Stopping the Cycle of Pain-DH DeForge, VMD

Stopping the Cycle of Pain in the Pet You Love!

The world is full of suffering, it is also full of overcoming it. --Helen Keller

A Commentary on Companion Animal Pain  

D. DeForge, VMD

"Today there is a better understanding of how pain develops and is perpetuated.  It is now well established that animals and humans have similar neural pathways for the development, conduction, and modulation of pain.  According to the principle of analogy, because cats and dogs have neural pathways and neurotransmittors that are similar, if not identical, to those of humans, it is highly likely animals experience pain similarly." Journal of the American Animal Hospital Association 2007;43:235-248 AAHA/AAFP Pain Management Guidelines for Dogs and Cats.

Bad pain is a form of pain that is unfortunately not recognized by the pet owner.  Bad Pain is pain that a pet lives with each and every day of its life and thinks that t this significant PAIN is NORMAL.  The greatest tragedy is that of the pet believing the pain that is in their life is normal and they must live with it each and every day of their lives.

Examples of Bad Pain are:

Osteoarthritis

Oral Pain

Cancer

Gastrointestinal

Dermatological

Ear Infections

Ocular

Urogenital

Neurological

Orthopedic

Post-Surgical Pain

Dr. Alice Villalobos has created her Quality of Life Scale which centers on patient comfort and pain control.  The Pawspice Reference in the chart is a reference to the first pet Hospice in the United States created by Dr. Villalobos.  
See Table Below:

Quality of Life Scale1         The HHHHHMM Scale
Pet caregivers can use this Quality of Life Scale to determine the success of pawspice care. Score patients using a scale of 1 to 10.
Score	Criterion
H: 0 - 10	HURT - Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet's pain successfully managed? Is oxygen necessary?
H: 0 - 10	HUNGER - Is the pet eating enough? Does hand feeding help? Does the patient require a feeding tube?
H: 0 - 10	HYDRATION - Is the patient dehydrated? For patients not drinking enough, use subcutaneous fluids once or twice daily to supplement fluid intake.
H: 0 - 10	HYGIENE - The patient should be brushed and cleaned, particularly after elmination. Avoid pressure sores and keep all wounds clean.
H: 0 - 10	HAPPINESS - Does the pet express joy and interest? Is the pet responsive to things around him or her (family, toys, etc.)? Is the pet depressed, lonely, anxious, bored or afraid? Can the pet's bed be close to the family activities and not be isolated?
M: 0 - 10	MOBILITY - Can the patient get up without assistance? Does the pet need human or mechanical help (e.g. a cart)? Does the pet feel like going for a walk?  Is the pet having seizures or stumbling?  (Some caregivers feel euthanasia is preferable to amputation, yet an animal who has limited mobility but is still alert and responsive can have a good quality of life as long as caregivers are committed to helping the pet.)
M: 0 - 10	MORE GOOD DAYS THAN BAD - When bad days outnumber good days, quality of life might be compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware the end is near. The decision needs to be made if the pet is suffering. If death comes peacefully and painlessly, that is okay.
*TOTAL=	*A total >35 points is acceptable for a good pawspice

                                                        
1.Adapted by Villalobos, A.E., Quality of Life Scale Helps Make Final Call, VPN, 
09/2004,for Canine and Feline Geriatric Oncology Honoring the Human-Animal 
Bond, by Blackwell Publishing, Table 10.1, released 2006.

A Human Pain Scale

Chart Above--Human Pain Scale from the Internet-No source available. 

Adaptation of a Human Pain Scale to Animal Pain is very difficult if not impossible.

Because there is no subjective pain definition in the companion animal it is not possible to easily rate pain as is done in a Human Pain Scale.  We can tell the doctor, as humans, about our subjective pain [i.e. our symptom of pain].  We can state if it is mild, moderate, or severe.  NOT so in animals. This objective v. subjective concept separates our objective observation of animal pain from the subjective definition of pain in the human species.  An example is the difficulty in determining the severity and actual presence of Bad Pain in animals. Non-apparent yet quite severe bad pain is a challenge to the clinician.  The pain of a broken leg can be defined in an animal.  The pain of chronic pain that the animal lives with day after day after day with no or minimal objective physical signs of discomfort is of major concern. This is a problem necessitating the full and complementary effort of ER Doctor, general practitioner, specialist, and home pet advocate.

Dr. DeForge's Pain Scale for Dogs and Cats

Condition Centered

0-No pain; healthy patient

I-Mild Pain-

                  Early osteoarthritis-minimal discomfort on joint examination by the clinician

                  Minor Dermatitis

                  Early Periodontal Pathology

                  Mild Gastroenteritis

                  Conjunctivitis

                  Minor otitis

                  Minor Trauma

                  Tracheitis-Pharyngitis

                  Cystitis Acute

                  Early Cancer

                  Post Surgical Discomfort following elective surgery

               

II-Significant Pain-

                  Advancing osteoarthritis

                  Acute trauma to a tooth with pulp exposure

                  Advancing Periodontal Pathology

                  Open sores on skin with secondary infection-Pyotraumatic Pain

                  Consistent vomiting and/or diarrhea

                  Anal Sacculitis

                  Cystitis-Urethrtis-Vaginitis-Chronic and prolonged without treatment

                  Corneal ulcer or blunt trauma to eye and tissues surrounding the eye

                  Glaucoma-Acute or Chronic

                  Otitis Externa and or Media Advanced Inflammatory Pathology

                  Advancing Cancer

                  Multiple Trauma sites

                  Post Surgical Discomfort following major surgery

III-Severe Pain-

                  Multi-Centric Osteoarthritis and/or Spondylitis

                  Advanced Oral Disease with root abscessation

                  Multiple tooth fractures with pulp exposure

                  Cat Stomatitis

                  Chronic Ulcerative Paradental Stomatitis in the Dog

                  Acute Necrotic Gangrenous and Ulcerative Periodontitis in the Dog

                  Deep Odontoclastic Osteoclastic Resorptive Lesions in the cat with pulp involvment

                  Trauma to mouth with pulp exposure or jaw fracture

                  Oral Cancer

                  Whole body pyoderma with excoriation

                  Anal Sac abscessation

                  Advanced Ocular Inflammation

                  Foreign body puncture of cornea involving anterior chamber

                  Foreign body: conjunctival in nature

                  Retrobulbar Abscess

                  Cancer

                  Tympanic Membrane Rupture

                  Trauma to long bones, chest, abdomen, or head

                  Intervertebral Disc Disease

                  ACL and Meninsal Problems of the knee

                  Urethral Obstruction

                  Gastric or Intestinal Foreign Body or Obstruction

                  Gastric Volvulus [Bloat]

                  Post Surgical Pain Following Lengthy Complex Surgery

                  Continual bloody emesis

                  Chronic bloody dysentery 

                  Auto Accident-Shock multiple trauma sites

                  High Riser Fall-Multiple trauma sites

                  Crushing Injury to head, trunk, long bones

                  Terminal Cancer

                  Terminal Organ Failure-not cancer

                  Heart Failure

                  Acute Pulmonary Failure

                  Laryngeal Paralsis

                  Tracheal or Esophageal Foreign Body

                  Terminal Pulmonary Failure

                  Pneumo and/or Hemothorax

                  Diaphragmatic Hernia

                  Hypertrophic Cardiomyopathy 

                  Vascular pain-Emboli 

Dr. Villalbos's Quality of Life Scale should be applied to all PAIN patients but definitely considered VITAL in the SEVERE PAIN CLASS III Patient.  No pet should live in pain.  If your pet is suffering from any of the conditions above ask for a consult with your local doctor of veterinary medicine and ask their help in the treatment of that pain.  The AAHA/AAFP Pain Management Guidelines are a starting point for your doctor.  There are also pain specialists in the United States that your doctor can contact for a Pain Control Consult and Review of Therapy.

Your doctor may want to consult with a doctor with a special interest in pain management [i.e. a member of the International Veterinary Academy of Pain Management]. 

FROM THE IVAPM WEBSITE: "The International Veterinary Academy of Pain Management is a multi-disciplinary organization that seeks to promote the acquisition and dissemination of knowledge related to the biology and clinical treatment of pain in animals. Stakeholders in this process include a wide cross-section of individuals.

The Academy seeks to: provide forums for communication among all interested parties of knowledge concerning the biology and treatment of animal pain, provide continuing education in the area of pain recognition and treatment, and establish a process whereby veterinarians with a special interest in the area of animal pain management can meet a set of prescribed objectives that will ultimately lead to certification in the management of animal pain.

Finally, the Academy seeks to promote humane, scientific investigation into the biology of animal pain and the assessment of the efficacy of defined treatment modalities."

There is a plethora of help for pain management in 2014.  Pain can be controlled and quality of life achieved if the pet advocate learns fundamentals in evaluating their own pet for pain at home.  All it takes is time and understanding of your pet's Quality of Life.  

Examine Dr. Villalobos's HHHHHMM Scale above and then--look at your own companion. If your pet is aging or if your pet has a serious medical problem............ today is the day to begin charting change.  Keep daily logs and share those logs on a weekly basis with your veterinarian.  Pain control is not a medicine but it is a system of monitoring, evaluating, and prescribing.  

The pain control system selected could range from physical therapy, to acupuncture, to multiple pharmaceuticals, and many other modules of pain care.  There is not one pain system for each condition.  The Pain Condition Chart that has been placed in this blog is for identification of severity.  Within each area: Mild I; Significant II; and Severe III, each patient may perceive pain differently.  

A patient in Mild Stage I Pain can have as serious a pain reaction as a Severe Stage III pain patient.  A pet can jump from one stage to the next in just a few days necessitating different pain control.  The only way to know where your pet is on the Pain Scale is to look at the Quality of Life Markers that Dr. Villalobos has so eloquently described. 

The greatest act of kindness is removing pain from the companion that supplies unconditional love.  If you are lost and cannot tell if your pet is in pain: Pick up the phone 
and schedule an appointment with your veterinarian.  Tell that doctor your concern and that you want to be certain you are not missing a vital pain marker.  Working together the pain can be identified and removed. 

“Kindness is a language which the deaf can hear, and the blind can read” Mark Twain

  

                  

Questions about this Blog?

Write to DoctorDeForge@yahoo.com

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26May2014