Attitudes and practices of veterinarians in Australia to acute pain management in cats

Attitudes to acute pain and the use of pain assessment scales among Spanish small animal veterinarians

Evaluation of acute pain in dogs and cats is the basis for an appropriate treatment and improved well-being. The difficulties involved in pain assessment pose a challenge for veterinarians, and recent findings indicate that the most effective tools available-validated pain assessment scales-may not be widely utilized.

Objectives

This study aimed to characterize the level of concern among Spanish veterinarians regarding acute pain in companion animals. Additionally, it sought to determine whether this concern correlates with the utilization of optimal assessment tools.

Methods

A survey was conducted to explore Spanish veterinarians' attitudes toward pain and its assessment. The survey was distributed through two most prominent small animal veterinary associations, the Spanish association for veterinary anesthesia and analgesia, as well as key industry players committed to proactive pain management. Descriptive analysis of the collected data was performed using Excel and SPSS.

Results

A total of 292 veterinarians participated in the study. A high level of concern regarding pain in dogs and cats was determined where 44% of surveyed veterinarians assessed pain in all patients. Despite an awareness of validated pain scales, only 28% used them. The preferred scales were the Glasgow CMPS for dogs (94%) and the Feline Grimace Scale for cats (93%). Among respondents who do not use these validated tools, there was a considerable interest in incorporating these scales into practice (85%) and considered lack of training was the most relevant issue (32%). Other challenges to scale utilization were identified, including constraints related to time, staffing, and the need to establish a habit.

Conclusions and relevance

Spanish small animal veterinarians demonstrated a strong awareness to pain in their patients and employed various methods for pain assessment. However, a limited use of validated tools was identified and likely attributed to challenges such as a lack of established routine, time constraints, insufficient personnel, and, notably, a knowledge gap among veterinarians who do not employ pain assessment scales. The most commonly used scales were the Glasgow CMPS for dogs and the FGS for cats. Overall, these results suggest a window of opportunity for the implementation of training programs in small animal pain assessment at a national level.

Euthanasia of Cats by Australian Veterinarians: A Survey of Current Practices

We sought to document the contemporary feline euthanasia practices among Australian veterinarians and determine the factors associated with the administration of a premedication or sedation prior to euthanasia. Australian veterinarians who had euthanised at least one cat during the previous 12 months were invited to participate in an anonymous online survey. From 615 valid responses, 585 respondents (95.1%) had euthanised at least one cat in the last 12 months, of which 462 respondents (75.1%) had performed an emergency euthanasia. Intravenous (IV) injection (n = 536, 91.6%) of pentobarbitone sodium (n = 584, 99.8%) was the predominant primary method. Premedication or sedation was administered to cats by 415/585 (71.0%) and 242/462 (52.4%) of respondents in non-emergency and emergency euthanasia, respectively. In a multivariable logistic regression analysis, for non-emergency euthanasia, being female and working in a metropolitan area were significant predictors for administering a premedication or sedation (p < 0.001 and p = 0.037, respectively). For emergency euthanasia, working in an 'other' type of practice was a significant predictor for administering a premedication or sedation (p < 0.001). Australian veterinarians vary in their approach to feline euthanasia. There is scope for refinement of euthanasia techniques to maximise the welfare of cats, their owners or guardians, and veterinary team members.

Euthanasia of Dogs by Australian Veterinarians: A Survey of Current Practices

Euthanasia techniques utilised by veterinarians impact the welfare of many dogs in their final moments. Despite euthanasia guidelines, little is known about euthanasia techniques used in practice. We administered an online survey of Australian veterinarians who had euthanised at least one dog in the previous 12 months. We found that 668 (96.8%) had euthanised a dog in the previous 12 months, almost all using intravenous pentobarbitone sodium (n = 651, 99.7%). For non-emergency euthanasia (n = 653), the majority (n = 442, 67.7%) administered a premedication or sedation prior to euthanasia versus less than half for emergency euthanasia (n = 286, 46.4%). Practices and views about euthanasia varied. Female veterinarians and veterinarians located in metropolitan regions were more likely to administer a premedication or sedation prior to non-emergency euthanasia (p < 0.05). Veterinarians in private mixed animal practices were less likely to administer a premedication or sedation prior to a non-emergency euthanasia (p < 0.05). For non-emergency and emergency euthanasia, veterinarians who worked in "other" practice types were more likely to administer a premedication or sedation than private companion animal practices (p < 0.05). The possible reasons for differences in euthanasia practices are explored, and scope for refinement is identified.

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

PRACTICAL RELEVANCE

Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can result in acute pain, and effective management of pain is required for optimal feline welfare (ie, physical health and mental wellbeing). Validated pain assessment tools are available and pain management plans for the individual patient should incorporate pharmacological and non-pharmacological therapy. Preventive and multimodal analgesia, including local anaesthesia, are important principles of pain management, and the choice of analgesic drugs should take into account the type, severity and duration of pain, presence of comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat friendly handling are likewise pivotal to the pain management plan, as is a team approach, involving the cat carer.

CLINICAL CHALLENGES

Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented, and signs of pain in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment of pain and the development of peripheral and central sensitisation. Lack of availability or experience with various analgesic drugs may compromise effective pain management.

EVIDENCE BASE

These Guidelines have been created by a panel of experts and the International Society of Feline Medicine (ISFM) based on the available literature and the authors' experience. They are aimed at general practitioners to assist in the assessment, prevention and management of acute pain in feline patients, and to provide a practical guide to selection and dosing of effective analgesic agents.