Guidelines for recognition, assessment and treatment of pain

Karol Mathews
Thursday, April 2, 2015

Use of this documentThis document is designed to provide the user with easy-to-implement, core fundamentals on the successful recognition and treatment of pain in the day-to-day small animal clinical practice setting. While not intended to be an exhaustive treatise on the subject matter, the text does provide an extensive reference list and there is additional material on the World Small Animal Veterinary Association (WSAVA) website (www.wsava.org) designed to provide resources for those wanting to further their knowledge of this subject matter based on the current literature.There are no geographic limitations to the occurrence of pain, nor to the ability to diagnose it. The only limiting factors are awareness, education, and a commitment to include pain assessment in every physical examination. As such, the pain assessment guidelines herein should be easily implemented regardless of practice setting and/or location.In contrast, there are real regional differences in the availability of the various classes of analgesics, specific analgesic products, and the regulatory environment that governs their use. This represents a significant hurdle to the ideal management of pain in various regions of the world, irrespective of the ability to diagnose. In the treatment section of these guidelines (not included here), these issues are taken into account by the provision of ‘tiered’ management guidelines beginning with comprehensive pain management modalities that represent the current ‘state of the art’ followed by alternative protocols that may be considered where regulatory restrictions on analgesic products prevent ideal case management. Owing to space limitations, tiered management cannot be listed for all situations, but the analgesics available can be selected from the recommended management. It should also be recognised that in some situations, whether due to a etiology or available analgesics, euthanasia may be the only moral or ethical (hence viable) treatment option available. Humane methods are presented.Sections are given on the various product and procedure modalities including pharmacology, mechanism of action, indications, contraindications, dosing, and practical clinical notes to help guide the reader in tailoring the therapeutic protocol to the needs of the individual patient.Recognise this document as providing guidelines only, with each situation unique and requiring the individual assessment and therapeutic recommendations that only a licensed veterinarian can provide. There are a number of statements that are the collective opinion of the authors, based on their cumulative experience with pain management gained within their respective fields but not yet evidenced via published data. It is the view of the group that providing this guidance is important in areas where to date there is little published work to underpin clinical pain treatment in dogs and cats.The contents should also be put into context of the following pain assessment and management tenets:• Pain is an illness, experienced by all mammals, and can be recognised and effectively managed in most cases• Pain assessment should accompany every patient assessment• Treat predictable pain — pain associated with surgery is 100% predictable• Pain assessment is key to determining the degree and duration of pain treatment but should not replace the adage of treating predictable pain• Perioperative pain extends beyond 24 hours and should be managed accordingly• Practice preventive (preemptive) pain management — initiate appropriate treatment before a procedure to prevent the onset of pain, and continue this to prevent occurrence of pain for the duration of time commonly recommended for the problem or which the patient requires• Response to appropriate treatment is the gold standard to measure the presence and degree of pain.We can't always know that our patient does hurt, but we can do our best to ensure that it doesn't hurt

Guidelines for recognition, assessment and treatment of pain
Guidelines for recognition, assessment and treatment of pain

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