Survey of Pain Knowledge and Analgesia in Dogs and Cats by Colombian Veterinarians

Application of the horse grimace scale in horses with dental disease: Preliminary findings

BACKGROUND

Dental disease is a common but often under-recognised condition in horses, possibly due to an inability to recognise clinical signs of oral discomfort. Some dental disorders are reportedly more painful than others, but there is no current metric by which dental pain can be objectively assessed. This study aimed to determine whether a facial expression-based pain scale offered an objective and reliable method for assessing dental pain in horses. It was hypothesised that dental disorders affecting the periodontium would produce high pain scores.

METHODS

Twelve horses with dental disease were evaluated for pain using a numerical rating scale (NRS) and a horse grimace scale (HGS) by blinded observers using still, lateral photographs.

RESULTS

Interobserver reliability was poor across all observers when both the NRS (intraclass correlation coefficient [ICC] = 0.36) and the HGS (ICC = 0.27) were used in horses with dental disease. The highest mean scores were given for horses with equine odontoclastic tooth resorption and hypercementosis (EOTRH) and periodontal disease (PD).

LIMITATIONS

This study has a small sample size of both horses and questionnaire respondents, and the respondent demographics are not representative of the wider veterinary population Furthermore, no positive or negative controls were used for the pain scoring.

CONCLUSIONS

The results of this study indicate the unreliability of tools designed for identifying acute pain for assessing chronic pain, such as dental pain. A more dental-specific ethogram is required to accurately identify dental pain in horses. Both the NRS and HGS produced the highest mean scores for EOTRH and PD, supporting existing literature that these conditions are associated with more obvious signs of pain.

Applicability, reproducibility, and reliability of the German version of the Glasgow composite measured pain scale - feline during implementation into a small animal clinic

OBJECTIVE

The aim of the study was to evaluate reproducibility and practicality of the German version of the Glasgow composite measured pain scale - feline, during its implementation into a German veterinary hospital.

MATERIAL AND METHODS

The study comprised of 2 parts. Participation of veterinary professionals was voluntary. During part 1, 15 staff members (all rater=AR) with variable clinical experience (nurses, interns, junior clinician, senior clinicians), from 4 disciplines (anesthesia, internal medicine, surgery, neurology), and one main investigator (AC), pain scored 45 diseased cats and 10 healthy cats. Part 2 was an online survey, evaluating the practical experience of participants during part 1 and asking for suggestions to improve the scale and process of pain assessment. For part 1 normal distribution of data was tested by Shapiro-Wilk-Test and histograms. Intrarater and interrater reliability were evaluated by calculating the intraclass-correlation. Statistical analysis of part 2 used descriptive methods.

RESULTS

The interrater reliability was moderate (ICC AR : 0.59) and the intrarater reliability was good (ICC AC : 0.88). The pain scores of cats with medical (AR: 3.06±2.33, AC 3.52±2.34) and surgical disease (AR: 3.78±2.38, AC: 4.02±2.72) showed no significant difference. All healthy cats were classified as "not painful" (AR: 0.77±0.67, AC: 1.09±0.83). Clinical experience of the rater did not significantly influence pain scores. The GCMPS-F was judged as easy to use and as helpful tool for cats with unclear pain conditions.

CONCLUSION

The GCMPS-F had a good acceptance and moderate interrater reliability.

CLINICAL RELEVANCE

Using the German version of the GCMPS-F, veterinary professionals from different disciplines and with different grades of specialisation can reliably assess pain levels in cats without prior extensive training.

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.

Perceptions of barriers to providing good cat care in Malaysian clinical practices

Many veterinary practices around the world do not meet basic post-operative cat care, thereby compromising cat welfare. Understanding why the appropriate care is not always given is important. The current study used a mixed methods approach of two phases, to investigate the barriers Malaysian veterinarians face in seeking to provide good cat care in practice. Phase 1 involved a survey consisting of 14 questions which were divided into three sections (demographic details, basic management and barriers experienced by practices) and emailed to 143 Malaysian veterinarians. While for phase 2, 20 interviews were undertaken (recruited from the survey sample) to further elaborate on the results. A Thematic Analysis was conducted to extract the main barriers experienced by participants. A total of 49 veterinarians completed the survey. Over half of the respondents were senior veterinarians (i.e. those with two or more years in practice) (53.1%; n = 26) who were aware of the basic environmental provisions that cats need post-surgery such as bedding and toileting facilities (57.1%; n = 28). Cost (47%; n = 23) was the biggest restriction to good care provision. Interview findings showed that participants were aware of comfortable post-surgery environments helping recovery, but barriers were highlighted: workload factors and a lack of understanding of cat pain behaviours and associated stress. This suggested that participants had the knowledge required to provide good cat care but experienced difficulties putting this into practice. Therefore, to improve cat welfare in veterinary practice, instead of focusing purely on education, interventions to increase good cat care could include targeted elements that support behaviour change to overcome the barriers.

Current attitudes and self-rated abilities of Bosnia and Herzegovina veterinarians toward pain recognition and quantification in domestic animals

In previous years interest has grown in investigating the attitudes and capabilities of veterinarians regarding the recognition, quantification and treatment of animal pain throughout different parts of the world and encompassing various species. This is the first report exploring the attitudes and self-rated abilities of veterinarians in Bosnia and Herzegovina (B&H) concerning recognition and quantification of pain in domestic animals. A study questionnaire was made available to 535 general practice veterinarians throughout B&H and 73 (14%) responded in full. The questionnaire contained polar, multiple choice, ordinal and interval scale questions and consisted of sections asking about demographic data, attitudes to pain recognition and quantification, use and availability of analgesics, estimates of pain intensity during specific surgical procedures, and the perceived need for pain assessment and continuing education programmes for analgesia. Half of the respondents considered the recognition and quantification of pain to be difficult while 89% did not make use of pain assessment scales. Of the respondents, (33/73; 45%) felt a certain level of pain to be advantageous since it reduces the activity of the healing animal, whereas 52% (38/73) did not agreed with this concept. Cost was a consideration when deciding whether or not to use analgesics for 58% (42/73) of the respondents with the most commonly used types being NSAIDs (72/73;99%) and opioids (60/73; 82%). Practitioners in B&H displayed awareness of the importance of pain assessment and management however a significant proportion were unaware of pain scales and relied upon physiological indicators of pain.

Recognizing Zooeyia to Promote Companion Animal Welfare in Urban Bangladesh

The One Health concept of zooeyia refers to the benefits of companion animals in human health and is gaining global research attention. This exploratory study aimed to understand contemporary experiences and perceptions of the social benefits and challenges of living with a companion animal in urban Bangladesh. Thirty-five qualitative interviews were conducted with companion animal owners (20), animal sellers (10), and livestock service department officers (5) from two major cities in Bangladesh, Dhaka and Khulna. Thematic analysis found that historically, animals had a utilitarian purpose, such as livestock for food and dogs for security. The role and perceptions of companion animals began to change for some around the turn of the century. Today, companion animal caretakers report social, psychological and physical health benefits from integrating companion animals into their lives. They also report that companion animal ownership can contribute to social problems due to the prevailing stigma against companion animals. This is rooted in the continued utilitarian role attached to companion animals by the majority of the Bangladesh population as well as religious-based non-acceptance. As a result, the Animal Welfare Act (2019) is not well implemented, posing a key concern for companion animal welfare. To tackle this, we propose various ways in which the emerging concept of zooeyia can help promote the welfare of companion animals by challenging the stigma associated with them in Bangladesh.

Lidocaine and bupivacaine as part of multimodal pain management in a C57BL/6J laparotomy mouse model

While the use of local anesthesia as part of multimodal pain management is common practice in human and veterinarian surgery, these drugs are not applied routinely in rodent surgery. Several recommendations on the use of local anesthesia exist, but systematic studies on their efficacy and side effects are lacking. In the present study, male and female C57BL/6J mice were subjected to a sham vasectomy or a sham embryo transfer, respectively. We tested whether a mixture of subcutaneously injected Lidocaine and Bupivacaine in combination with systemic Paracetamol applied via drinking water results in superior pain relief when compared to treatment with local anesthesia or Paracetamol alone. We applied a combination of methods to assess behavioral, emotional, and physiological changes indicative of pain. Voluntary Paracetamol intake via drinking water reached the target dosage of 200 mg/kg in most animals. Local anesthesia did not lead to obvious side effects such as irregular wound healing or systemic disorders. No relevant sex differences were detected in our study. Sevoflurane anesthesia and surgery affected physiological and behavioral measurements. Surprisingly, Paracetamol treatment alone significantly increased the Mouse Grimace Scale. Taken together, mice treated with a combination of local anesthesia and systemic analgesia did not show fewer signs of post-surgical pain or improved recovery compared to animals treated with either local anesthesia or Paracetamol.

A survey study on the recognition and treatment of pain in dogs and cats by Slovenian veterinarians

OBJECTIVE

To obtain information on pain management in dogs and cats by Slovenian veterinarians, and to compare it with reports from other countries.

STUDY DESIGN

Prospective online survey.

METHODS

The questions were uploaded using open source survey software and pertained to demographic data, self-evaluation of acquired and current knowledge, attitude towards pain and evaluation of actual knowledge, assessment of chronic and acute pain and pain due to surgery or medical conditions, and the use of analgesics. Descriptive statistics were used to summarize frequency distribution. Wilcoxon signed rank test, Mann-Whitney U test and Spearman's rho were applied where appropriate.

RESULTS

The response rate was 11%. From 680 registered members of the Veterinary Chamber of Slovenia, 73 veterinarians completed the survey. Most of the respondents were women (71.2%) working in small (60.3%) or mixed (21.9%) animal practices. A more recent year of graduation was positively correlated to the self-reporting of knowledge acquired during undergraduate studies (r_s = 0.339, p = 0.003) and to current knowledge about the topic (r_s = 0.293, p = 0.012). Cats were assigned higher scores than dogs for signs of acute (p < 0.001) pain. Female respondents assigned higher scores than male respondents for chronic pain in dogs. Dogs were assigned higher pain scores than cats for surgical procedures and medical conditions. The most frequently used non-steroidal anti-inflammatory drugs (NSAIDs) in dogs and cats were meloxicam and carprofen, and butorphanol was the most commonly used opioid. The choice of NSAID was influenced by perceived effectiveness, experience with use and anti-inflammatory effect. Opioid use was influenced by experience with use and perceived effectiveness.

CONCLUSIONS AND CLINICAL RELEVANCE

Slovenian veterinarians acknowledged the importance of pain management as reported for other European countries. However, the use of multimodal analgesia is limited, and inadequacies remain in the pain management of cats.

Clinical applicability of the Feline Grimace Scale: real-time versus image scoring and the influence of sedation and surgery

Background

The Feline Grimace Scale (FGS) is a facial expression-based scoring system for acute pain assessment in cats with reported validity using image assessment. The aims of this study were to investigate the clinical applicability of the FGS in real-time when compared with image assessment, and to evaluate the influence of sedation and surgery on FGS scores in cats.

Methods

Sixty-five female cats (age: 1.37 ± 0.9 years and body weight: 2.85 ± 0.76 kg) were included in a prospective, randomized, clinical trial. Cats were sedated with intramuscular acepromazine and buprenorphine. Following induction with propofol, anesthesia was maintained with isoflurane and cats underwent ovariohysterectomy (OVH). Pain was evaluated at baseline, 15 min after sedation, and at 0.5, 1, 2, 3, 4, 6, 8, 12 and 24 h after extubation using the FGS in real-time (FGS-RT). Cats were video-recorded simultaneously at baseline, 15 min after sedation, and at 2, 6, 12, and 24 h after extubation for subsequent image assessment (FGS-IMG), which was performed six months later by the same observer. The agreement between FGS-RT and FGS-IMG scores was calculated using the Bland & Altman method for repeated measures. The effects of sedation (baseline versus 15 min) and OVH (baseline versus 24 h) were assessed using linear mixed models. Responsiveness to the administration of rescue analgesia (FGS scores before versus one hour after) was assessed using paired t-tests.

Results

Minimal bias (-0.057) and narrow limits of agreement (-0.351 to 0.237) were observed between the FGS-IMG and FGS-RT. Scores at baseline (FGS-RT: 0.16 ± 0.13 and FGS-IMG: 0.14 ± 0.13) were not different after sedation (FGS-RT: 0.2 ± 0.15, p = 0.39 and FGS-IMG: 0.16 ± 0.15, p = 0.99) nor at 24 h after extubation (FGS-RT: 0.16 ± 0.12, p = 0.99 and FGS-IMG: 0.12 ± 0.12, p = 0.96). Thirteen cats required rescue analgesia; their FGS scores were lower one hour after analgesic administration (FGS-RT: 0.21 ± 0.18 and FGS-IMG: 0.18 ± 0.17) than before (FGS-RT: 0.47 ± 0.24, p = 0.0005 and FGS-IMG: 0.45 ± 0.19, p = 0.015).

Conclusions

Real-time assessment slightly overestimates image scoring; however, with minimal clinical impact. Sedation with acepromazine-buprenorphine and ovariohysterectomy using a balanced anesthetic protocol did not influence the FGS scores. Responsiveness to analgesic administration was observed with both the FGS-RT and FGS-IMG.