Page 15 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir even if they score outside the treatment cut o Using pain scales
using the scale. Pain is a very individual sensation
or all pain scales, training will improve the
and there is no one protocol ts all answer for its
assessment or its treatment. probability and consistency of pain
Although scoring systems are not perfect at identi cation. All team members involved in
identifying pain in all patients and scores patient care should understand the importance
between assessors may vary, validated scoring of pain scoring and all patients that have
systems, and training with the scoring systems, undergone painful procedures should be
greatly decrease variability. or example, in assessed for pain. he scales are designed to
cats, using a validated scoring system by decrease the sub ectivity of pain scores and, to
reviewers who received hours of video best support that goal, the assessment
training on the system resulted in only a 6.1 protocol outlined in the instructions that
di erence between the observers regarding accompany the scale must be followed. It is
which cats should receive rescue analgesia best if the same person scores the patient at
Benito et al., 17 . In addition, each assessment time but this is not always
multidimensional composite scales include possible. Using validated scales promotes
both observation of the patient from a distance consistent assessment. he assessments
and hands on interaction with the patient, should be repeated at scheduled times, and
which forces the observer to open the cage extra assessments added at important times,
and put hands on the patient and not merely such as after treatment. he interval between
assume that patients that are sitting uietly are assessments should not be automatically set
pain free. In actuality, immobility is often a sign at a pre determined interval for all patients but
of severe pain and failure to treat a patient with should be based on the nature of the pain i.e.
that degree of pain is unacceptable. hus, the acute or chronic , the intensity of the pain, and
interactive portion of pain scales is a critical the patient s response to analgesic therapy
part of the most e ective pain scoring systems. athews et al., 14 .

Authors’ perspective
Using pain scales and scoring systems
A patient’s pain score is a composite of multidimensional factors such as behaviours, body
postures, facial grimaces and (for some scales) physiological parameters that might indicate pain.
■ Change in behaviour between pre- and post-painful stimulus is the most consistent
indicator of the presence of pain.
■ When in doubt as to whether or not a patient is in pain, the default is administer analgesia
and reassess their comfort level.
Best practice for using pain scoring systems or scales:
. Scores are most consistent if the same person scores the patient before and after painful
events. The use of validated scoring systems improves consistency of scores if different
people need to score the patient.
. A time schedule should be set for scoring so that the patient has consistent care. However,
this is only a guideline and the actual schedule should be patient-based and adapted to the
situation. For instance, scoring should be more frequent than the scheduled interval if the
patient’s analgesic protocol needs to be altered for the likelihood of breakthrough pain. If
analgesic drugs are administered, patients should e reassessed within minutes of the
administration to ensure pain relief.
• ever treat a patient and assume that treatment was effective. ain and response
to analgesic drugs are speci c to each individual so assess each patient.

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