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| Today’s TechnicianPAin AssessMent in DoGssome signs of pain in dogs are apparent andeasily detectable, while others are more subtle.table 1 lists the most common signs of pain indogs: 14-18table 1. signs of Pain in DogsCategoryAttitude/MentationBodyMovementfacialexpressionGuardingPostureRespiratoryPatternvocalizationClinical signs• scared, submissive appearance• Unwilling to eat or interactwith people• inability to lay down• constant trembling with/without stimulation and/orhandling• Flinching from fingertipslightly brushed over thebody• Tense facial muscles withfurrowed brows• Lips drawn back• Grimace with unfocused orfearful look in eyes• dilated pupils• ears flattened against head• Guarding or biting at apainful area• Tensing abdomen whenpalpation is attempted• Growling when approached• Back or abdominal pain:hunched up or tenseappearance• severe abdominal pain:Prayer position (standing onthe hindlimbs, with sternumand forelimbs flat on thefloor)• May move to back of cageor into corner• short, shallow breathingpattern• crying, whining, whimperinginto consideration several parameters, such as: 12,13• Demeanor• Response to people• Posture, mobility, and activity• Response to touch• Attention to painful area• Vocalization.This pain scoring system has been well validated foruse in veterinary medicine, and has been shown to bereliable and sensitive. Application of scaling models tothis score has also enabled the use of this system inclinical research and clinical trials. 13A shorter version of the CMPS, the Short Form(CMPS-SF, Figure 1, page 69), 14 was developed in 2007for the purpose of routine clinical use, with emphasison speed, ease of use, and guidance for analgesiaprovision. The CMPS-SF is comprised of 6 behavioralcategories with associated descriptive expressions:1. Vocalization (4 descriptions)2. Attention to wound (5 descriptions)3. Mobility (5 descriptions)4. Response to touch (6 descriptions)5. Demeanor (5 descriptions)6. Posture/activity (5 descriptions).Items are placed in increasing order of pain intensityand numbered accordingly. The observer choosesthat item within each category that best describes thepatient’s behavior and ranked scores are summed; themaximum pain score is 24; 20, if mobility is impossibleto assess.Figure 2. Anxious, postoperative patient.Courtesy Holly Killian, CvTsuBjeCtive PAin AssessMentPractical clinical experience is one of the most effectiveways to become adept at pain assessment. Signs of painvary greatly among individual patients, and differencesin pain expression may be subtle and difficult to evaluatewithout sufficient experience or knowledge. 1Clinical experience is also valuable because somesigns of pain must be assessed by touch (tactile versusvisual assessment). For example, tenseness of theabdomen is best assessed with gentle palpation.In the hospital setting, particularly 24-hour facilitieswhere patients may be monitored by several differentveterinarians and veterinary technicians, it becomesvital to:• Discuss pain assessment for each patient amongthe practice team• Have the same individual, as often as possible,70Today’s Veterinary Practice March/April 2012
Today’s Technician |Pain assessment in dogs & catsFigure 3. Painful, postoperative thoracotomy patient;note the facial expression with grimace and furrowedbrows. Courtesy Holly Killian, CvTFigure 4. Patient from Figure 3 resting morecomfortably after a dose of analgesics.Courtesy Holly Killian, CvTmake serial assessments of a patient’s pain toreduce the possibility of interobserver variability.• Develop a specific pain assessment protocol thatallows all personnel to use the same parametersto assess patient pain.visual Pain AssessmentPrior to Examination• The patient should be evaluated from a distanceprior to handling to avoid changes in behaviorresulting from human proximity. 15,16• While observing, the respiratory rate and patternof breathing should be noted.• Posture, facial expression, position of ears, andtenseness of body should all be observed as theymay change significantly once the caregiver interactswith the patient.Examination Room• In an examination room setting, it may be beneficialto observe and examine the patient bothwith and without the owner present. For example,animals that are frightened or suffer from separationanxiety may be easiest to examine with theowner in the room.• Pet owners should be asked about their animal’snormal behavior at home and how they havereacted to pain previously. This allows better painassessment during physical examination and hospitalstay.In the Hospital• Some hospitalized patients will let down theirguard and allow signs of pain to be observed.• However, there are many that never relax whilehospitalized, and subsequently are much moredifficult to accurately assess.• There are also animals that maintain their inherentsurvival mechanism, which causes them to hideany sign of weakness, including pain. These stoicdogs can appear deceptively relaxed and comfortable,despite being in significant pain.<strong>Physical</strong> examinationA thorough physical examination should be performedafter the initial visual examination. However, theimportance of physical examinations to assess patientpain must be balanced against the possibility of causinga patient further stress with repeated handling.• Gentle and compassionate handling of the patientduring the examination is vital, particularly ifpatient pain is anticipated.• Potentially stressful procedures, such as checkingrectal temperature, should be performed at theend of the examination, if possible.• If the source of pain is already known, the rest ofFigure 5. A patient resting comfortably in the hospitalMarch/April 2012 Today’s Veterinary Practice 71
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