Pain assessment methods

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Pain is often considered to be the fifth vital sign, alongside body temperature, pulse rate, respiratory rate and blood pressure. The recognition and management of pain in animals has gained considerable momentum over the past three decades. This chapter considers the importance of pain assessment, objective and subjective measures of pain, assessment of acute perioperative pain and assessment of visceral and chronic pain.

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9.1 Improvised algometer, made out of a loss-of-resistance syringe and the rubber plunger head of a 5 ml syringe that has a section of exactly 1 cm. Note that the index finger should be kept on the syringe cap to prevent it being propelled off the syringe when pressure builds up during testing.
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9.3 A 5-year-old, neutered male Pointer, after tibial tuberosity advancement surgery. The dog is looking at the limb and keeping it elevated, which are signs of pain.
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9.4 An 8-year-old, female neutered Lurcher, with a 1-month history of neck pain due to intervertebral disc disease. Note the rigid posture when standing and that the neck is held down. Due to wind-up and anticipation, the patient needed to be muzzled for examination; the unexplained aggressiveness was a behavioural response to pain.
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9.6 The Colorado Feline Acute Pain Scale. (Reproduced with permission from Peter W Hellyer, Colorado State University, Veterinary Medical Center, USA)
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9.7 The Glasgow Composite Measure Pain Score (short form). (Reproduced with permission from Jacqueline Reid, University of Glasgow, School of Veterinary Medicine, UK)
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9.9 A 2-year-old, female neutered, Domestic Longhair cat, with postoperative pain following an exploratory laparotomy. The cat presents with a dull look, the head is held below shoulder level and the coat is unkempt; the abdomen was tense on palpation.
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9.10 A 1-year-old, Domestic Shorthair cat recovering from ovariohysterectomy. A glazed look and eyes partially closed (squinted eyes) is one of the miscellaneous behaviours included in the UNESP-Botucatu Multidimensional Composite Pain Scale for assessment of postoperative pain.
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9.11 A 2-year-old, female neutered Domestic Shorthair cat showing a typical ‘praying’ position. The cat was experiencing abdominal visceral pain due to possible portal hypertension after ligation of a portosystemic shunt.
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9.12 A 6-year-10-month-old male Beagle with a 5-year history of lameness and allodynia of the left hind cushion. The dog developed neuropathic pain after surgery for removal of fibrotic tissue in that area and remained unresponsive to traditional analgesics. Orthopaedic and neurological examinations were unremarkable with lumbar MRI and EMG within normal limits. Von Frey filament examination showed a low-threshold response (0.6–2 g). The animal responded to the addition of amitriptyline to the treatment. (Courtesy of Jaime Viscasillas, Royal Veterinary College, Hatfield, UK)
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