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<strong>copy</strong> <strong>focus</strong> <strong>143</strong>.qxp_Layout 1 20/04/2018 12:56 Page 26<br />

26<br />

Pets<br />

<strong>Burnham</strong> & Dengie Focus<br />

FOCUS<br />

ON PET HEALTH<br />

CAN YOU RECOGNISE ACUTE<br />

PAIN IN CATS<br />

Recent advances in pain assessment in companion animals<br />

represent a tenacious, painstaking ad time consuming dedication<br />

to improving animal welfare. Recently gained knowledge about<br />

pain assessment in animals, particularly in cats, has increased the<br />

use of pain-relief in hospitalised patients.<br />

It is necessary, from an ethical and humane point-of-view, to<br />

prevent and relieve suffering and pain in all animals, but because<br />

this article is about cats, I will refer primarily to cats. The<br />

understanding of the pain mechanism has progressed at a far<br />

faster rate than the ability to assess pain in animals because of<br />

the lack of assessment markers. The term ‘pain’ is a combination<br />

of the actual physical (sensory) injury and the emotional or<br />

affective state, which makes pain very subjective. This means that<br />

if two cats are faced with the same surgery, for example,<br />

neutering, the physical ‘injury’ is the same and one would expect<br />

the same response (in terms of pain) in both cats, but because<br />

there is an emotional component to the experience of pain, cats<br />

do not react in the same way. This is the same for humans.<br />

how do we recognise and grade acute pain in cats? There are<br />

two validated composite scoring systems; composite scales aim<br />

to assess the affective component and pain intensity. The more<br />

time-consuming is the UNESP-Botucata Multidimensional Pain<br />

scale consists of 10 behavioural categories and includes appetite<br />

and blood pressure measurement. This is freely available at<br />

http://www.animalpain.com.br/assets/upload/escala-en-us.pdf<br />

The Glasgow Composite Measure Pain Scale for acute pain in<br />

cats is composed of seven questions, with a possible score of 20,<br />

with a guide of pain relief intervention for scores equal to or<br />

above 5. The scale is available to download from<br />

http://www.aprvt.com/uploads/5/3/0/5/5305564/cmp_feline_eng.<br />

pdf<br />

Pain assessment in the presence of the caregiver may affect the<br />

response and can contribute to a placebo effect. Pain scales offer<br />

a very helpful tool in the assessment of pain, but should not be<br />

used in isolation. They are best used as an adjunct to a<br />

comprehensive clinical assessment.<br />

Jürgen Theinert BVSc BSc MRCVS<br />

Edgewood Veterinary Group<br />

Pain assessment is a routine part of a clinical examination,<br />

following temperature, pulse rate and respiratory rate; pain<br />

assessment can be considered the fourth vital sign. It must be<br />

appreciated that there is no single behaviour in isolation that is<br />

definitive of pain in cats and that both objective and subjective<br />

assessments must be made to determine the level of pain being<br />

experienced by the individual cat. One must also appreciate that<br />

the absence of certain behaviours does not mean the cat is not<br />

experiencing pain. Because of the emotional component of pain,<br />

it is very helpful to know the normal behaviour of the cat prior<br />

to surgery. Pain behaviours can be very subtle and can take a<br />

long time to recognise and can be associated with fear,<br />

apprehension or anxiety and with cognitive dysfunction. All-inall,<br />

cats are a little difficult when assessing the level of pain being<br />

felt!<br />

The common behavioural signs of pain in cats include:<br />

• Depression, immobility or reluctance to move<br />

• Hunched posture with low head position<br />

• Eyes semi-closed: ‘squinting’<br />

• Vocalisation<br />

• Changed facial expression<br />

• Restlessness<br />

• Lower tolerance of handling or interaction with the caregiver,<br />

manifested in aggression or a flight/fight response<br />

• Increased reaction to wound palpation or manipulation of<br />

painful area<br />

• Changes in locomotion: may include limping, reluctance to<br />

jump/climb<br />

• Change in appetite<br />

• Change in grooming habits<br />

• Tail flicking and swishing<br />

• Change in pulse and respiration rates<br />

• Change in urination/defaecation habits<br />

Vocalisation is a non-specific behaviour and cats do not always<br />

vocalise when in pain, but they may hiss, growl or spit. Some cats<br />

become very quiet when they are in pain; this must not be<br />

construed as a sign of comfort! Inappropriate loud vocalisation<br />

may occur in ageing cats with cognitive dysfunction syndrome. So<br />

WE PRINT ALMOST ANYTHING BUT NOT QUITE EVERYTHING

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