease experience less pain post extractions compared to cats with severe disease. Cats with oral pain require longer periods of time to eat both dry and soft food than those with minimal pain. These facts could be incorporated into client literature.
These cats underwent a multimodal analgesia protocol (single dose opioid, NSAID post-op, bupivacaine nerve blocks) during their dental work. Despite this, new behaviours were seen in the post-op period indicative of pain. This suggests that additional analgesia would be beneficial. We would recommend repeating the opioid – a single premed dose was used in this study. The use of ketamine prior to dental extractions would improve analgesia, either as a single dose or a CRI. Instead of acepromazine in the premed, an alpha-2-agonist would offer a synergistic analgesic effect with the opioid. A further consideration is to provide these cats with NSAIDs prior to the dental treatment, which we recommend.
A point to consider when using the CMPS-F for dental cases is the following. In this study palpation of the painful area (question 6 of CMPS-F) was performed over the lips since direct palpation of gingiva would not always possible due to some cat’s temperament. It is worth adapting your use of the CMPS-F for dental patients in this way.
The papers reviewed in this Reflect article are designed to generate questions. We recommend that you follow the links to read each paper – they are all open access.
To read next
The analgesic effects of buprenorphine (Vetergesic or Simbadol) in cats undergoing dental extractions: A randomized, blinded, clinical trial.
Aims & key results
This study aimed to evaluate the analgesic efficacy of two different products containing buprenorphine at different concentrations (Vetergesic and Simbadol) in cats undergoing dental extractions. It involved 23 cats with oral disease, divided into two groups: one receiving Simbadol (1.8 mg/mL) and the other Vetergesic (0.3 mg/mL).
Key findings include:
Both Simbadol and Vetergesic provided similar analgesic effects when used with a multimodal analgesic protocol, including local anesthetic nerve blocks and meloxicam.
Pain and sedation scores were not significantly different between the two groups.
Sedation scores were higher up to 2 hours postoperatively in both groups.
Pain scores were higher up to 8 hours postoperatively and at 8 am on day 2 compared to baseline.
Pain scores were increased for longer in the Vetergesic group compared to the Simbadol group.
The requirement for rescue analgesia and resentment during drug administration were not significantly different between the groups.
The Vetergesic was administered IM. Administration IV as a less painful route could be considered – in this study the licensed route of administration in Canada is IM.
Overall, Simbadol and Vetergesic were effective in managing pain in cats undergoing dental extractions without significant differences in their analgesic effects.
The Zero Pain View
Of interest to us in this Reflect article is how pain was assessed. Pain was scored using both the Glasgow Composite Measure Pain Scale and the Feline Grimace Scale. The outcomes of the study were based on CMPS-F and the scores relating to the FGS were used for a separate validation study for that pain scale. If the cat scored 5/20 or more, rescue analgesia was provided with hydromorphone.
Simbadol is a once-daily subcutaneous injection of buprenorphine and provides 24-hour continuous control of post operative pain associated with surgical procedures in cats and can be be administered for up to 3 days. Simbadol is available in North America.
Link to prescribing information
Where do we see the value in this work?
Our view is that this study provides support for the use of the CMPS-F in the effective assessment of dental pain in cats.
How does dental pain affect cats?
Title of the paper
A multidisciplinary study of pain in cats undergoing dental extractions: A prospective, blinded, clinical trial
Summary & key findings
This was the first of these three studies to be published. The study aimed to evaluate pain scores, analgesic requirements, food intake, and serum inflammatory cytokines in cats before and after dental treatment. It involved 24 cats divided into two groups: one with minimal dental treatment and the other with multiple dental extractions.
Key findings include:
Pain Scores: Cats with severe oral disease had significantly higher postoperative pain scores compared to those with minimal disease, lasting up to day 4.
Analgesic Requirements: The need for rescue analgesia was significantly higher in cats with severe disease (91.7%) compared to those with minimal disease (0%), with analgesics required up to day 3
Food Intake: Cats with severe disease had significantly lower dry and soft food intake throughout the study
Inflammatory Cytokines: Differences in cytokine levels were observed between the groups, associated with the presence of tooth resorption and the number of missing teeth and tooth fractures
The study highlights the importance of long-term analgesia for cats with severe oral disease to manage pain and maintain food intake.
Our thoughts
Cats were painful up to day 4 following dental extractions. This study used the same anaesthetic protocol as the aforementioned and we therefore echo our previous thoughts on optimising that analgesic protocol and providing analgesia prior to the treatment.
To our knowledge there are no studies looking at the benefits of adding a ketamine infusion to the analgesic protocol, although it is something we commonly include.
Reflections from all three papers
What are the discussion points for the practice team from this research?
Does this give you confidence with your approach to pain scoring cats undergoing dental work?
Have you considered pain scoring prior to the procedure to establish a baseline?
Which pain behaviours do you regularly ask clients about when evaluating the need for dental treatment in cats?
Do you routinely prescribe analgesics prior to dental treatment in cats?
Could you optimise your analgesic approach. Remember that we offer a premed review service via the telemedicine page and we can help you with a premed review.
References
Watanabe R, Marcoux J, Evangelista MC, Dumais Y, Steagall PV. The analgesic effects of buprenorphine (Vetergesic or Simbadol) in cats undergoing dental extractions: A randomized, blinded, clinical trial. PLoS One. 2020 Mar 6;15(3):e0230079. doi: 10.1371/journal.pone.0230079. PMID: 32142538; PMCID: PMC7059904.
Watanabe R, Frank D, Steagall PV. Pain behaviors before and after treatment of oral disease in cats using video assessment: a prospective, blinded, randomized clinical trial. BMC Vet Res. 2020 Apr 10;16(1):100. doi: 10.1186/s12917-020-02302-w. PMID: 32272922; PMCID: PMC7146962.
Watanabe R, Doodnaught G, Proulx C, Auger JP, Monteiro B, Dumais Y, Beauchamp G, Segura M, Steagall P. A multidisciplinary study of pain in cats undergoing dental extractions: A prospective, blinded, clinical trial. PLoS One. 2019 Mar 1;14(3):e0213195. doi: 10.1371/journal.pone.0213195. PMID: 30822336; PMCID: PMC6396900.
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