References
Pain scoring systems in the canine and feline patient
Abstract
It is important that veterinary professionals are able to recognise and assess pain in patients under their care. Veterinary patients cannot verbalise, or self-report on the amount of pain they are experiencing, so it is the responsibility of the professionals caring for them to be able to recognise the signs of pain, which can differ greatly between species. Once the veterinary professional has recognised the signs of pain during assessment they can then determine and appreciate the type or types of pain the patient is suffering, for example neuropathic, acute and chronic, and create an individual analgesic treatment plan. The assessment of pain in animals is for the most part based on the recognition of behavioural changes in response to pain, which cannot only vary between species but also between individuals within that species. Pain scoring systems can be utilised to quantify pain; putting a number on the level of pain for the purpose of determining whether pain exists, whether analgesia is sufficient, and in order to monitor patient progress in terms of pain management. These take into account the behavioural changes and responses of the patient and guide the user towards the calculation of a score. This article explores some of the key concepts relating to the recognition and quantification of pain, and the reliability and validity of pain scores, before considering the different pain scoring systems available for use in veterinary practice and their relative merits.
Mathews et al (2014: 5) in the World Small Animal Veterinary Association (WSAVA) guideline described pain as the fourth vital sign, and proposed the following definition of pain: ‘a complex multi-dimensional experience involving sensory and affective (emotional) components. In other words, pain is not just about how it feels, but how it makes you feel, and it is those unpleasant feelings that cause the suffering we associate with pain.’ Based on this description, it is clear there are going to be inherent difficulties associated with a veterinary professional being able to quantify pain in animals as veterinary patients are unable to verbalise the location of their pain or indeed how it is making them feel. This problem is similar to that found in human medicine where the professionals are attempting to recognise, assess and quantify pain in (pre-lingual) newborn and infant children, whose ability to verbally communicate is limited or indeed absent (Bellieni, 2012). Bellieni (2012) highlighted that with these pre-lingual patients medical professionals observe and measure a number of physical and behavioural cues, and the responses they record feed into their overall judgement about levels of pain and whether the analgesic plan needs amending. These cues include:
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