VETgirl April 2024 Beat e-Magazine

QUARTERLY BEAT / APRIL 2024

ME-OUCH! FELINE PAIN ASSESSMENT AND INTERVENTION

KELLY M. FOLTZ AAT, CVT, LVT, RVT, VTS (ECC) BluePearl, Tampa FL USA

In this VETgirl veterinary technician webinar, "Me-OUCH! Feline Pain Assessment" will provide you with a review of the physiology of pain, common behaviors, pain scales, and assessment tools to best evaluate and handle pain in cats. Cats are not dogs! Use tips discussed here to better recognize feline pain signals and individualize multimodal analgesic protocols. Check it out HERE!

of pain behaviors to assign a score; these scales are evaluated for objectivity, reliability, repeatability, and applicability across individuals and disease states. Assessment includes evaluation of spontaneous behavior (e.g., when the evaluator is not handling or stimulating the patient) and evoked behavior (e.g., when a surgery site is palpated). An advantage of multidimensional pain scales, aside from their rigorous validation process, is that many establish a score where interventional analgesia (rescue analgesia) is recommended. Several multidimensional pain scales for cats have been developed in the past decade including the Colorado State University Feline Acute Pain Scale (CSU-FAPS), the UNESP-Botucatu multidimensional composite pain scale for cats, the Glasgow Composite Measure Pain Scale (CMPS-Feline), and the Feline Grimace Scale (FGS). When selecting a pain scale and reviewing the available literature, it is important to remember that sample populations in veterinary research are significantly smaller than in human medicine. A veterinary study may have a sample size of 8, 12, 24, 60, or 200 patients rather than the several thousand found in a human study exploring a similar hypothesis. Each practice should select a validated, multimodal pain scale that meets the needs of their practice, ensure that all personnel are trained in use of the pain scale, and use it consistently.

Veterinary analgesia has made enormous strides since the 1980s and 1990s, when it was first realized that small animal patients could benefit from multimodal analgesia. Prior to that time, analgesics were rarely prescribed for canine and feline patients and principles of analgesia were seldom taught in veterinary professional programs for DVMs and technicians. In the intervening decades, veterinary medicine has come to understand that untreated pain has detrimental effects on quality of life, glycemic regulation, cortisol regulation, wound healing, and immune function. Veterinary research has established dose recommendations, safe drug classes, modes of action, and pharmacokinetic data for a variety of animal species. The specialty of veterinary anesthesia and analgesia has emerged for both veterinarians and veterinary technicians. Practitioners continue to explore new drugs and to adapt advanced analgesic techniques from human medicine for animal species, including felines—yet according to many studies, feline patients are prescribed analgesic medications less than canine patients and chronic pain in cats is poorly understood. This is concerning given that there are approximately 75 million companion cats in the Unites States. Veterinary technicians are on the front line of pain recognition, evaluation, and intervention in feline patients; as client educators, they are also in an excellent position to help clients understand feline pain and the value of appropriate pain management.

social components.” In applying this definition to clinical practice, almost every facet of animal disease and most clinical procedures have the potential to induce or intensify pain. Acute pain and perioperative pain are not the only analgesic concerns in small animal medicine. Sensitization of the central nervous system and pain pathways lowers pain thresholds, inducing responses to both noxious stimuli (i.e., hyperalgesia) and to non-noxious stimuli (i.e., allodynia). Chronic pain in cats is under diagnosed and under treated. Many factors affecting the recognition and treatment of pain in cats have been proposed, including the following: challenges in pain assessment in this species, lack of validated pain scoring instruments for cats, deficiencies in the education of DVMs and technicians in regard to feline pain, concern over drug diversion/side effects/drug availability/drug cost, and the fear that analgesic use will blunt recognition of patient decompensation/ worsening clinical condition. Cats “behaving badly” may not have their pain addressed due to concerns about personnel safety. Much “bad” feline behavior in the clinical setting can be attributed to pain, fear, or the misinterpretation of the cat’s communication by handlers. Escalated restraint frequently results in an escalation of fight/flight behavior by the cat, is never appropriate in a cat that may be in pain, and results in an increased number of bite/ scratch injuries and an increase in worker’s compensation claims. Feline pain responses are not synonymous with canine pain responses although their nociceptive pathways are identical. A better understanding of feline body language can minimize miscommunication. When assessing behavior or temperament,

it is important to consider the role of pain, especially since degenerative joint disease is under-diagnosed in cats. Pain behaviors in cats include, but are not limited to reduced activity (including jumping onto higher perches), hyporexia/anorexia, reduced curiosity/exploring/interactive behavior, hiding/ vocalization/hissing, guarding parts of body, excessive or reduced grooming, stiff gait/altered body posture, tail flicking, increased sleep/more time spent in one place, and periuria (urinary or fecal accidents near the litter box or outside the box). It is reasonable to assume that if a condition or injury is painful for a person or dog, it is also painful for a feline patient (e.g., a laceration, arthritis, pancreatitis, exploratory laparotomy, or liver disease). Recent attention to the recognition of pain as “the fourth vital sign” has led to the development of a variety of pain scoring systems for cats. Pain scales are classified as unidimensional or multidimensional. Visual Analog Scales (VAS), Simple Descriptive Scales (SDS), and Numeric Rating Scales (NRS) are examples of unidimensional pain scoring scales. These scales commonly feature a horizontal line with vertical right and left borders; sometimes segmental dividers are present with or without numeric ratings. The user selects a numeric signifier that correlates to the patient’s perceived level of pain; in human medicine, the patient selects their own level of pain. The signifiers may range from 0 (least painful/no pain) to 10 (worst pain imaginable/severe pain). These scales are prone to bias and lack objectivity. Multidimensional pain scales are also known as composite pain scales and use quantitative assessments

WEBINAR HIGHLIGHTS

Pain is defined as “a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and

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