Over my (Perry Jameson) nearly 30 years of practicing veterinary medicine, one of the major and best changes is our management of pain. We have virtually the same medications at our disposal to control pain in our patients that are available for humans. There are now medications produced specifically to control pain in pets that avoid some of the side effects the human equivalents can cause.
On the human side, the patient can orally tell her physician where, when, and even how bad the pain is. Then, when she returns, they can discuss how any therapy has helped and adjust accordingly.
In veterinary medicine, our patients, obviously, cannot describe to us how they are hurting. As I discussed in a recent column, there are multiple reasons that dogs mask pain symptoms, which making diagnosis of pain and disease difficult. I think cats are even harder to diagnose than dogs.
When I personally go to my physician, I know exactly why I am there, but I still find myself becoming nervous for some unknown reason. Just imagine being a cat and having no idea where you are or why. Strange people are touching and looking closely at you. The cats are nervous, frightened and ready to run or fight. This causes the release of multiple hormones that temporarily relieve pain. This makes it extremely difficult for us to identify pain during a physical examination.
With dogs, we can have Mom or Dad walk them down a hallway or even outdoors to assess for changes in their gait. Rarely can this ever be done with a cat. When I place a cat on the exam room floor to watch him walk, usually he runs beneath a chair and hides or crouches, making observation of lameness impossible.
Since our patients cannot inform us, we primarily depend on Mom and Dad for help. This is important as our ability to provide comfort and pain relief is only as good as our ability to recognize it.
You know your cat better than anyone, so the first thing to watch for is a change in ordinary activities. Describe these changes to your pet’s veterinarian. I know some of my clients get frustrated when I take a history, as I frequently interrupt with questions, but I need to know certain things in detail to better identify the problems.
In particular, note changes in eating and drinking routines. Bathroom habits may be altered. They may have trouble getting into and out of the litter box and may even change the posture they use while eliminating. Going outside the box may not be behavioral but from the discomfort of getting into the box or pain in posturing low enough. Notice changes in activity level and socialization.
One of the best tools in the past five years is the ability to record videos on our phones. Record what your cat is doing at home, where it will be much more active than in an exam room. Cats will move normally and not in a fearful manner. My history-taking has evolved to now ask parents if they have a recording of their pet’s behavior for me to watch.
It is hard for us to often assess how painful our hospitalized patients and post-operative patients truly are. Researchers are constantly coming up with new ways. Some involve measuring hormones released when in pain to diagnose and then noting drops when therapy is working. But this is not practical in most settings.
Dr. Paulo Steagall, an associate professor of veterinary anesthesia and analgesia at the University of Montreal, presented his research at the AVMA convention in August. He developed the Feline Grimace Scale as a means of measuring cat pain.
He used several different changes in facial expression to create a score from 0-10, with the number increasing with the level of pain. The cat gets a score of 0-2 for the following five different facial action groups: ear position, orbital tightening, muzzle tension, whisker position and head position.
An example of ear-position scoring is ears upright and facing forward is 0, ears pulled slightly apart is 1 and ears flattened and rotated outward is 2. Another example is whiskers loose and curved scores 0, whiskers slightly curved or straight 1, and whiskers straight and moving forward 2.
Using this scoring system, they were able to document scores dropping with analgesic therapy. He described a cat that was brought to the ER following a spay with a score of 10. Once pain medications were started, her score dropped to 3.
It is important to treat our pets for their pain. By making them feel better, they will eat sooner and heal faster. However, to treat we have to be able to identify that they are in pain. Like most problems, this involves you and your pet’s veterinarian working together.