Excellent analgesia management starts with pain assessment. If we understand how uncomfortable our patients are, we can start to tailor a plan to that individual.
Question - do you think this cat is painful?
If you are looking to find all of the resources on pain scoring in one place, then we are here to help. In this pain update, we cover the 2022 American Animal Hospital Association pain management guidelines for dogs and cats, which you can download 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. You can read more about this here.
As part of our Zero Pain Practice accreditation scheme, one of the requirements is that you should provide documentation of a clinical audit. Auditing pain scoring is a really good example of a clinical audit, which helps everyone in your clinic achieve analgesic excellence.
In the AAHA guidelines, they describe proactive and pre-emptive pain management. We are all familiar with the term pre-emptive analgesia - administering analgesic therapies as soon as possible, such as prior to the start of surgery with the objective of preventing the establishment and maintenance of pain. In dogs, a pre-emptive benefit has been documented for opioids (pethidine/meperidine) and NSAIDs (carprofen).
As in all areas of pain management, having a team approach is really important. And getting everybody to understand how we incorporate that into our clinic protocols is the first step. Of course, a huge aspect of pain management comes down to how we handle the pets in our care. The guidelines touch on the importance of handling and also the use of pre-visit medications, which may help provide anxiolysis to those painful pets presenting to us. You can read more about pre-visit medications in this link here.
The subsequent section in this review looks at guiding principles of pain assessment and provides great information with how to approach incorporating pain management in your clinic. The next section in the review looks at pain assessment tools for cats for both acute pain and chronic pain, considering the parameters that can be looked at and how those are incorporated into the pain scores that we have available to us. In figure 1, there's a really good flowchart differentiating acute pain scales from chronic pain scales.
Turning to pain assessment tools for dogs both acute and chronic pain assessment tools are listed. In our webinar, here, Professor Jackie Reid from Newmetrica reviews the development of acute and chronic pain scoring tools in dogs and cats.
The AAHA article then goes on to look at the concept of a decision tree for pain management therapies, which I find a really useful way to think about how to provide analgesia in the acute setting and the chronic setting in both dogs and cats. They look at 1st tier analgesics, 2nd tier analgesics, and 3rd tier analgesics. This is certainly something worth reviewing and having a discussion within your clinic about how to approach these types of pain.
The review then looks at a brief dig into physiology behind with relevance to some of the analgesics that we use. So it's a nice quick way to bring your knowledge up to speed. Of course, if you want further information, you can explore these topics in either our pain updates or our webinars on Zero Pain Philosophy.
The article finishes with a section on roles and responsibilities of the practice team and client education instructions and follow-up. And finally, the top five messages for effective pain management:
1. Be proactive, train, and prepare the whole vet team.
2. Use tools and recommendations available to facilitate and assist with assessing pain.
3. Engage the owner as a team member in both recognition and management of pain.
4. Practice pre-emptive multimodal management based on a tiered approach using both pharmacological and non-pharmacological treatments.
5. Key thing here, re-evaluate patients on a regular basis. Adjust our treatment plans accordingly.
We found this a really useful review, and we are sure that you will find the same.
Did you think the cat in the first image was painful? I'm sure a lot of you said no. The image below is him after I interacted with him during pain scoring. From outside the kennel he looked comfortable and then when you open the door he also looks ok, as shown in the picture above. This highlights the importance of interacting with our patients - as soon as his abdomen was stroked this was his response - not a comfortable cat at all!
He responded really well to additional methadone and a ketamine infusion and here he is 30 minutes later looking a lot more relaxed.
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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