Recognising and Quantifying Pain

Question 1

Give 5 ways behaviour can be assessed wrt pain

Answer 1

Spontaneous behaviour 
Qualitative assessment (description) 
Ethogram 
Change in behaviour with analgesia 
Evoked behaviour eg MNT

Question 2

What types of quantitative testing exist? What are the problems associated with quantitative sensory testing?

Answer 2

> Threshold testing
- Acceptibility in clinical cases (especially thermal testing) Although widely used in humans
- Difficult to interpret meaning, though withdrawal CHANGE useful
Phyiological measurement
- HR and HR variability, resp rate, temp
- not pain specific, mounting evidence to suggest not useful in pain appraisal though still used
Neurophysiology and cortical activity measurement
- Not feasible clinically
- Interpretation hard
- Difficult in awake animals (EEG electrodes under skin)
- Not immediate - requires processing and interpretation

Question 3

What novel methods of quantifying pain exist?

Answer 3

Facial expression - limited application to actual clients, duration of expressions
Attentino as a biomarker
Judgement bias and anhedonia for chronic pain - time consuming and difficult to interpret, not validated

Question 4

What type of behaviours can be looked at to understand pain states in animals?

Answer 4

Complex behaviours eg. burrowing in rats

CPPT paradigm

Question 5

What is the CPT paradigm?

Answer 5

Continuous performance task/test paradigm - measure of attention

Question 6

Why may over estimating pain also have sever consequences?

Answer 6

Overdose of analgesia

• Opioids - sedation/excitation/nausea
• NSAIDs - gastric ulcers

Question 7

Why do attitudes towards pain medication differ between species?

Answer 7

eg. Cattle - it is physically possible to restrain them, won’t show many overt signs of pain
eg. Cats less likely than dogs to be given pain medication as overt behavioural signs are less obvious

Question 8

How does anxiety affect pain perception? What other confounding factor may affect these results?

Answer 8

^ pain severity
- also confounds behavioural and physiological analysis of pain in animals
> envorinmental modification to reduce stress important
- sedation and effects of drugs may also confound

Question 9

What is a DIVAS?

Answer 9

Dynamic interactive VAS

- mportant as outwardly may not appear in pain but gentle palpation -> detection of 2dry hyperalgesia

Question 10

Why are drugs developed in animals models often not effective?

Answer 10

Don’t combat emotional side, only nocicpetive thresholds

Question 11

Why have grimace scales been more effective in some species than others?

Answer 11

Mouse - succesful as lab mice effectively clones
Less successful in horses and dogs
> lesions to rostral interior insula attenuate pain face behaviour but did not affect other measures of noccipetion

Question 12

Give 4 examples of pain scales

Answer 12

SDS - simple descriptive score, linear scale
NRS - numerical
VAS - diagrammatic
- moving away from unidimensional -> CPS - composite pain scales

Question 13

What are the issues likely to confound pain appraisal?

Answer 13

Differentiating between pain, anxiety and sedation

Question 14

Why is detection of chronic pain in animals challenging?

Answer 14

• detecting dyaesthesias eg. neuropathic pain
• pain states, better/worse at different times?
• owners don’t know what signs to look for
• treating pain should be a separate mission to treating the disease itself

Question 15

Give an example of a study on analgesic drug attitudes wrt farm animals

Answer 15

Fajt 2011 - 70% calves being castrated do not receive analgesia
cf. Waran 2011 - 70% horses DO receive analgesia for castration

Question 16

Give an example of a study on analgesic drug attitudes wrt small animals

Answer 16

Williams 2011 - cats provided with analgesia less than dogs
- show less signs of pain?
Keown 2011 - minimal numbers of guineapigs and rabbits provided with analgesia

Question 17

What affects attitudes towards pain?

Answer 17

Prey v predator?
Social v soliatry?
Inadequate training of observers?
Human-animal bond?

Question 18

Who originally asserted that nonhuman animals are capable of expressing emotion through facial expression?

Answer 18

Darwin

Question 19

Give a study looking at facial expression in non-humans.

Answer 19

Langford 2010 - mouse grimace scale
Keating 2012 - rabbits
Love 2011 - horse
Klaus 2012 - dogs

Question 20

Chemical lesioning of what produced attenuation of the pain face?

Answer 20

Anterior insula

• in man associated with the emotional processing of pain
• no affect on measures of nociception

Question 21

Give studies looking at developing pain scales for animals

Answer 21

Brondani 2011 - cats

Bussieres 2007 - horses

Question 22

Give a study looking at quality of life assessment in the cat

Answer 22

Niessen 2010 - diabetes mellitus
Lynch - cat and dog owner questionnaires QoL
Wiseman-Orr - Dogs QoL