Tim May 1998 - November 2012 - Assessment of acute pain in cats using scoring systems
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2021‐04‐12
Assessment of acute pain
in cats using scoring
systems
Susan Little, DVM, DABVP (Feline)
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Bytown Cat Hospital, Ottawa, ON, Canada
@catvetsusan
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catvet@vin.com
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Tim
May 1998 – November 2012
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Agenda
Attitudes Examples
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Pain Scales Resources
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Pain is under recognized and under treated in cats
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EASY TO MISS CATS ARE NOT DOGS NOT ENOUGH DRUGS ADVERSE EFFECTS
Indicators may be subtle Pain looks different in cats We need more safe, Fear of using opioids &
effective analgesics for NSAIDs
cats
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Attitudes about
pain in cats
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BRAZIL
• Cats are less
painful than
dogs after
common
surgeries.
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NEW ZEALAND
• Analgesics
often used
while the animal
is in the
hospital, but
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UK
• Spay &
castration are
more painful for
dogs than cats.
• Lower rates of
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FRANCE
• Don’t involve
vet technicians
in assessment
of pain.
• Misconceptions
not after analgesics about
discharge. prescribed for analgesics,
cats. especially
• Some pain opioids.
helps reduce
activity after
surgery.
Lorena S et al, Vet Anaesth Analg, 2014
Hunt JR et al, Vet Rec, 2013
Coleman DL et al, Vet Rec, 2007
Farmworth et al, N Z Vet, 2014
Hugonnard M et al, Vet Anaesth Analg, 2004
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What do owners
think?
• Pain affects quality of life
• Analgesia is important
• All necessary analgesic
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drugs/techniques should be
used
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• Cat owners believe analgesics
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are necessary more often
than dog-only owners
Simon BT, et al. Vet Surg. 2018;47(2):277‐284.
Steagall PV, et al. J Small Anim Pract. 2017;58(7):380‐388.
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Posture, attitude, body
position, facial expression
Interactive
Reaction to touch/palpation of
wound or painful area
Courtesy Dr. Sheilah Robertson
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Before we can treat
something, we first
must recognize it.
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Dr. Sheilah Robertson
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Pain scoring tools
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Pain scales for verbal
patients
• Numeric
• Rate pain from 1 to 10
• Visual analog
• Rate pain from none to the worst
you’ve ever felt
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Pain scales for nonverbal patients
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• Orbital tightening
• Nose bulge
• Cheek bulge
• Ear & whisker position
• Crying, irritability, behaviour
• Facial expression
• Extremities tone
• Vital signs
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Acute pain scoring tools
with NO validity testing in cats
01 University of Melbourne Pain Scale
02 Colorado Feline Pain Scale
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03 Visual analog and numerical rating scales
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• Does it measure what it claims? Or is it
measuring something else?
• Are results consistent with different people?
Or the same person at different times?
• Does the result help me with my patients?
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Acute pain scoring tools
WITH validity testing in cats
01 Glasgow Composite Measure Pain Scale: Feline
02 UNESP‐Botucatu multidimensional composite pain scale
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03 Feline Grimace Scale
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Measure Pain Scale -
Feline
• Behavioural assessment,
7 questions
• Intervene at >5/20
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UNESP‐Botucatu Multidimensional • Reaction to wound
Composite Pain Scale for assessing palpation
postoperative pain in cats • Behaviour assessments
• Appetite
• Blood pressure
Intervene at >7/30
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or
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>6/27 if blood pressure is
not assessed
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Feline grimace scale Head position
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Paulo Steagall, Beatriz Monteiro, et al
Ear position
Orbital
tightening
Change in
whisker position Muzzle
tension
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scoring
Total ≥ 4/10:
• Probably needs analgesia.
• Consider the patient’s
physical status & drugs
already given.
• If you’re uncertain, score
again in 15 minutes.
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0‐2
Ear position 2
Orbital tightening 1
Whisker position 2
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Head position
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Muzzle tension 2
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0‐2
Ear position 0
Orbital tightening 1
Whisker position 1
Head position 1
Muzzle tension 1
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Comparison of pain scoring tools
Glasgow UNESP‐Botucatu Feline Grimace Scale
• Validated for any type of • Validated for spay • Validated for any type of
acute pain surgery acute pain
• Easy to use • Time-consuming, need • Easy to use
• Observation of training • Facial expression
behaviour • Observation of • 5 questions
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• Response to palpation behaviour
• Facial expression • Response to palpation
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• 7 questions • Appetite, blood pressure
• 10 questions
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Score &
re-evaluate
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There may be
confounding factors…
• Individual cat personality
• Nausea?
• Fear & stress in the hospital
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• Effects of some anesthetic drugs
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• Effects of some diseases
• Lack of training/experience with scoring tools
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Resources
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www.felinegrimacescale.com
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www.animalpain.com.br
UNESP‐Botucatu tool
Excellent training videos
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www.wsava.org
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Update coming!
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www.catvets.com
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Journal of Feline Medicine & Surgery
journals.sagepub.com/home/jfm
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Check out the videos in the supplementary material
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Journal of Feline Medicine & Surgery
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journals.sagepub.com/home/jfm
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Final thoughts …
• No cat should have to prove it is in pain before you
provide analgesia.
• If the pain score is good but you think you can do
better, trust yourself.
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• We now have validated acute pain scoring tools –
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use one!
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@
catvet@vin.com
@catvetsusan
@purrpodcast
purrpodcast.net
bit.ly/CatBites
drsusanlittle.net
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