Guiding principles of pain assessment
According to American Animal Hospital Association (AAHA) guidelines, pain management should be proactive and preventive rather than reactive and “damage control.”
The AAHA advisory committee determined the following guiding principles for pain management:
1. the care team must consciously create a shared approach to pain management and client communication, especially for the assessment, interpretation, and explanation of acute and chronic pain;
2. the concept of physical examination must extend beyond handling and include observation of posture, gait, and behavior;
3. emphasis on behavioral observations, including those reported by the owner, should not increase the time required for examinations;
4. for all the principles previously listed, pain assessment must be different between dogs and cats, requiring different tools, observations, and communication techniques.
These principles work and need to be implemented with the understanding that the presentation of acute and chronic pain is different and therefore requires a markedly different approach to both assessment and communication with animal owners.
Evaluation of acute pain, compared with chronic pain, is generally easier for both the veterinarian and the owner; in fact, in this case, the response to palpation and recognizable signs are generally more easily observed. For chronic pain, it is more important to acquire the owner’s assessment, which is why pain assessment tools have been defined specifically for pet owners.
Assessment of feline pain
In cats, assessment of acute pain should be based on a combination of palpation and pain assessment tools, such as the Feline Grimace Scale. In contrast, the assessment of chronic pain depends to a much greater extent on the owner’s input. Thus, a professional-owner collaboration is important in order to identify behaviors associated with chronic pain, observe and monitor them using both tools developed for specific conditions and general tools for quality of life assessment. Veterinarians, during a clinical visit to evaluate the cat, must recognize the power of the owner’s observations, particularly for chronic musculoskeletal pain, and must keep in mind that normal imaging examinations do not necessarily mean no pain.
Assessment of pain in dogs
Tools for assessing pain in dogs, by both veterinarians and owners, range widely and include: physical examination, clinical observation, analysis of physiological variables (heart rate, respiration, blood pressure), palpation, video and photos in daily life, and actigraphy (activity monitoring). Assessment methods can be empirical and unvalidated (e.g., “How does your dog climb stairs?”) and validated (e.g., peak vertical forces measured by force plates). Pain assessment is divided, from a practical point of view, into acute or perioperative pain assessment and chronic pain assessment.
Key steps for effective pain management
The AAHA has identified 5 key steps for effective pain management:
1. be proactive, i.e., educate and prepare the veterinary team to understand and appreciate procedures and pathologies that may be associated with pain, to proactively manage diseases early in their course;
2. use available tools and recommendations to facilitate pain assessment and management;
3. involve the owner, as a team member, in both the recognition and management of pain;
4. implement preventive and multimodal management based on a multi-level approach to both pharmacological and nonpharmacological treatments.
5. reassess patients on a regular basis and adjust treatment plans accordingly.
Reference
Gruen ME, Lascelles BDX, Colleran E, Gottlieb A, Johnson J, Lotsikas P, Marcellin-Little D, Wright B. 2022 AAHA Pain Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2022 Mar 1;58(2):55-76. doi: 10.5326/JAAHA-MS-7292.
