Page 363 - ONLINE PROCEEDING BOOK WSAVA 2017
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WSVA7-0552
GLOBAL PAIN COUNCIL
REAL PAIN CASES- INTEGRATION OF DRUGS AND NON-DRUG THERAPY FOR ACUTE PAIN
B.D. Wright1
1Veterinary Anesthesiologist — Integrative Pain Management Specialist, Mistralvet.com
Time: When evaluating a new patient, I generally schedule for a full hour. I get to know the pet through gentle contact while questioning the owner for history. Forms can help with this process- and can be given to the client to  ll out ahead of time. However, I  nd that many variables come out during my questioning that are missed by the forms- many activities that cannot be accomplished for reasons that are more complex than simply pain (neurologic weakness, sarcopenia, obesity, cardiopulmonary compromise, etc). Pet owners are a vital source of information in chronic pain, but often I need to “calibrate” them with repeated conversations.
Pain /QOL Assessment tools: Canine Brief Pain Index (CBPI)
1) pain severity (4 questions)
2) pain interference with function (6 questions)
3) quality of life (1 question)
Scores for each item are derived from a scale from 0 – 10 (no pain or does not interfere to extreme pain or completely interferes)
• Validated
• Scores are based upon owners’ assessment of pain and behaviors over past 7 days
• Separate scores can be compared over time for pain severity, functional impairment and quality of life
• Repeat at subsequent visits to assess response to analgesic therapy
• Available to anyone to use in clinical setting at: http://www.vet.upenn.edu/research/clinical-trials/vcic/ pennchart/cbpi-tool
Cimino Brown D, Boston RC, Coyne JC, Farrar JT. 2007. Development and psychometric testing of an instrument designed to measure chronic pain in dogs with osteoarthritis. Am J Vet Res. 68; 631-637.
Helsinki Chronic Pain Index (HCPI)
1) A simple descriptive scale where 11 items are scored 0 –4
2) Owners are asked to assign a description to speci c behaviors; no reference to presence or absence of pain is included.
• Also validated
• Simple descriptive modi ers require less analysis by pet owners regarding whether a pain is the cause of a behavior vs. something else (neuropathy, sarcopenia, cardiac disease)
• Does not suggest evaluating behaviors over a time- period: just in the moment
Hielm-Björkman HK, Rita H, Tulamo R-M. 2009. Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. Am J Vet Res. 70;727-734
Cincinnati Orthopedic Disability Index (CODI)
1) owner-generated list of  ve activities that are impaired in their dog
2) the owner then assigns a disability score (simple descriptive) to each activity
3) scores are not weighted for importance
4) common impairments that are followed include: long walks, dif culty with slippery  oors, getting in and out of the car, retrieving toys, playing with other animals, stiffness and pain with defecation
• Also validated in dogs; more easily adapted to cats and other animals (not validated)
• Individual case-speci c questionnaire for assessment of disability and chronic pain
• Owners are involved in identifying speci c behaviors with which their dog is having dif culty
• This questionnaire allows owners and clinicians to follow progress (or lack thereof) related to activities deemed important to the dog, yet not typically evaluated on a standard orthopedic questionnaire
• Could be used as a quality of life scale based upon case-speci c behaviors/activities deemed important to the pet
• Some activities may not respond much to analgesic treatments (slipping on  oors)
Gingerich DA, Strobel JD. 2003. Use of client-speci c outcome measures to assess treatment effects in geriatric, arthritic dogs: controlled clinical evaluation of a nutraceutical. Vet Ther 4:1; 56 – 65
Functional assessment example: CSU outcome measures (pelvic limb, thoracic limb, neurologic)
1) In clinic assessment of speci c tasks
2) Score increases as the patient demonstrates ability
3) Evaluates speci c functional qualities- overlap with pain but doesn’t differentiate
An Urban Experience
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