Pain Recognition and Assessment

I guess do this along with the slides... kinda hard cause its so conception based

Describe the 3 dimensions of pain…

1) Sensory - descriminitive

• Where, when, how intense

2) Motivational - affect

• Disturbanc of feelings of well-being to a greater or lesser degree of unpleasantness

  • I hurt my finger, and that is making me feel sad and lack motivation

3) Cognitive - evaluative

• Argument for whether or not animals experience this dimension

• Is the influence of previous experiences on how pain feels

What are the three different kinds of uni-dimensional scales that are used to “measure” pain in vet practice?

1) Numerical Rating Scale

• Pain either described as a 0/1/2/3 or rated on a scale of 1-10

2) Simple Descriptive Scale

• Mild/moderate/severe

3) Visual Analogue Scale (VAS)

• See image; based on assessment of patient’s behavior

• Put the point by where along the scale you would rate the patient’s behavior, then measure the line

  • In the example’s case, pain would be rated 62mm out of 100mm

• Can be helpful to do a DYNAMIC INTERACTIVE Visual Analogue Scale (DIVAS)

  • Perform 2 VAS assesments; one where you simply observe the animal, then another while you’re physically examining them. Then, take the average of the two

Just to make a note:

WE ARE BIASED when it comes to pain. No pain score is going to be the same between two different vets

What is an example of a COMPOSITE pain scale? What are the advantages of using one?

Example: Colorado State Scale (see image)

• GLASGOW SCALE

Advantages:

• Offers CONSISTENCY between observers

  • For monitoring post-operative pain

  • Gives everyone a ‘stake’ to measure by; a vet nurse could do this as well and report to you with an accurate number

  • Easily incorporated into clinical practices

• Educational

  • Can have these up in the clinic for clients to read

Overall, what are the major requirements a pain assessment tool should have to be effective?

Validity

• Ability to measure what it is supposed to measure

Reliability

• Ability of a scale to give repeatable results

Responsiveness

• Ability to measure change when change occurs

These standards offer us a robust measurement of pain

What is an example of a robust pain scale?

The Composite Measure Pain Scale - Short Form (CMPS-SF)

• Validated tool for acute pain measurement in dogs

• Scored out of 20 or 24 (depending on whether or not you choose to measure a section (see image))

  • Total score used as a measurement of pain

• LEVEL AT WHICH YOU GIVE ANALGESIA → 5/20 or 6/20

They also have one for cats; incorporates facial expressions, ear positions, and reaction to being stroked

• Analgesic intervention → 5/20

Describe the feline grimace scale… what features go along with mild, moderate, and severe pain?

No pain / mild pain = 0

• Ears facing forward

• Eyes open

• Muzzle relaxed (round shape)

• Whiskers loose and curved

• Head above the shoulder line

Mild / moderate pain = 1

• Ears slightly pulled apart

• Eyes partially opened

• Muzzle slightly tense

• Whispers slightly curved or straight

• Head aligned with the shoulder line

Moderate / severe pain = 2

• Ears flattened and rotated outwards

• Squinted eyes

• Muzzle tense (elliptical shape)

• Whiskers straight and moving forward

• Head below the shoulder line or tilted down

What are some examples of pain scales for CHRONIC pain? What makes these different from acute pain scales?

Main difference → acute pain is measured by vets, chronic pain is measured by the OWNER

• Give them a form to fill out; allows them to keep track of pet’s condition and can alert them to negative changes

Examples:

• Canine Brief Pain Inventory (CBPI) - owner-proxied form to complete; has owner rate things like pain, function, and overall quality of life on a scale of 1-10

• Vetmetrica - subscription-based online assessment for clients

  • Scored mainly by demeanor out of 1-100:

    • Happy/content

    • Energy/enthusiastic, etc.

  • Keeps comfort and well being the focus

  • Puts all of these factors on a GRAPH over time for owner to track (see image)

    • Can track trends and see how they compare to the average healthy dog (~ 50 for each factor )