Pain Measurement

Question 1

Physiologic indicators of pain

Answer 1

**unreliable and not specific to pain (influenced by anxiety, stress, fear, drugs)
-Linked to sympathetic nervous system
-increases HR, RR, BP, temp, pupil dilation
-increased biomarkers (beta-endorphin, catecholamines, cortisol, chromagranin A)

Question 2

Pain indicators

Answer 2

-behaviour
-posture
-facial expression

Question 3

Practical subjective approach to assess pain

Answer 3

1. Observe patient without interaction (orientation in cage, posture, activity level, facial expression, attitude)
2. Observe patient while interacting
3. Observe patients response to palpation of painful site

Question 4

Interaction with patient

Answer 4

1. establish contact first: call by name
2. stoke along back from head to tail
3. Is response normal?

Pain= uninterested, indifferent, unresponsive, tense up, anxious, aggressive, tries to escape

Question 5

Response to palpation of painful area

Answer 5

• no rxn to touching but vocalizes/tenses up with pressure
  -looking at area in question
  -withdraws
  -defensive by protecting the area
  -withdraws fast, vocalizes, bites
  -freezing, gets rigid

Question 6

Challenges in pain assessment

Answer 6

-dynamic, complex, multi-dimensional experience involving sensory and affective components

-uniquely personal experience

Question 7

Pain assessment specifically in animals

Answer 7

-use a DVM or owner as a proxy (observe and respondent bias)
-variations in pain based on age, species/breed, individual
-environmental or situational stressors (animal can mask pain; white coat effect)
-different types of pain (acute, chronic)
-fearful vs pain

Question 8

Need for Pain assessment tools

Answer 8

-need to increase objectivity and accuracy; improves consistency of pain recognition and allows us to quantify and assess pain= outcome measure!

-can also ensure pain is prioritized

Question 9

What makes pain assessment tools efficient?

Answer 9

-user friendly
-score linked to intervention level
- valid: measures what is intended to measure
-Reliable: produces the same score when unchanging subject is measured at 2 time points by same observer or 2 observers at one time
-Responsive: identifies clinically relevant changes (increase in pain/response)

Question 10

Preventive scoring system

Answer 10

Score is assigned based on level of pain that animal is believed to be experiencing

Categories: none, mild, moderate, severe

Allows for preventive analgesic planning

Question 11

Subjective or unidimensional scales

Answer 11

Not as reliable

-Simple descriptive scale (SDS)
-numerical rating scale (NRS)
-visual analog scale (VAS)
-dynamic interactive visual analog scale (DIVAS)

Question 12

Simple descriptive scale

Answer 12

-most basic
- 4-6 descriptors (no pain to severe pain)
>often open to different interpretations
>very subjective; lack of sensitivity to detect small changes in pain

-scales are non linear

Question 13

Numerical rating scale

Answer 13

-implies equal difference of weighting between each category
-discontinuous scale
- not really useful with animals

Question 14

Visual analogue scale

Answer 14

-horizontal line representing pain experience
-0=no pain; 10= severe pain

-used with humans but there is a lot of variability/bias by observers in vet med

Question 15

Dynamic and interactive visual analog scale

Answer 15

-improvement of VAS
-includes dynamic and interactive assessment of patients
1.observation from distance
2. Interaction
3. Palpation of injured area

-score more than 40mm= rescue analgesia

Question 16

Categorized numerical scale rating methods

Answer 16

1. University of melbourne pain scale
   2.Colorado state university pain scale
2. canine brief pain inventor

Question 17

Multi-dimensional composite pain scales

Answer 17

1. Glasgow composite measures pain scale
2. UNESP

Question 18

Categorized numerical rating scales

Answer 18

-includes observing and interacting
-different categories where certain behaviours are chosen and assigned a value
-sum of category scores is pain score
-species and situation specific

Question 19

University of melbourne pain scale

Answer 19

• designed for clinical use
  -multiple descriptors in 6 categories; based on specific behavioural and physiological (HR, pupil size, salivation) responses
  -total score of 27
• increased accuracy; not validated; labour intensive. Requires baseline data

Question 20

colorado state university canine acute pain scale

Answer 20

-developed as a teaching tool
-intended for dogs and cats after trauma/surgery
-3 categories; scores from 0-4
-includes observation of behaviour and palapation

-practical, user friendly, visually appealing, not validated

Question 21

Glasgow composite measure pain scale (CMPS)

Answer 21

-first validated canine acute pain scale

-includes seven behavioural categories with 47 descriptors (behaviour, rxn to people, posture, mobility, activity, response to auscultation, treatment, vocalizations)
>very time consuming; very useful but not feasible in clinic

Question 22

CMPS short form

Answer 22

-For assessment of acute pain (orthopedic, soft tissue injury, medical conditions). Highly practical and clearly repeatable. validated, reduced observer variability

-includes behavioural assessment (observation, mobility, palpation, overall assessment)
-includes intervention score

-Reduced observer variability. Validated.

Question 23

6 behavioural changes in CMPS for use in clinica

Answer 23

1. posture
   2.activity
2. vocalization
3. Attention to wound or painful area
4. demeanor
5. response to touch

Question 24

What are the analgesic intervention scores for CMPS?

Answer 24

6/24 OR 5/20

**max score 20/24

Question 25

UNESP- Botucatu Multidimensional composite pain scale

Answer 25

-used for cats undergoing OHE
-4 categories (psychomotor changes, protection of wound, physiologic variables, vocal expression of pain)
-total score 0-30

Question 26

Cow pain scale

Answer 26

-7 behaviours evaluated
>attention to surroundings, head position, ear position, facial expression, response to approach, back position, lameness)

-intervention score 5/14

Question 27

Facial expression scoring system= grimace scale

Answer 27

-identify and assess severity of pain
-first used in research setting but developed for mice, rabbits, horses, sheep, pigs,
-easy to use
-often incorporated in multidimensional pain measures

Question 28

Facial action units

Answer 28

-orbital tightening
-ear position
-cheek bulge
-nose bulge
-whisker position

Question 29

Horse grimace scale

Answer 29

-simple descriptive scale
-6 facial parameters with well defined categories
-0-2 scale
-good reliability and validity, easy to use, quick

Question 30

Feline grimace score

Answer 30

• app developed
  -observe ear position, orbital tightening, muzzle tension, whiskers change, head position

Question 31

Chronic pain assessment

Answer 31

-need to use owner
-looks for subtle behaviour changes; but these can be masked by fear, excitement, anxiety

-useful to assess effect of treatment

Question 32

Behaviours used to detect chronic pain

Answer 32

-going up or down stairs
-eating
-grooming
-ability to jump in car
-difficulty rising
-inappropriate urination or defecation

Question 33

Categorized numerical rating scales

Answer 33

-used for owners to record assessment of chronic pain from osteoarthritis and bone cancer

-assesses pain severity and how pain interferes with daily life/function

Question 34

Feline musculoskeletal pain index

Answer 34

measures the impact of osteoarthritis in terms of:
-pain (adverse sensory and emotional experience)
-mobility
-activity
-affective effects (mood)

Question 35

Client specific outcome measures

Answer 35

-need to identify problem activities (ones that the animal struggles with now or can’t do at all)

Question 36

Gait analysis

Answer 36

-can use force plate or pressure mat walkways
-objective method to evaluate limb motion
-commonly used in research and facilities BUT not practical in clinic

-can be difficult to interpret in presence of multiple sore joints
-helpful in detection of changes in lameness but not stiffness

Question 37

Accelerometers

Answer 37

-used to evaluate active movement at home

-objective, non-invasive, portable