Developed by Paulo V. Steagall, DVM, MS, PhD, DACVAA, the Feline Grimace Scale assesses pain using a point system based on ear position, muzzle tension, orbital tightening, whisker position, and head position. The treatment of pain in pets does not start and end at the veterinary clinic. Instead, owners are critical players in the long-term analgesic plan for our patients. According to the American Animal Hospital Association (AAHA), the role of the technician in pain management is to maintain effective client communication and education. Therefore, it is essential we as technicians take the time to educate owners about the signs of pain in their beloved pets, as well as what medications are available for treatment. History of pain in pets Before we dive into what we should be telling owners about pain, it is important to understand the current and past mindset of pain in pets. For centuries, it was believed animals did not experience pain similar to people. In human medicine, pain in pediatric patients was only documented and acknowledged beginning in the 1980s. In fact, it has only been in the last two decades or so that orthopedic pain in veterinary patients has been studied in a controlled setting. Given the results, interest in the topic of pain has taken off, with studies being done by veterinary specialists from almost every academy. Yet, for all the progress we’ve made in the study of analgesia and pain management in companion animals, it remains a second thought for many practicing veterinarians. We can do better, however. By working with owners to help them understand the signs of pain, technicians can ensure patients are better taken care of than in the past. Starting the conversation At the appointment, begin by letting the owner know you are there to discuss their pet’s pain management and treatment plan. Assure them their pet is currently very comfortable, and the goal is to make a seamless transition from hospital to home care while keeping them pain-free. Provide clients with detailed information regarding the signs of pain in their pet (See AAHA’s handouts for dogs and cats at bit.ly/2CYQxXh and bit.ly/3gheiII) and walk them through the subtle signs and symptoms unique to the species. Signs a dog is in pain Symptoms of pain in dogs (see Table 1) can be broken down to changes in behavior in the following nine subcategories: vocalization; activity level; self-protection; daily habits; facial expression; aggression; self-mutilation; grooming; and posture. Discerning pain in cats is trickier The subcategories of signs of pain in cats are the same as for dogs (see Table 2). And because cats are notoriously good at hiding pain, examining subtle changes in their faces can provide important clues to what they are feeling. Developed in 2019 by Paulo V. Steagall, DVM, MS, PhD, DACVAA, associate professor of veterinary anesthesiology and pain management at the University of Montreal in Canada, the Feline Grimace Scale (Figure 1) assesses pain using a point system based on ear position, muzzle tension, orbital tightening, whisker position, and head position.* A score of “0” is normal, “1” is moderate or unsure, and “2” is obvious appearance. A total score over “4” indicates pain that would warrant analgesia. Using the feline pain scale can greatly improve the owner’s overall ability to assess the need for analgesia in their cat. Due to the fact cats can be so secretive about their pain, sharing the grimace scale as a tool to recognize more subtle signs of pain is an essential part of at-home treatment. The at-home treatment plan Once we have reviewed with the owner the signs of pain in their pets, as well as the unique ways he or she is experiencing pain, we can move on to discussing the at-home treatment plan. Many of the treatments prescribed by the veterinarian will be on a set schedule. However, some pain medications are preferred to be given on an “as-needed” basis with a maximum dose within 24 hours, or not sooner than so many hours apart (e.g. give one tablet every four to six hours as needed for pain). This is where our previous discussion with the owner is crucial for administering medication properly. Although the goal is to keep the pet comfortable, we do not want to give these medications more frequently than necessary due to the negative side effects that can accompany them. Coaching on medication administration Many of us forget owners do not feel as comfortable giving medications as we do, and this can lead to a lack of compliance. Showing clients how to give pills to pets who will not take medications in food can help with this issue. Also, for cats receiving buprenorphine, demonstrating how to give the medication sublingually, rather than orally, is essential for efficacy. While coaching clients on medications, it’s a good idea to remind them that although they may find it scary to pill their cat, doing so will help their pet feel better. Further, you may want to show the client on how to give the medication to their pet using a placebo until they feel comfortable. And lastly, encourage the pet owner to take a video of the demonstration with their phone for future reference. Communication is key Encourage the client to keep a log of signs of pain in their pet, as well as when the medication is given and at what dosage. In patients with chronic ongoing pain, advise owners to list any previous or regular activity that may have happened before this flare up of pain occurred. This can be very useful with older arthritic patients in establishing limitations for exertion, as well as long-term patient comfort. Become an educator and advocate for your patients Use the information provided in this article and relevant websites (see list to the left) to create your own questionnaires and educational material for clients. As licensed veterinary technicians, we have a critical role to play in pain management and how it is applied at home. Let’s take every opportunity to ensure pets live happy, pain-free lives. Lindsey Howard, LVT, VTS (anesthesia & analgesia), is a tactical support manager at Vetland Medical Sales & Services, as well as a part-time small animal VTS in anesthesia and analgesia for BluePearl Veterinary Partners in Louisville, Ky. Her background and experience have focused on teaching veterinary students, interns, and technicians anesthesia-related topics, as well as focusing on the importance of analgesia and anesthesia machine maintenance. Howard currently works with Vetland Medical to provide dealers and customers with assistance on anesthesia and vaporizer-related questions, and educating them on proper use of anesthetic equipment. She has coauthored an article for the Journal of the American Veterinary Medical Association (JAVMA) and has spoken at many local, regional, national, and international veterinary conferences on anesthesia and analgesia-related topics.
