Pain and pain assessment in dental patient

Question 1

Signs indirectly associated with dental
pain?

Answer 1

*Halitosis
*Teeth chattering
*Weight loss
*Change in eating habits
– Difficulty in holding food
– Several attempts at prehension of food

*Lethargy
*Change in behaviour
*Difference in human-animal interaction

Question 2

How do we assign a pain score?

Answer 2

*Visual analogue scale
*Numerical rating score
*Simple descriptive score

Question 3

Described acute pain behaviours in dogs?

Answer 3

*Avoidance behaviour and flinching
*Facial expressions
*Escaping behaviour
*Attention to wounds
*Vocalisation

Question 4

What is the Glasgow composite acute pain scale?

Answer 4

*Within 6 categories, the 30 descriptors are ranked
numerically according to their associated pain severity
*The person carrying out the assessment chooses the
descriptor within each category which best fits the dog’s
behaviour/condition
*The six categories are: posture, activity, vocalisation,
attention to wounds, demeanour, mobility and response to
touch.
*The maximum score for the 6 categories is 24, or 20 if
mobility is impossible to assess (recommended analgesic
intervention level is 6/24 or 5/20)

Question 5

What are the 3 pain scoring systems validated in cats?

Answer 5

*Glasgow composite measure pain scale for
cats (Glasgow CMPS)
*UNSESP Botucatu multidimensional composite pain scale (UNESP)
*Feline Grimace Scale (University of Montreal)

Question 6

What should you look for when assessing cat pain level?

Answer 6

*Changes in cat’s normal behaviour
*Facial expressions
-Furrowed brow
-Orbital squeezing
-Hanging head
*Posture
-Hunched position or tense abdomen
-Shifting of weight or lying in an
abnormal position
*Attention to wound
-Licking
-Chewing
-Scratching
*vocalisation
-Cats previously vocal being quiet
-Hissing
-Growling
* Response to
palpation

Question 7

What is the UNESP Botucatu pain scale?

Answer 7

*Validated in Portuguese and English
*Composite simple descriptive scale
*Includes objective and subjective evaluations
*Intervention level of ≥ 8 out of 30

Question 8

What is the Glasgow CMPS feline pain scale?

Answer 8

*Composite simple descriptive scale
*Presence / absence of behaviour questions
*Caricatures of two aspects of facial
expression
*Intervention level is 5 out of 20

Question 9

What is the feline grimace scale?

Feline Grimace Scale has been validated for use after dental
extractions

Answer 9

Based on looking at the movements of five facial action units
(AU) that comprise an expression.
– Ear position
– Orbital tightening
– Muzzle tension
– Whisker position
– Head position
– Don’t score AU that can’t be assessed
– Analgesia intervention level is >0.39 out of 1.0
Improve

Question 10

Discuss chronic pain behaviours in dogs?

Answer 10

*Enthusiasm and type of play
*Exercise tolerance
*Time spent with owner
*Attitude to other dogs or people
*Noise sensitivity
*Ability to cope when left alone
*Ability to cope when travelling in the car
*Appetite
*Sleeping
*Acceptance of grooming / stroking
*Mood and demeanor in general

Question 11

Discuss ways to notice chronic pain in cats?

Answer 11

*General mobility and ease of movement
*Performing normal activities
*Eating and drinking
*Grooming and scratching
*Social activities involving people and other pets
*Resting and relaxing
*Temperament

Question 12

What has been reported post dental with dogs with no real known cause?

Answer 12

Post-anaesthetic deafness have also been reported after dentals in dogs, with no real known cause.

Question 13

What dugs can effect cancer metastasis?

Answer 13

Ketamine and high doses of opioids appear to have a negative effect on tumours
spread (i.e. worsen it) whereas local anaesthetic techniques seem to be associated
with a better prognosis.

Question 14

What are the 3 main types of pain scoring systems?

Answer 14

The three main types of pain scores are known as:
1.visual analogue scales (VAS)
2. numerical
rating scales (NRS)
3. simple descriptive scales (SDS)

Question 15

The pain pathway consists of four different main stages and different analgesic drug groups
(denoted in italics) work at different parts of the pain pathway; list them?

Answer 15

Transduction – noxious stimulus is converted into an electrical signal at the nocioceptor
: (Non steroidal anti-inflammatory drugs, some applications of local anaesthetic)

Transmission – of a nerve impulse along nerve fibres to dorsal horn of spinal cord :
(Local anaesthetics)

Modulation – of pain information at various sites of CNS including amplification and
inhibition (Opioids, alpha 2s, ketamine, nitrous oxide)

Perception – conscious perception of pain : (Opioids, alpha 2s, ketamine, nitrous
oxide)