Integrative Pain Management

Integrative Pain Management

Carolina Medina


Assessment and treatment of pain in animals is essential for optimal health and well-being. Assessment of pain in animals is challenging as they are nonverbal; however, the use of validated pain scales provides an objective measurement of pain and therefore treatment success. Management of pain should focus on anticipation of pain, early intervention, and evaluation of treatment response on an individual-patient basis. A multimodal approach to managing pain, including both pharmacologic and non-pharmacologic modalities, is superior to single therapies alone.

Pain Assessment

One of the most challenging aspects of veterinary medicine is pain assessment. Since animals are nonverbal, owners and veterinary professionals must perform pain assessment. If pain is identified, a treatment plan should include assigning a pain score, appropriate pain management, and re-assessment to determine if the selected treatment is effective.

Behavior is the most accurate method for evaluating pain in animals. Attention should be paid to maintenance of normal behaviors, loss of normal behaviors, and/or development of new behaviors that could indicate an adaption to pain or a response to pain relief.

For common causes of pain in dogs and cats, as well as pain behaviors in dogs and cats, please refer to Tables 20.120.4.

Table 20.1  Common causes of pain in dogs.

  • Osteoarthritis

  • Fracture

  • Trauma

  • Surgery

  • Torn cranial cruciate ligament and/or meniscus

  • Intervertebral disc disease

  • Cystitis, bladder/renal calculi

  • Tooth root abscess

  • Corneal ulcer, glaucoma

  • Foreign body

  • Pancreatitis

  • Neoplasia

  • Otitis

Table 20.2 Common causes of pain in cats.

  • Degenerative joint disease

  • Fracture

  • Trauma

  • Surgery

  • Urinary obstruction, FLUTD, cystitis, bladder/renal calculi

  • Aortic thromboembolism

  • Tooth root abscess, resorptive lesions

  • Stomatitis

  • Pancreatitis

  • Corneal ulcer, glaucoma

  • Foreign body

  • Neoplasia

  • Otitis

Table 20.3 Pain behaviors in dogs.

  • Excessive panting

  • Changes in habits (less social, decreased appetite, changes in sleep, changes in eliminations)

  • Abnormal posture (arched back, tucked abdomen, low head carriage)

  • Vocalizations

  • Changes in activity level (restless, hiding, difficulty standing, rising and/or walking)

  • Aggression

  • Self-trauma

  • Self-protection (decreased weight bearing, protecting body part, not allowing to be held or pet)

Table 20.4  Pain behaviors in cats.

  • Facial expressions (grimaces, flattened ears, glazed eyes, mydriasis)

  • Change in habits (less social, decreased appetite, decreased grooming, changes in sleep, not using the litter box)

  • Abnormal posture

  • Vocalizations (meowing, growling, hissing)

  • Changes in activity level (restless, decreased jumping, hiding)

  • Aggression (growling, hissing, biting, pinning ears back)

  • Self-trauma (excessive licking, scratching, biting)

  • Self-protection

Pain Scales

There are several species-specific pain scales to assess both acute and chronic pain in animals (Table 20.7). The use of pain scales decreases subjectivity and observer bias, therefore resulting in more effective pain management leading to overall better patient care.

Table 20.7  Links for pain scales associated with this chapter to be posted on book webpage.

Colorado State University Canine Acute Pain Scale
University of Glasgow Canine Short Form Composite Pain Score
UNESP-Botucatu Multidimensional Composite Pain Scale
Colorado State University Feline Acute Pain Scale
University of Glasgow Feline Facial Expression Tool
Helsinki Chronic Pain Index
Canine Brief Pain Inventory
Liverpool Osteoarthritis in Dogs
Feline Musculoskeletal Pain Index

Acute post-operative pain scales for dogs include the Colorado State University Canine Acute Pain Scale, and the University of Glasgow Short Form Composite Pain Score. The Colorado State University Canine Acute Pain Scale contains psychological and behavioral indicators of pain, as well as a pain response to palpation [1]. The University of Glasgow Short Form Composite Pain Score is a validated pain scale that is considered a clinical decision-making tool for dogs in acute pain, an indicator of analgesic requirement, and it includes 30 descriptors and 6 behavioral indicators of pain [2].

The UNESP-Botucatu Multidimensional Composite Pain Scale is validated in cats for acute, post-operative pain. This pain scale assesses pain expression through behavior, vocalization, and reaction to palpation of a surgical wound. In addition, psychomotor change of posture, comfort, activity, and attitude are included as well as physiological variables such as appetite and arterial blood pressure. Colorado State University developed a Feline Acute Pain Scale for acute, post-operative pain. This scale is based on psychological and behavioral responses, response to palpation of surgical wound, and body tension. The University of Glasgow has developed a facial expression tool to assess acute pain in cats. This facial expression scale was designed using the ear position (slope of line joining base of ear and tip of ear) and the muzzle/cheek shape. Caricatures were developed and sequenced as a facial scoring scale; one depicting the ear position and the other depicting the nose/muzzle shape. Standardized mouth and ear distances when combined showed excellent discrimination, correctly differentiating pain-free and painful cats in 98% of cases [3].

There are three validated canine chronic pain scales that were created for owners to assess their dog’s pain level at home; they include the Helsinki Chronic Pain Index (HCPI), the Canine Brief Pain Inventory (CBPI), and the Liverpool Osteoarthritis in Dogs (LOAD). The HCPI was validated in 2009 [4] for canine osteoarthritis, and it evaluates demeanor, behavior, pain, and locomotion. The CBPI was validated for canine osteoarthritis in 2007 [5] and osteosarcoma in 2009 [6]. It involves assessing pain severity, pain interference with function, and quality of life. The LOAD was validated to evaluate canine elbow osteoarthritis in 2009 [7], and it assesses a dog’s mobility in general terms and with exercise.

Jul 30, 2023 | Posted by in ANIMAL RADIOLOGY | Comments Off on Integrative Pain Management

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