Pain Assessment

Question 1

Why is recognizing pain important?

Answer 1

need to recognize it to treat it —> assume if a patient looks painful and if a procedure seems painful, it is painful

Question 2

Why is subjective assessment difficult?

Answer 2

observers must assign a degree of pain according to their own impressions and experience = huge amount of interobserver variability

Question 3

What are 4 possible objective measures of pain? What do they not consider?

Answer 3

1. physiologic variables: HR, RR, pupil diameter (drugs can affect this!)
2. acute phase proteins: varies with species and not well correlated with pain
3. force plate: orthopedic, force applied while ambulating
4. mechanical/thermal threshold

emotional component of pain

Question 4

What are validated objective measures of pain?

Answer 4

reliable and valid ways/algorithms for determining pain, where multiple evaluators use the same scale on the same patient and interobserver reliability and variability are high (reproducibility of scores is high)

Question 5

What is the CSU acute pain scale? Is it validated?

Answer 5

a reasonable scale where the dog/cat is observed before and after the surgical site is palpated

no —> dependent on observer

Question 6

What validated pain scale is commonly used?

Answer 6

CMPS-SF - has more parameters compared to CSU, not dependent on surgery, more involved

Question 7

How are pain scores used to assess necessity for analgesics?

Answer 7

unable to assess mobility - <5 = no analgesics needed, reassess in 2 hours; 5-12 = analgesics, reassess in 4 hours; >13 = notify DVM

including mobility -<6 = no analgesics needed, reassess in 2 hours; 6-15 = analgesics, reassess in 4 hours; >15 = notify DVM

Question 8

What is the feline grimace scale?

Answer 8

an unvalidated scale that uses ears, eyes, muzzles, whiskers, and head placement to assess pain in cats

Question 9

What kind of pain are scales and scoring used to assess? What is their purpose?

Answer 9

acute pain

decision-making on the necessity of analgesic administration - always err on the side of treatment (score within 30 mins when drugs kick in)

Question 10

What causes the use of different scales when scoring canine pain?

Answer 10

ability to ambulate (unable = more pain)

Question 11

What are 4 confounders to scoring patient pain?

Answer 11

1. dysphoria/emergence delirium during recovery
2. excessive sedation
3. anxiety, aggressive behavior
4. need to urinate/defecate

Question 12

How can pain be differentiated from dysphoria or behavior?

Answer 12

analgesic trial (fentanyl - short-acting)

• if behavior goes away, then patient was likely painful (opioids do cause sedation!)
• if behavior remains or gets worse, likely dysphoria, anxiety, or fear —> administer sedatives or anxiolytics

Question 13

Why are pre-anesthesia/pre-operative assessments of pain helpful?

Answer 13

establishes a baseline, especially in behaviorally challenging patients

Question 14

What breeds experience more dysphoria in response to opioids?

Answer 14

winter breeds - Husky, Bernese Mt. Dog, St. Bernard, Samoyed, Newfoundland, etc.