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26 Veterinary Laser Therapy in Small Animal Practice

Table 4.2 Overview of some of the available pain assessment scales and staging tools.
Condition Scale or staging tool Appendix
Acute pain, hospital setting Glasgow – short form A1, A2
Chronic pain CBPI A3
Lameness Hudson VAS A4
Feline musculoskeletal pain FMPI A5
Osteoarthritis COAST, LOAD
Notes: If none of these are possible, at least a simple NRS should be used. CBPI, Canine Brief Pain Inventory; COAST, Canine Osteoarthritis Staging
Tool ; FMPI, Feline Musculoskeletal Pain Index; LOAD, Liverpool Osteoarthritis in Dogs; VAS, visual analog scale.

scale. VAS represents this range with a 10 cm line, may indicate the small animal patient is suffering neu-
where 0 represents absence of pain and 10 is extremely ropathic pain: frequent or constant licking, chewing,
severe, or the worst imaginable kind. A mark is drawn or scratching of an area where there is apparently no
on the line and the distance from 0 measured. NRS use disease (to the point of self-mutilation in the worst
numbers (e.g. from 0 to 10, or 0 to 4). Using descriptors cases), presence of hypersensitivity or allodynia, etc.,
of the ratings is useful to make pain assessment more but it is not always that obvious. You can read Chapter
consistent, especially when different evaluators are 9 for more information about chronic pain assessment.
involved. For NRS, patients with a pain score of 3/10 or In general, younger animals tend to be more vocal
above should be treated. and expressive about pain; older animals in chronic
It sounds simple and it is simple. So simple, that it is pain can be more challenging to diagnose. It is impor-
very often overlooked or not performed. Please choose tant to understand how chronic pain can affect quality
one scale, either a basic VAS/NRS or one of the ones of life, and the most popular scales for chronic pain
we will mention here, for acute and chronic situations, consider this as well as other descriptors (you can find
and start using it. You will shortly see how it becomes them in section 9.6.1). To get a better, fuller picture
quicker and easier, and it is time well used for the sake and improve assessment, ask about the activities of the
of your patient. patient during the whole day; behavioral changes such
Acute pain is easier to assess. The most common sce- as decreased exercise tolerance or difficulty with stairs,
nario is postoperative pain, and two of the most popular jumping, getting up, or lying down. Changes in the
and more complete scales to assess it are the Botucatu position or places they defecate or urinate. Cats in pain
and Glasgow Scales. The original Glasgow Composite often decrease self-grooming. If necessary, get videos
Measure Pain Scale was developed in 2001, [94] and later recorded for you of specific conducts. Quiet animals
a shorter form was also proposed for its speed and may just be a bit more withdrawn.
ease of use in a clinical setting [95] (see Appendix A1).
A specific version of this scale has also been developed 4.3 Analgesia in different conditions:
for cats [96] (see Appendix A2). The UNESP–Botucatu clinical studies
Multidimensional Composite Pain Scale, developed
in Brazil, [97] was later validated in English, [98] and Laser therapy has been used to treat different kinds of
focuses on postoperative pain in cats. The function of pain for quite some time now, and there is a good body
such scales is not just to evaluate pain; they define an of literature supporting different applications, most of
intervention level score above which measures should them concerning musculoskeletal ailments in humans.
be taken to treat pain. They are very valuable tools for There are inter-species differences, but a clinical study
veterinarians and nurses, and quick and easy to use and of musculoskeletal or chronic pain in people prob-
implement in daily practice. ably more closely resembles the dose and penetration
Chronic pain is more challenging to diagnose, but needed in a dog than an experimental study in mice.
some scales and questionnaires have been developed. In In human medicine, it has become evident in recent
this case, owner information is key to evaluating changes years that new tools to treat pain are necessary – not
in dogs’ behavior, which may be subtle. Some behaviors just to be able to treat cases that do not respond to

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