Matthew Gurney (BVSc CertVA PgCertVBM DipECVAA FRCVS) presented “Setting standards in chronic pain management” on the Webinar Vet. In it, we seek to answer the age-old client question: “is my dog in pain?”. It’s not always a difficult question to answer but it’s a difficult thing to quantify. Quantifying pain is important, how else are we to see if our treatment has worked, or the disease has progressed?
One of the most common causes of chronic pain in animals is osteoarthritis. We’re introduced to plenty of staging tools in this webinar. These include “Liverpool OA in Dogs (LOAD)”, “Helsinki Chronic Pain Index”, “Canine Brief Pain Inventory”, and “Vetmetrica HRQL”. Using these tools we’re able to answer whether the dog is in pain, and how bad the pain is making the animal feel. Matthew presents an extra approach, to use with pain scoring. This approach is to find the motivational affective component – using pain scoring to identify pain behaviours. Does the dog tend to hide under the table when in pain, or refuse to walk further than the end of the garden? We can use these measures as outcome measures to assess the success of failure of treatment.
Staging the Disease
As pain is secondary to a disease, it’s important to stage the disease – how far along is the disease progression? In our webinar we’re presented with a canine OA staging tool but it’s acknowledged that we still need tools for syringomyelia and chronic disc disease. In addition, a study is linked in this part of the webinar, which I quite liked. You can find that here. The study includes a tool which allows you to grade the dog and the joint. As we all know, the answer to ‘how is your dog doing’ can depend on so many things – has the owner had a bad day? Do they have a good memory? Do they keep any sort of records about changes in behaviour? The study allows us to see how things change over time in a less subjective way.
Appraising the Evidence
There are so many useful links and studies that are shown in the webinar. Evidence based medicine is emphasised as incredibly important in our profession and our speaker takes some time from the presentation to give some tips on how to critically appraise papers – much like in our recent webinar. – “how to critically appraise a paper”
In pain consults, clients can often feel underwhelmed with results. We have to recognise that it’s often impractical to do an arthritis consult in 10 minutes. There’s rarely any flexibility with time in a veterinary clinic. What we can change is how much value we provide the client. In this way, the client feels like the time was full of useful information. We’re given some tools to help us do that, including VetMetrica – a health related quality of life measure. Further, our speaker emphasises ensuring the whole veterinary team is on the same page.
Perhaps we should be putting emphasis on “how much pain is my dog in” rather than “is my dog in pain”. Quantifying pain is difficult but there are useful tools out there. To learn more check out the webinar at this link here. Our previous members webinar on pain was “multimodal approach to pain in the ICU”. You can read blog posts about that here and here.