Page 13 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir due to visceral a erents synapsing on spinal to determine whether or not a patient is in
cord neurones that receive information from
pain is to administer a dose of an analgesic
drug and utili e pain scores to monitor the
somatic nociceptors.
Pathological chronic pain is pain that is still patient s response.
present after the originating painful stimulus
has disappeared. Chronic pain is mostly as a Acute pain scales and pain
result of C bre activity. It is not stimulus ethics
speci c or protective and inevitably leads to he provision of e ective pain relief in small
morbidity. Both wind up and central animals and its importance in relation to
sensiti ation are involved in the development of patient care and welfare is becoming more
chronic pain states. widely accepted by the veterinary profession
Phantom pain refers to perception of pain Lascelles et al., 199 ; Paul urphy et al.,
from a part of the body that has been removed. 4; athews et al., 14 . Nevertheless,
It is due to depolari ation in nerve endings that studies suggest that there is no agreed gold
originally carried sensation from the standard provision of perioperative analgesia
amputated limb. to small animal patients ohoo and ohoo,
1996; illiams et al., . In several studies,
Pain and quality of life the clinician s di culty in recogni ing and
assessing pain is often raised as a reason for
assessment methods in not administering analgesia, together with the
dogs and cats fear of side e ects. Because of this there have
been ma or e orts to produce reliable,
or many years pain treatment has been based validated pain scoring systems taking into
on the principle of if it hurts us it will hurt them , account the painful conditions regularly
which is a good starting point but is very much encountered in small animal practice to allow
a generali ation; this approach is almost a targeted analgesic therapy clinically and to
preconception of how likely a procedure is to be support research and development of new
painful but takes little account of the patient s analgesic drugs Sharkey, 1 .
response. It could be said that this approach is a It is accepted that the recognition and
pre emptive pain scoring system based on the assessment of pain in animals is problematic. In
science of the preservation of the pain pathway people, self reporting of pain is recogni ed as
across mammalian species, with the addition of the gold standard tool for measuring pain levels
anthropomorphism and the pro ection of human athew and athew, . In veterinary
emotions and feelings on to animals. Arguably medicine the recognition of pain relies on the
the biggest breakthrough in small animal pain sub ective interpretation of the patient s
medicine has been the introduction of pain physiology and behaviour by an observer. hus,
scoring systems, which have allowed us to unlike in human medicine where pain is what
attempt to uantify pain in patients and the patient says it is , pain in veterinary patients
therefore ad ust analgesia accordingly. is better de ned as what the observer says it is .
Although incredibly helpful as a guide to pain his leaves an unacceptable burden of proof of
treatment, pain scoring systems should be used the existence of pain on the skill and bias of the
to guide analgesic therapy but pain scoring observer unless standardi ed pain assessment
should never override clinical examination and tools are utili ed. hus, pain scales or scoring
decision making. In particular, companion systems, with the ideal properties of validity,
animals that are expected to be painful but reliability and sensitivity to change athews et
score low on pain scales should always be al., 14 , are needed for veterinary patients.
given the bene t of doubt and analgesia Attempts to validate and accurately assess
should not be withheld. Even with the utili ation pain in animals initially began in the 198 s by,
of pain scoring systems, the most accurate way for example, aylor and oulton 1984 . Initial

8

Ch02 Pain Management.indd 8 19/12/2018 10:33