Microsoft PowerPoint - KLW 1.pptx [Read-Only]Kate White
Pain scoring
and owners
• Pain scoring should be part of everyday
clinical practice
to assess and score pain
Pain scoring
• Pain scoring systems should be validated
• Mid 1980s (USA teaching hospitals) 40%
dogs & cats received post op analgesia
• 1990s (Canada) 10-12.6% dogs
neutered received analgesics
• In New Zealand in 2005 there was a further
reported increases in the use of analgesics
• Veterinary Schools’ curricula are changing &
place more emphasis on pain scoring &
analgesia
• Some behaviours are strongly suggestive of pain
• No behaviour in isolation is pathognomic for pain, and absence of a behaviour does not mean absence of pain
• Use objective and subjective assessments together
• Know what is normal for the animal
Limitations of pain assessment
• Behaviours should be observed prior to
and during interaction with the patient
• There will be variability!
general ill health
detect
Pain scales
Pain scales - limitations
VAS)
The short form of the Glasgow
Composite Pain Scale
• CMPS-SF – analgesic intervention 6/24 or 5/20
Minimal
Mild
movement
Comments
Feline Acute Pain Scale
Interested in or curious about surroundings
Constantly yowling, growling, or hissing when unattended
May bite or chew at wound, but unlikely to move
if left alone
Receptive to care (even mean or wild cats
will be more tolerant of contact)
May not respond to palpation
May be rigid to avoid painful
movement
palpation (may be experiencing allodynia, wind-up, or fearful that
pain could be made worse)
Reacts aggressively to palpation,
any contact
of wound or surgery site
Not bothered by palpation of
wound or surgery site, or to palpation elsewhere
Animal is sleeping, but can be aroused - Not evaluated for pain
Animal can’t be aroused, check vital signs, assess therapy
Signs are often subtle and not easily detected in
the hospital setting; more likely to be detected by
the owner(s) at home
surroundings or change in normal routine
In the hospital, may be content or slightly unsettled Less interested in surroundings but will look
around to see what is going on
Decreased responsiveness, seeks solitude
Lays curled up or sits tucked up (all four feet
under body, shoulders hunched, head held
slightly lower than shoulders, tail curled tightly
around body) with eyes partially or mostly closed
Hair coat appears rough or fluffed up
May intensively groom an area that is painful or
irritating
Responds aggressively or tries to
escape if painful area is palpated
or approached
up when petted as long as painful
area is avoided
Pain scales for chronic pain Liverpool Osteoarthritis in Dogs Questionnaire (LOAD)
• Information on validation can be found at www.ncbi.nlm.nih.gov/pubmed/19527419
• Owner questionnaire containing 23 questions covering detailed aspects of exercise tolerance and mobility levels.
Canine Brief Pain Inventory (CBPI)
• Can be downloaded from https://centri.unipg.it/cesda/doc/files/scale_del_dolore/Canine_Brief_Pain_Inventory.pdf
Owner questionnaire.
• Asks for a score to be assigned to 11 questions relating to pain and how this affects ability to perform daily functions
Helsinki Chronic Pain Index (HCPI-E2)
• Can be downloaded from http://www.vetmed.helsinki.fi/english/animalpain/hcpi/index.html
• Separate questionnaires for vet and owner covering demeanour and mobility levels
• Client Specific Outcome Measures (CSOM)
Quality of Life Assessment (Wiseman-Orr/GUVQuest)
• www.ncbi.nlm.nih.gov/pubmed/17078742
• Series of questions to quantify quality of life, as a measure of chronic pain
• This is only for the dog owner…
Pain scales
should not be used in isolation
• Pain scales should not replace sound
clinical judgement