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What can be achieved in a 10 minute consult

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Abstract

: Where to start can depend on whether the consultation was booked to specifically discuss pain or whether pain was detected as part of a routine examination. Validated pain scores are an essential resource to provide a structure to owner questioning. For the planned consultation these can be emailed to the owner prior to the consultation or where pain is noted in a routine consultation can be given to the owner for completion after the consultation. Pain scores are really useful not only for providing a baseline prior to initiating treatment, but as a basis for discussion and further history taking. I find they stimulate owners to mention additional information that can be useful. Options to consider are: Canine Brief Pain Inventory (CBPI); Liverpool Osteoarthritis in Dogs (LOAD); Helsinki Chronic Pain Index (HCPI); Feline Musculoskeletal Pain Index (FMPI); Vetmetrica Health Related Quality of Life System. During history taking I aim to establish 3-5 pain behaviours to use as a baseline. These may be new behaviours associated with pain or behaviours that the pet doesn’t do anymore where the change could be attributed to pain. This introductory session covers the different attributes of these pain scoring systems and when you may choose one over another.

Chronic pain takes time to develop and will take time to resolve or manage, therefore the first thing to emphasise to the client is that this initial consultation (or from wherever the clinician is picking up the case) is just that: initial, and that there will be a plan to progress the treatment. The first consultation should identify the owner’s concerns; try to establish the sources and classifications of pain present; identify some clear, initial outcome measures; and begin the process of reducing the patient’s suffering. Owner concerns include: their pet’s suffering; inability to exercise; withdrawal and reduced interaction (especially cats); unwanted changes in behaviour (including toileting irregularities; restlessness at night; fearful behaviours); possible side effects of medication; absence of a firm diagnosis; and a potential misunderstanding of what can be achieved with chronic pain problems (i.e. management versus cure). The clinician should observe movement, gait and postural abnormalities. The examination should be performed on as relaxed a patient as possible; aim to establish the presence or absence of secondary sensitisation; and minimise pain and fear. From the history and the examination, the sources and classification of pain may be established; the clinician should aim to identify at least one sign of suffering and/or physical outcome measure, start on appropriate analgesia and arrange a review.

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