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Recognizing Pain in Animals with Dr. Tammy Grubb - Ep. 11
370 Plays1 year ago
Imagine a dog limping into your clinic with its concerned owner in tow. It’s not too hard to presume that the animal is experiencing some degree of discomfort. But what about a cat who suddenly spends less time grooming? Or a dog who no longer wants to chase their favorite toy around the house for hours at a time? Our furred companions are remarkable at masking signs of pain, which may have served them well as a survival tactic from their wild roots, but now may hinder pet caregivers from providing appropriate care and honoring their animal’s quality of life. In recognition of Animal Pain Awareness Month, host Dr. Bonnie Gatson welcomes esteemed guest Dr. Tammy Grubb. Dr. Grubb is a boarded veterinary anesthesiologist, president-elect of IVAPM (International Veterinary Academy of Pain Management), and a world-renowned expert in the recognition and treatment of pain in companion animals. Together, they will decode various classifications of pain, offer inciteful methods of assessing pain in different domesticated species, and discuss the role of modern technology in advancing the field of pain assessment in animals.
Links to content/resources mentioned in the podcast:
Learn more about Animal Pain Awareness Month
2022 AAHA Pain Management Guidelines
WSAVA Global Pain Council Guidelines
Short Form of the Glasgow Composite Measure Pain Scale for dogs
Client Specific Outcome Measure
Feline Musculoskeletal Pain Index (Pain-Free)
Canine Brief Pain Inventory scale.
Additional pain assessment tools:
The COAST Tool developed by Elanco (Canine OsteoArthritis Staging Tool)
Osteoarthritis Pain Checklist developed by Zoetis for dogs and cats
Recommended
Transcript
Introduction to the Podcast
00:00:06
Speaker
Welcome back fellow gas passers to another episode of the official podcast of the North American Veterinary Anesthesia Society, where our goal is to help veterinary professionals and caregivers advance and improve the safe administration of anesthesia and analgesia to all animals. I'm your host,
Importance of Recognizing Animal Pain
00:00:24
Speaker
Dr. Bonnie Gatson, and today we're diving into a topic that lies at the heart of compassionate veterinary care, recognizing pain in our patients.
00:00:33
Speaker
The International Veterinary Academy of Pain Management, or IVAPAM for short, has declared September to be Animal Pain Awareness Month. So I'm really glad that we here at NavVis can do our part to shed some light on this issue. Pain is a complex biological process that creates an unpleasant experience that is unique to each individual.
00:00:57
Speaker
Think of the last dog or cat that came into your place of work that seemed obviously painful. Was the animal crying out in pain, limping, maybe flinched when you touched a particularly uncomfortable spot?
00:01:15
Speaker
While these all may be indicators that an animal is suffering from a painful condition, I still challenge you to think that maybe it's possible that animals can be experiencing pain and showing different types of behaviors.
00:01:31
Speaker
And these behaviors may change from the home to the veterinary clinic. From a dog's subtle and quiet withdrawal to a cat's seemingly mysterious behavioral change, our furry friends often communicate their pain in ways that require a discerning eye.
00:01:49
Speaker
I think we can all agree that as caregivers to our furry, feathered, or scaled friends, understanding when they're in discomfort is crucial for their well-being. And only
Interview with Dr. Tammy Grubb
00:02:01
Speaker
when we can effectively recognize when an animal is pain can we truly begin the healing process.
00:02:09
Speaker
Our special guest today, Dr. Tammy Grubb, is a true expert in this realm with a wealth of experience and a profound empathy for our nonverbal companions. She is here to unravel the subtle cues and signals that speak volumes about an animal's pain. Our guest brings a wealth of knowledge and experience to the table.
00:02:31
Speaker
As a renowned veterinary anesthesiologist specializing in pain management and present elect of Ivapam, she's dedicated her career to decoding the intricate language of our pet's discomfort. Through her pioneering research and hands-on experience,
00:02:46
Speaker
She's honed the ability to read the unspoken language our animals share, helping us to provide the care they so rightfully deserve. We'll explore the nuances that set one animal's behavior apart from another's, the incredible adaptability of our animals to mask their pain,
00:03:04
Speaker
and the innovative methods that veterinarians are employing to diagnose and manage pain more effectively than ever before. So whether you're a fellow veterinarian seeking to enhance your diagnostic skills or a dedicated veterinary technician eager to deepen your connection with your four-legged patients, this episode promises to be an illuminating journey into the realm of recognizing pain in animals.
00:03:29
Speaker
Join us as we learn from the wisdom of Dr. Tammy Grubb and embark on a quest to make our furry friends' lives pain-free and full of comfort right here on the NavAss Podcast. Hi, welcome to the NavAss Podcast. Dr. Grubb, do you mind introducing yourself? And I'm also curious, why did you choose to dedicate your career towards becoming an animal pain specialist?
00:03:59
Speaker
Oh, I would love to introduce myself. It's always easier, right, to talk about yourself. So I am, as you just said, like you, board certified veterinary anesthesiologist. And yes, I do have a really strong interest in pain. You know, I think I'm a good example to young veterinarians of don't think that you have a straight path.
00:04:19
Speaker
to whatever your end point is in this career and that you can't deviate from it because I've done a lot of different things. And doors just kept opening. I was in mixed practice when I graduated from veterinary school and thought that's what I would always be doing. And then got a chance to go back and do a year of equine medicine in academia, did that, found anesthesia while I was there, did that.
Understanding Pain in Animals
00:04:41
Speaker
And then as an anesthesiologist, I was one of the members of the Pfizer's was before Zoetis.
00:04:48
Speaker
sedation and pain management team and just really opened my eyes to how much animals need us and need someone, many ones focusing on pain management. And so just all of those doors opening and I finally found my really true passion.
00:05:06
Speaker
That's so wonderful to hear that it's not always a straight path. I'm not necessarily a newer specialist, but I do feel like the doors are always opening and my career path is always shifting still. So it's nice to hear that you can keep finding your journey as you go through it. This is a totally crazy offshoot question, but do you have a favorite class of anesthetic drugs?
00:05:31
Speaker
You know, it's a crazy question I guess for a crazy person because yeah, I feel like a geek But I do have a favorite class and it's the local anesthetics because they are just so powerful You know, they can stop pain from getting from the periphery to the central nervous system which means less effective components of less effective manifestations of pain and
00:05:55
Speaker
less likelihood of central sensitization and they're easy to use and they're widely available. And so yeah, okay, but I get to ask back. Do you have one? I do. It's ketamine, which I already had a lengthy podcast episode about induction agents, but we definitely had ketamine as the star of that episode. That's a good one. Yeah, a good one too. It's so versatile. It's just crazy what all it can do.
00:06:20
Speaker
All right, so let's jump into our main discussion about pain recognition in animals. And I think before we start talking about that, I think we need to start by defining some terminology that we'll be using throughout the discussion since we're going to be talking about pain. Let's just start with what is pain? How would you define pain in the context of animals?
00:06:42
Speaker
Hey, you know, I think we all start out the answer to that question the same way. And it's with that international association for the study of pain definition. And it's a good place to start, but I'm going to expand on it because, you know, you know, the definition we all use, the pain is an unpleasant
00:06:59
Speaker
sensory and emotional experience associated with actual or particular tissue damage or described in terms of such damage. And right, what does that mean to me? Like, ah, what is that? And I used to hate that definition, but honestly, it has some utility. It reminds us that acute pain has a job. The classic example is a person putting their foot in the fire and you withdraw it immediately because it's painful and then pain decreases the
00:07:26
Speaker
Development of tissue damage right we took our foot out of the fire so we were away from the damage and stimulus and so now we have less tissue damage so it certainly does have some utility that definition but really. Point is that pain itself is what the patient says it is what the animal says it is which we have
Methods to Identify Animal Pain
00:07:44
Speaker
to talk a lot about cuz how do they say things.
00:07:46
Speaker
But when we look at definitions and what's happening to the patient, not just the utility of pain, we see definitions like an unpleasant sensation that can range from mild localized discomfort to agony. It's distressing, suffering, right? And honestly, the word pain comes from the Latin word for punishment, pina. And so I think what the patient feels that pain is, that definition for the patient is much different than that utilitarian
00:08:15
Speaker
definition from the IASP. So it's good to use that definition, but also really think about what is going on with that animal. What would the animal say that pain is to them? So you mentioned acute pain and how it has like a biological necessity. How would we define acute pain as opposed to chronic pain?
00:08:38
Speaker
Yeah, they're very different, aren't they? And you and I is nested to deal with both. We see probably more acute pain because of the immediate post-op component of our jobs, but chronic pain is also so important to recognize. And as we just said, acute pain has a job. We say it has biological value or it's purposeful. It's what we call protective because as we just said, it's protecting us from tissue damage,
00:09:05
Speaker
or from further tissue damage, there might already be some damage, but getting away from that acute pain source. We also call it adaptive. It's a normal adaptation of the pain pathway or physiologic adaptation, so we can call it that. And it really is important for healing. And as long as there is
00:09:22
Speaker
some inflammation that's causing that pain, so it's really directly tied to that inflammation. And as long as there's the inflammation there that's promoting healing, that acute pain has that purpose. So if there's a little bit of pain, the animals don't overlook their wounds, right? And some people will say, oh, they lick more if they're pain-free, and it's not true.
00:09:45
Speaker
I'm going to sound like my parents back when I graduated. So I'm going to do it back when I graduated from Vetsville and we still weren't doing good pain management. A lot more licking when they're painful in those wounds than are surgical incisions than not painful.
00:10:00
Speaker
The thing is that as that inflation resolves, the pain should resolve. But we have to help it, too, because uncontrolled acute pain can lead to chronic pain. And that brings us to chronic pain, which we call non-purposeful. It's pathologic. It's not normal. It's maladaptive. It's not a normal adaptation of the pain pathway.
00:10:18
Speaker
It doesn't really have a job because it often comes from a source other than the tissues that are healing. So you and I probably always use the same example, at least I know I do. So phantom limb pain where the limb is gone, the painful limb is gone, and yet a human says they still feel pain from that limb. And I do think animals experience that. So that's obviously not purposeful or protective. The tissues are gone. Or if we're talking about chronic pain, it comes from
00:10:45
Speaker
something that's not healing like osteoarthritis that doesn't heal. So pain from osteoarthritis isn't helping that animal. So we get all the adverse effects of pain without any value. And so chronic pain really, pain is the disease. It doesn't matter what's causing it because we need to treat that pain. Whereas acute pain, again, it has a job
00:11:07
Speaker
And we still have to control it, but at least it has a reason to be there. Chronic pain, you know, it may be protective, like in wild animals, if they're always in pain, they're always hypervigilant, always hiding from the predator so that they don't get eaten. But you know, our dogs and cats probably were not going to eat them. So they don't need that level of pain. And certainly humans, we don't need that level of pain because then we get the behaviors, the health, the quality of life, adverse effects from that pain or not any benefit.
00:11:37
Speaker
Something else I wanted to mention, and it's actually something that I read that you had written that really put this difference between acute and chronic pain into perspective for me, but something that I think is misleading about acute and chronic is that when you use terminology like acute and chronic, it gives a sense of a timeframe. So acute pain only happens in the short term and chronic pain is only something that happens
00:12:08
Speaker
in the long term. And I think that it has, for me, that just exactly what you described has allowed me to stop really using the terminology acute and chronic because a lot of times I find that those conditions are not necessarily within the confines of a time span. Sometimes
00:12:28
Speaker
the onset can happen
Tools for Chronic Pain Evaluation
00:12:29
Speaker
really fast. And so I like adaptive and maladaptive pain personally because maladaptive gives the connotation that the painful condition is truly pathologic. And I don't know how you feel about that.
00:12:43
Speaker
Yeah, I 100% agree with you and thank you for reading something I wrote. It makes me feel good. Thank you. But you're right. You know, when we're talking to pet parents, acute and chronic, even those words sometimes are not really tangible to them. You know, like pain right now versus pain long-term is often
00:13:02
Speaker
that's something that's easier to understand. But I'm with you as professionals, adaptive and maladaptive really do describe that. Adaptive is a normal physiologic response. It's involved with healing. Adaptive, as we've said, really has no purpose and just causes the adverse effects of pain. And you're right about the timeframe. You know, people, they try to define it as longer than three months. Or, you know, the definition is longer than the normal tissue healing time.
00:13:29
Speaker
Because, of course, skin would be different from a tendon or a bone. And so what is normal tissue healing time? It's going to be different. And saying maybe three months, well, would that even fit for our patients? They have a shorter lifespan than humans. So your right time really is a bit irrelevant in this. So I completely agree. Adaptive and maladaptive is what we should be saying.
00:13:51
Speaker
The next thing I wanted to ask you about, and I think it might lead into our recognition discussion, is that when we're classifying different aspects of pain, sometimes we talk about the sensory process that's happening and there's also this like effective component of pain. So I was wondering if you could differentiate between these two arms of the pain experience.
00:14:16
Speaker
Absolutely. And another long answer, just because there's a lot to talk about with this difference between the sensory and the affective components. And there's another IASP kind of definition that the sensory part of pain or discriminative dimension, right? So it's referred to by the IASP as the intensity
00:14:38
Speaker
of the pain and because it's discriminative it allows us to say hey the pain is in my foot we know where it is and how long it's been there. The effective component the IASP describes as the unpleasantness so you've got the intensity and the unpleasantness.
00:14:55
Speaker
And really it is that unpleasantness. It's the effective component that we have to look for in our patients. So your right leads to pain assessment. And it's really what's important. I hear people say all the time, it's too bad animals can't give us a number for their pain. But the number, honestly, even in human medicine where I can say something painful just happened to me and it was a five to me,
Educating Pet Owners and Staff
00:15:20
Speaker
The exact same thing might happen to you, the same amount of tissue damage, the same cause of pain, and yet maybe you don't feel pain as much as I do. So you might say, that was just a two. So even numbers in human medicine don't necessarily mean anything. What means something is why you said a two and why I say a five. How does that pain affect us? And that really is what's important. That's what we need to treat.
00:15:47
Speaker
Because if we really just gave every pain stimulus a number, we would be under treating some patients. We ourselves would be under treated because the okay, sorry, then we could say this. No, it's not that painful. You can't have drugs. But to me, it was painful. And so it's impacting my health and my behavior and my quality of life. So
00:16:08
Speaker
It's effective that we really need to focus on, not really intensity. We want to base our analgesic protocols on the proposed intensity, how painful we think something is, and then just look at the patient and see the effective component. I want to touch base on that number that you report to a doctor when you're feeling uncomfortable because in human medical practice, your doctor may ask you questions like, what is the intensity of the pain you're feeling on this scale?
00:16:38
Speaker
to gauge your level of discomfort. Obviously in animals, we don't have that luxury because we're dealing with a nonverbal species. They're speaking in their own language that unfortunately we just don't understand. So in animals,
00:16:55
Speaker
It seems to me that we often rely really heavily on observing changes in behavior and also our perception, just as you mentioned, of how uncomfortable we think the animal may be in, based off of maybe
Conclusion and Acknowledgments
00:17:08
Speaker
the disease process or trauma or the surgery that we did or whatever that might be. Why is it that we look at behavior changes in animals to quantify pain and how reliable is using this type of method?
00:17:23
Speaker
Well, great question. And because what we see is the effective component, that's why we have to look at behavior, right? That is what we have to assess pain in animals. And again, that's not all bad because we want to see that change in behavior to support our intervention level. But of course, we have to know to look for those signs of behavior. And they're not precise.
00:17:49
Speaker
What I tell pet parents and colleagues that are learning about pain, we should be looking for behavior changes. And then we should say, okay, that behavior change means something. It's not always pain. And especially with chronic behavior change, maybe there's a new dog in the household at home and the cat hasn't gotten used to it or something.
00:18:09
Speaker
But looking for those behavior changes and then saying, could it be pain? So for us as anesthetists, as we said, a lot of it's pain right after surgery or after trauma. And so looking at how interactive, for instance, that cat or dog was before surgery and then
00:18:25
Speaker
did that behavior change post-surgery. So we did something painful. And there's a quote from Bernie Hanson, an old quote. Bernie, as I think everybody knows, is a criticalist that says, we shouldn't make animals prove that they're in pain if we know we did something painful. So yes, we want to look for the behavior, but it shouldn't take much of a behavior change for us to say, OK, yeah, that's pain.
00:18:46
Speaker
So the validity of it is what we want to see, but animals are really good at hiding their behavior, hiding their pain. And so it's as good as we are at looking for it. And we have to learn how to look for it and learn what we're looking for. And then seriously, really look.
00:19:06
Speaker
because they'll tell us they're in pain, but we have to find it. And sometimes if we're not sure, we should, if we can't say that pain's not there by whatever their behavior is, then we should say it probably is there. So we should treat
00:19:21
Speaker
that patient or that pet for pain. So I know it's sort of a rambling answer, but I'd love your opinion too. I mean, we have to look for it and it is a good marker, but it's not perfect. We're not perfect. And they're so good at not showing us their behavior. So there's a lot of fraughtness to it. I don't know if that's a word. I might've just made it up.
00:19:43
Speaker
But it's what we have. One more common on that too is by the time we see behavior changes, they're painful. They want to hide pain from us. So by the time we see it, it hurts a lot and we need to treat that. So what do you think? I'm sure you use behavior as well. How do you feel?
00:20:02
Speaker
For me, I think behavior is important. I really liked your point about by the time they're showing us they're uncomfortable, that's a tipping point, right? I like the idea of giving animals the benefit of the doubt that they might be uncomfortable. And then even if we're doubting ourselves to just go ahead and treat pain, I mean, not every drug that we have to treat pain is benign, but there are some that are a little safer than others.
00:20:32
Speaker
that we can choose from as far as our arsenal is concerned. I like the idea of using behavioral changes but I also like the idea of using like an array of things because behavior is one thing that we can look at but there's also other factors like what's their heart rate, what's their blood pressure. We'll go into other type of tools that we can use beyond just behavior but I like to use a lot of different tools and I also like to
00:21:02
Speaker
Personally, just use, like treat the animal and see how they respond. Sometimes, I mean, that sounds very like, I don't know, maybe it's old school, but sometimes if you're unsure, just giving a medication to treat the pain and observing behaviors or observing how the animal reacts to that, I think is also something that can help reinforce that.
00:21:26
Speaker
I couldn't agree with you more and I don't think it's old school. I think it's actually new school because there are still so many veterinarians out there that are afraid to treat like, no, I'm not sure so I'm not going to treat and I'm with you. Let's use new school. Let's ask them. That's what I call it. Asking them. Asking them pharmacologically.
00:21:45
Speaker
if they're in pain. And I agree with you, that really sometimes is the absolute best way. And I think this is Dr. LaSalle's, I'm sorry for quoting people, but they're smarter than me and they say really good things. I think Dr. LaSalle's is the one that has said that that's really the best way to tell if they're in pain. If you're not sure, the best way is to treat and observe the response. So now I think that's really, whether it's acute or chronic pain, I think that in the end is the answer. And especially if you're not sure, if you can't be sure that they're not in pain, there's a double negative.
00:22:14
Speaker
And you should assume that there probably is some pain. Right. So we've been dancing around this topic a little bit, but what are some examples of some painful behaviors that we might observe in dogs and maybe also some painful behaviors you might see in cats because they're definitely different?
00:22:33
Speaker
Right. When we say they're their own species, like no kidding, right? They're probably from a different planet. And great question. And I want to throw in some resources too. I'm sure everybody has read the new aha pain guidelines. Those are amazing. And then I want to steer everyone also to the was saw the global pain management guidelines, also amazing and more like a book, right? The aha guidelines, quick guideline, quick read,
00:23:00
Speaker
the WASAVA guidelines, seriously 80 pages, it's great, lots of information, and there's some lists of different behaviors and different pain scales and things in those guidelines that can help people because one of the things I think we need to do is really educate ourselves on what we are talking about, what are we looking for,
00:23:20
Speaker
And any change in behavior, in my opinion, should be investigated. So things we're looking for, of course, that would be a little bit obvious would be either a dog or a cat that was friendly before surgery or before it got arthritis.
00:23:37
Speaker
And now it has either withdrawn so it doesn't want to be so obviously it's friendly and social and now it's withdrawn it doesn't want to be around humans or other animals or it's reactive and saying ouch this hurts every time you touch me I don't know what to do so I'm going to bite you so we get these kind of extremes in behavior sometimes in either species.
00:23:59
Speaker
Dogs can be harder, I think, to determine because they want to be, oh, hi, I'm your buddy. I want to be your friend. And so we have to make sure we're watching them when they don't see us. Cats are always hard because they like to hide. And poor cats, they're confused. Are they prey because they're small? Or are they predators because they eat mice? They're always conflicted. Do I show a prey behavior or a predator behavior? So I can, poor cats, I don't know.
00:24:26
Speaker
I can't imagine being that confused all of the time, but the cat hiding and then hissing the dog, wagging its tail maybe, but not wanting to come out of the cage, right post surgery. So just subtle things like that too, that might, it doesn't have to be as strong as hiding versus reactive, maybe under grooming or over grooming.
00:24:49
Speaker
Again, maybe just not wanting to come out of the cage and when it was really come out really quickly before so Just looking for subtle signs. It's really really important. What signs do you look for?
00:25:03
Speaker
Well, I actually am going to throw this back at you for a minute because I've heard of people who are smarter than me doing this. And I'm curious what your opinion about this is. So I think one thing that trips people up when they're trying to recognize painful behaviors in animals that are in the hospital has to do with
00:25:23
Speaker
whether or not these painful behaviors are being masked by anxiety types of behaviors. And sometimes if an animal is going to be in the hospital multiple days, they will kind of come out of their shell after they are a little bit more comfortable in this new environment. And what I hear some people doing is actually having owners, like when the animal comes into the hospital,
00:25:45
Speaker
Do a quick like behavior like what is normal for your dog so what is your dog normally friendly or anxious is your dog like approachable unapproachable i'm honestly i'm making this up but i'm assuming those are like like a small questionnaire about the animals normal types of behaviors that they're observing at home.
00:26:04
Speaker
And then observing these animals in the hospital and seeing if their behaviors are deviating really far away from these particular normal behaviors that they're exhibiting at home. Like is your dog a picky eater or do they eat a lot normally?
00:26:21
Speaker
And so not only does that gauge the level of anxiety and fear an animal might be feeling in the hospital, but that might also be feeding into whether or not an animal is uncomfortable, especially if we're looking at these animals after surgery. So I've heard of some people doing that. And I don't know if you've heard of anything like that or if I've totally like made that up. So I was curious what you thought about that.
00:26:46
Speaker
I think it's amazing and I'm like you, yes, wouldn't it be awesome if we had time to do that with every patient? Because we should be doing that, I 100% agree. We should be doing that so we know more about that pet. And I think it's so useful to know because absolutely, if the cat's normally friendly and the owner says that, friendly, social, and now we look in the cage and it's hiding in the back and we haven't even done anything yet, okay, we're starting out now with anxiety and then how do we tell pain on top of that?
00:27:14
Speaker
And that's one of the reasons to me that the nurses or technicians, and of course the term depends on the country that they're licensed in. So nurses or technicians are the best at knowing when those patients are in pain post-operatively because they've had a little conversation with the owner when that pet was dropped off. And so they usually have a little bit more information than we do. And we should take a few seconds to get that every time. I love your idea.
00:27:42
Speaker
I didn't know if anyone had been looking at that or not so I think I've heard that a little bit like pain scale or not pain scales like behavior scoring even before an animal comes into the hospital and then
00:27:54
Speaker
doing not only pain scales, which we'll get into in a second, but also like behavior scoring that animal as well and seeing like how the two are changing throughout the course of the animal's treatment in the hospital. Okay, so let's get into some pain recognition tools that can be used in practice. As I've been practicing more, I have been seeing many practices adapting pain scales
00:28:22
Speaker
And I think that's been amazing just to see practices, pain scaling and scoring their patients while they're in the hospital. So first of all, I've been really happy to see that that has been changing in a lot of practices. But for those practices that haven't introduced a pain scoring system or pain scale, what is a pain scale? What's a pain score?
00:28:47
Speaker
I'm with you, isn't it great that we're starting to be better at using pain scales and pain scores? And those really are quite important. And I think, I'm sure we probably all have sort of the same definition, a scale or a score is just a way to take the information that we're seeing from that pet, from that cat or dog or whichever species we're scoring and saying, okay, we see these things that deviate from what is
00:29:15
Speaker
proposed normal behavior in that patient or that we know is normal behavior because we talked to the owner before like we were just discussing and ticking off those boxes. Okay. This cat is doing this now and it wasn't before this cat's face looks like this now it didn't before this dog is flicking its ear. And we know we just did a surgery on its head and whatever behavior is different.
00:29:40
Speaker
And putting that into an algorithm, that score, that scale, so that we can say, all right, these are the things we just saw. And that adds up to a certain number in our scalar score.
00:29:54
Speaker
And that number then tells us where to treat. Is this higher than the treatment cutoff number for this scale of score? And I'm going to make a caveat right quick, though. Even if the number is, let's say, the cutoff number is four, if they score a four or higher, we're going to treat them. Even if the number is a three, we should treat if we think they're in pain. So it's back to what you and I have been talking about.
00:30:16
Speaker
If you feel like they're in pain, let's ask them pharmacologically because if you can't prove it's not there, that must mean some is there. But the scales help us put all of our knowledge together and then also they help with consistency. So again, let's say I scored a cat a five out of the scale I'm using and I treated it and then I go home for the day. Yay, somebody gets to go home now and then and so someone comes behind me to score that cat.
00:30:44
Speaker
And they need to know what I saw so they can know if there was a difference. So pre-pain behavior versus post-pain behavior, but also pre-treatment behavior versus post-treatment behavior. I keep saying behavior, but whatever's in the score, and you're right, we're skipping over heart rate and stuff like that. I shouldn't have been doing that, but whatever's in your score. So then that way that person can say, yes, this patient's better or no, it's not.
00:31:08
Speaker
So it really does help us see that patient by looking at this list of things, look at the patient, look at your list. And then again, it helps with consistency. Do you think pain skills do a good job of differentiating acute pain and chronic pain?
00:31:25
Speaker
I'm gonna say I don't, I want your opinion too. I don't think, I think we have to use our diagnostics to know if we have acute or chronic. And most of the scales really are for acute or chronic because if you've been in pain for a long time, you may not be showing the same signs as if all of a sudden right now you got a migraine and you're painful now. And so they exhibit different signs. So I don't, I think we have to use our own diagnostics to do acute versus chronic. What do you think?
00:31:55
Speaker
I agree with that. I think that most of the pain scales and scoring systems that are adopted in hospitals that I work at are usually pain scoring systems that are designed to be used for acute pain. So they're not doing a good job of picking up dogs that are painful because they have osteoarthritis, same thing with cats or some other chronic pain state.
00:32:22
Speaker
So I think that, you know, I deal a lot with post-surgical pain because I'm an anesthesiologist and so I like a lot of the pain scales and looking at them and using them.
00:32:34
Speaker
for observing treatment over time when we're trying to create an effective treatment protocol for an animal in the post-operative period. And I like using pain scales to say like, oh, we're doing a good job or we could do doing better and things like that, along with vital parameters like heart rate and blood pressure and respiratory and things like that. But if we're just like having an animal come in the hospital for like a wellness visit,
00:33:00
Speaker
And we're getting a pain scale number on top of, you know, doing our other vital parameters when they walk in the door, which is something that I definitely recommend that all animals who do a physical exam get a, get pain evaluated as well. A lot of practices are using acute pain scales for that process. And that's not, in my opinion, you're, you're not going to pick up the cat that's, that has like low grade osteoarthritis that way. So that's my opinion on that. I don't know how you feel about that.
00:33:30
Speaker
I think you're right and it is a big misconception and I think unfortunately that means that we have very good intentions and yet we're still missing the pain in that patient and I agree getting a pain evaluation is probably the physical exam and a quick history about anything that pain might look like because pet owners normally don't know what pain looks like. These things that you and I have been talking about and just think if you didn't know what pain looked like
00:33:59
Speaker
Like, how would you know what pain looked like? You know, that sounds kind of silly, but the point is that owners, pet parents,
00:34:09
Speaker
Pet parents don't understand that the things that we've been talking about, like behavior change might mean pain. Because as humans, we talk about it, right? We don't have to know what pain looks like. I will tell you if I'm in pain. I will tell you all about it. And I want to know what your treatment would be. And we talk and talk and talk. And animals don't do that. So pet parents don't know what to look for. So they don't bring them in for pain.
00:34:33
Speaker
And then what you brought up doing a quick pain evaluation really is important so that we catch the pain that the animal might have. And so also that the parent starts to understand what pain might look like. It's amazing how many animals that we know are in pain out there and they don't come in.
00:34:50
Speaker
And it's not because they're bad owners, it's because the owners don't know what to look for. So doing that quick evaluation. You know, just think about why the scales may not cross over between acute and chronic pain. Because let's talk about the feline grammar scale. That's my favorite one for cats. It's so amazing for cats. It's so easy to use.
00:35:09
Speaker
And it is acute pain. And just all of a sudden have a migraine right now, you're probably squinting your eyes and clenching your jaws, right? You're making that pain face like cats do.
00:35:21
Speaker
But after a while, you have to go on with your day, your life. So if you have chronic pain, you don't go around making that face all the time. You might, if you had a bad moment, if you had acute on chronic moment, but you don't go around making that face all day. It's only that acute pain. And so if veterinarians and veterinary nurses and technicians and pet parents are looking for that face change with chronic pain, they're not gonna have it.
00:35:47
Speaker
They may be saying, okay, my cat's not in pain when we really need to be looking at something else, quality of life, different behaviors, more things that would lead to a chronic pain diagnosis than that particular pain scale. Can you provide some examples of pain scales that you would recommend that veterinary practitioners use either for acute pain or for more chronic pain and for any of those pain scales
00:36:16
Speaker
just for our listeners, I'm going to link all of them in the show notes, all the ones that Dr. Grubb recommends. Great, great. Yeah. And there's good listening with Saba guidelines too. And then thanks Bonnie for linking them. That's awesome. We just mentioned the feline grimace scale. Do you use it? Yes, I love the grimace scale.
00:36:36
Speaker
I think pain scales involving like how an animal's facial expressions change in related to pain, like that's really been exploding. And for our listeners, if you want to really dive deeper into grimace scales, you can find grimace scales for all kinds of species. I haven't found one once in sea lions. Oh my gosh.
00:36:57
Speaker
When i was like looking around yeah can you like talk a little bit about how to use the feeling grima skill or how people can find out how to use the grima skill specifically for cats.
00:37:10
Speaker
Absolutely. So the Feline Grimace Scale, which of course has been validated to identify acute pain in cats, comes with a training manual. Yeah, it's a point that probably you and I would both make. And that is to point one, choose a pain scale and use it.
00:37:29
Speaker
but to read about it and learn how to use it. Because if we're not using it correctly, and this one's not hard, but if you're not using it correctly again, we're probably missing cats in pain. And our goal is to not miss them. And with the training manual, it talks about the different dimensions that we're looking at. And it's the eyes,
00:37:50
Speaker
whether they're open or somewhat closed or a lot closed. The ear position was normal for the cat, which brings us to like Scottish folds. Of course, I should just throw that out right quick. The scales don't necessarily work for every single patient. So with the Scottish fold cat, if you're trying to look at ears, obviously not going to work really. And then the position of the whiskers and the tension in the muzzle,
00:38:16
Speaker
And they're really easy to see in cats. So once you get the training manual and you look at a cat and you look at your training manual, look at the cat training manual, you can, it's on the job training. So you've learned about it. You go look at cats. And then like you and I have been saying, if you think they're a painful treat and then go back and look at the cat again and look at those same things, the same domains in that cat's face.
00:38:39
Speaker
And it's fascinating to me the explosion. I go to PubMed and search grimace scales for pain. And I didn't know about sea lions, but there is a grimace scale for almost every species, which is important because a horse's ears are going to do something different than a cat's ears. And also different age groups. So I just threw out horses. So I'll stay with that for just a minute. There's adult horse scale and the scale for foals and like pigs, sows and piglets.
00:39:08
Speaker
Sheep, adult sheep, and lambs. And that's also important because the younger patients often are a bit more expressive. And this is all based on a scale developed in the 1980s that was developed by two nurses, Nurse Wong and Nurse Baker.
00:39:27
Speaker
to the Wong-Baker facial scale. And it was for infants or neonates that couldn't express pain. And in fact, remember back then, there was still the thought that they didn't feel pain because they had an immature nervous system. And now we know, of course they feel pain. And that's what the nurses said too. Not only do they feel pain, but we can tell by what's going on with their face, their eyes,
00:39:51
Speaker
the, again, the tension in the jaw, you know, like, are they grating their teeth? And we know that they are in pain. And so they developed that pain scale. And it was finally brought into animal medicine, I think 2011 is when the first one was published for animals, and that was the rat grim scale.
00:40:09
Speaker
And probably most of us aren't working on rats, but it's great they got the first one because they're research animals. And if we're going to cause pain, we're going to cause it. We'd better be able to find it. I feel the same thing about surgery, right? We caused it. We find it. And so then it exploded next. It was mice and then rabbits and then horses and then cats.
00:40:29
Speaker
It is amazing, but they really are good scales and they make it even better as they get more automated, right? Using artificial intelligence. Now there still needs to be a person to say, yes, that really is a painful animal, but we may be able to even be a bit more consistent with things like that. So it's crazy how much it's exploded. Yeah, I totally agree. And just to get back on cats really quickly, we're going to jump to dogs in a second, but for cats,
00:40:57
Speaker
I think that I find most practitioners are using the Colorado State University pain scale for cats and for dogs. I think people really like those scales because they're very easy to use. It's like a score of zero to four, I believe. And there's pictures and verbiage associated with those things.
00:41:20
Speaker
for what each category you can put an animal in. I personally think the grimace scale, at least for cats, I think is better for acute pain than the CSU. It is validated for cats. And I also like the benefit of using the grimace scale, I think, is how fast the evaluation is. You're only really looking at five different parameters. And I think where I see people get tripped up,
00:41:46
Speaker
is sometimes the facial changes are very subtle. For me, the one that's the hardest is to look at how puffy the cheeks are. And they're either flat against the face or very nice and puffy. And I think sometimes I'll stare at a cat and I really can't figure it out. But the nice thing is that the grimace scale has a contingency plan for that. So if you're not sure, you just assign a one for that animal.
00:42:12
Speaker
And so I also really like that if you're not sure, the scale gives you like a suggestion on how to address that problem. For me, I like for cats, at least in acute pain, I really like the grimace scale. It's actually the one that I recommend people use even over the CSU scale. And I don't know if you agree with that.
00:42:33
Speaker
Yeah, I do. I love that grandma scale. And, and I forgot that you're right. Five domains. And I mentioned four eyes, ears, whiskers, and then puffiness of the cheeks. I'm with you. That's the hardest one. And then also the position of the head in relationship to the shoulders and body, right? Is it, you know,
00:42:48
Speaker
head down or head up and looking around. So those are the five. It is so fast. And really honestly, I'm going to be very opinionated here, but I don't think any clinic can tell me they're too busy to do a quick feline grimace scale on cats. It's so fast. And then of course you get the cat out and you do, you know, further exam, but just walking by the cage, you can tell which cats need to be looked at and which cats like
00:43:12
Speaker
look pretty okay and which definitely need treatment see it's a really good screening tool and I love what you just said about it too that that one is important so the other thing that's easy if you haven't used them yet like Bonnie said there's a score zero one or two it's either not there it's there a little bit that's the one or it's there a lot right there's none of this like maybe it's a five and a half I don't know right zero one or two
00:43:37
Speaker
And that one is important. Like you said, if you're not sure that it's not there, then it probably is there. So just give it a one. If you really are not clear, give it a one. We're deviating in fairness to the animal, right? We're saying like, okay, we were going to give this animal the benefit of the doubt that it might be in pain. The other thing about that scale is it gives us a cutoff number when to treat, which the Colorado State Scale doesn't have a to treat number.
00:44:03
Speaker
And that number is four. And again, we're deviating in fairness to the animal. It's a very low number, which is good. So if we did miss something, if we really couldn't tell about the cheeks, the likelihood all the others would add up to more than a four and we would treat that animal, that, I keep saying animal, cat, from that cat.
00:44:22
Speaker
I really love how there has been a recent explosion in recognizing pain in cats and also there has been some newer medications that are coming out to treat pain in cats. So that's been really wonderful, but I feel so bad for dogs because they've kind of been left behind a little bit. So can you tell me a little bit about what pain scales you would recommend to use for dogs?
00:44:48
Speaker
Yeah. And isn't it a travesty? Poor dogs. And I ask audiences every time I'm talking about pain assessment and I described the grimace scale and the nurses and all the background. And I talk about, you know, they came out in rats first and then I say, what species that we treat commonly do you think got the first grimace scale? And everybody picks dogs. Of course it would be the dogs. The dogs get everything first. And
00:45:13
Speaker
I'm sure everybody listening knows, and like you just said, there's not a grimace scale for dogs and lots of research. There will be, but a big problem with, not a problem, a fact with dogs is that they have so many different facial shapes. And cats, again, like the Scottish foals can be a bit problematic with the grimace scale and maybe even the break of some phallic cats, although I still really think it works in those cats as well. But the authors of that scale caution that those cats may be a little bit
00:45:43
Speaker
different to identify the pain with the scale. Dogs, I mean, put a German Shepherd next to a pug. I didn't know what kind of facial scale you're going to come up with. So I think there's probably going to have to be one for long nose dogs and ones for short nose dogs. I do look at a lot of the same components though. Is there ear position normal for that dog? You know, is it a dog that should have really upright expressive ears or even long ear dogs?
00:46:09
Speaker
Is it just flat with no expression, no movement, the ears? It would be different from how the ears are when it's not in pain. Also the eyes, the eyes in any species are a big component of a facial grimace scale. So are their eyes squinted or are they open? So I still do use those as a marker. And I like the Glasgow scale, the Glasgow short form scale. Again, another one that's really easy to use.
00:46:36
Speaker
There's pictures. It really does not take any time at all to do a quick Glasgow assessment. And back to the Colorado State Scale. I do like it if people are really looking at each component. Like you said, the facial grimace scale, you really need to look at the face. And the Colorado State Scale doesn't describe it in detail like the true facial grimace scale.
00:46:58
Speaker
But it does give you a place to put together. This is what I saw in the face. This is what I saw in body positioning. You know, is it flat out or is it curled up normally?
00:47:09
Speaker
And this is what I saw with the attention to the wound and the behavior. It's a good clearing house to put your stuff in to me, but I agree that we need something that really, okay, what are we looking at? What exactly should we be looking for? And that one just doesn't quite have that detail. So I use Glasgow. That was a long story for that. What do you use?
00:47:28
Speaker
I'd say I like Glasgow as well for dogs. And like so weirdly, I don't know why I never thought of this, but just when you mentioned about how there's so many different facial types in dogs, you know, you have like, I can't imagine trying to pain score.
00:47:46
Speaker
like a Japanese chin and have that be the same as like a Belgian Malinois, you know, because they're completely different. So I don't know why I never thought of that, but it's so true. And that's probably why there is no grimace skill yet for dogs, but I bet there will be based off of like breed types. That's really fascinating. I want to talk about other tools.
00:48:05
Speaker
that we can use to identify pain in animals. And I'm going to ask you about a few different tools that have recently become available. And I'm hoping to get your hot take on some of these instruments that have been advertised as pain identifiers in animals, if you know anything about this. One I get asked about a lot is the pain trace. And I don't know if you have any experience using it or not, but I was going to ask you what your opinion on the pain trace was.
00:48:32
Speaker
So the pain trace gives us a way to actually measure the pain. And I think it's very, very exciting. And I've used it and I think it's quite good. I've used it in both acute and chronic pain. And I'm gonna go back to the number for a minute. Cause I said, if we give pain a number from our brain, like so earlier I gave you something painful that you scored as a two and I gave myself that same thing. And I scored it as a five, right? That's from our brain.
00:48:59
Speaker
But the pain trace can actually give pain a number based on whatever it is measuring. That's not my thought on the pain, right? This is how we feel. So we can give it a number which we've said still we need to look for effective components. That's very, very important.
00:49:16
Speaker
But that would be really, really useful in not only treating our patients, but also in research. So post-surgical pain, and we're going to say, okay, we're going to do this research surgery, but we have to make sure we do it exactly the same. And we have to have the same breed of dog and the same weight of dog, and everything has to be done exactly the same for us to compare these two drugs.
00:49:37
Speaker
Well with the pain trace, maybe it could be a whole bunch of different surgeries as long as the outcome was always a five. If the level of pain is a five, we can put this dog in the study. We don't have to do 10 of the same surgery. We can do 10 whatever's happening to the dog. So that would be really useful and also animal welfare. So I think it's very, very exciting and I can't wait till I'm smart enough to figure out how it works.
00:50:00
Speaker
I personally, just to give a disclaimer, I don't work for pain trace. For those of you who are interested in learning more, I will put a link to their website on the show notes so people can learn more about the pain trace. I've never used it and I'm curious about it. People have asked me about it and I don't know. I've never used it.
00:50:21
Speaker
So yeah, in full disclosure, I have given some lectures for pain trace and included pain trace in my pain assessment lectures. But my disclosure slide for every lecture is that I want to try everything. I'm going to try every treatment for pain, every pain assessment tool, and then talk about it. Tell people about it so that you can go and decide for yourself whether pain trace works, whether
00:50:45
Speaker
of the drug I'm using works and so yeah I have put it in my lectures but they don't pay me darn it. Have you used any thermal imaging at all? A little bit. I am not well versed in it but a good friend and colleague Dr. Jen Johnson uses this a lot and she went to one of her lectures and she taught me a bit about the thermal imaging and
00:51:07
Speaker
And it's very interesting because since there is a sympathetic nervous system response to pain, we can get some vasoactive changes that can be identified by thermal imaging. So you can get a better idea of where pain is coming from if you already think the animal's in pain and you can find that pain. Or if it's having a behavior that you're not sure is pain.
00:51:29
Speaker
you can image them and go, oh yeah, look, here's a change. There's probably some pain in the lumbar muscles or something. So yeah, I think it's also quite an interesting tool. Have you used any like force plate or gait analysis or anything like that when you are evaluating animals for pain?
00:51:48
Speaker
Yeah, and you know, for me, the force plate, the gait analysis, they're a little bit limited in a number of factors. One is they're pretty much only at universities, right? Or kind of difficult just to put one in your practice. Some people have them, but kind of difficult. Also, they're good for lameness, but not really other sources of pain. And there are so many sources of pain. And even with lameness, there are some factors like how fast is the dog walking?
00:52:16
Speaker
How habituated is it to its environment? Because we've all seen animals that are stressed that the owner says they're lame at home, right? And then they bring them into the clinic and they're not limping at all. Cause like, I'm not going to show, I can show you I'm lame. I'm going to power through this. So I think it's a good research tool, but it's not as great as we thought it was for a while. And you know, a lot of the chronic pain drugs were approved using force plate or gait analysis.
00:52:44
Speaker
And now, like the recent chronic pain drugs have been approved with things that the client's looking at at home, so some of the chronic pain scales. So yes, I think it's good, but it's not my everyday go-to. And for cats, oh my gosh, try having a cat on a force plate, right? Not going to do it. Plus, cats, when we're doing gait analysis, we want to watch them move vertically, don't we? We want to see them climbing their kitty tree or jumping up into a window sill.
00:53:13
Speaker
not so much walking across the floor. Right. The picture I have in my mind of a cat on a force plate is there was this viral video going around a few years ago where there's a cat in a water treadmill and the cat was literally just putting its paw on the treadmill and sitting in the corner like a limp noodle.
00:53:37
Speaker
So we talked a lot about acute pain scales essentially and also I really liked your idea about when you're evaluating cats for pain and you're trying to do some kind of
00:53:50
Speaker
gait or analysis on those animals, you are really looking for vertical movement. But since we've been focusing a little bit on the grimace scale and acute pain scales, I'm curious, what do you recommend as far as tools that can be used effectively to identify and monitor chronic pain in animals?
00:54:07
Speaker
And it is more difficult, isn't it? Because not only do we need to be able to identify it, but we need to be able to teach the pet parents to identify because they're seeing that pain at home. And, you know, for cats, I really like the feline musculoskeletal pain screening.
00:54:26
Speaker
the FMPS. And there's a great website on that pain scale and another one that's easy to use. But again, every time I say easy to use, I should caveat with training, but that would be obvious, I guess. So I think the FMPI is a great tool and the pet parents can use that, go to the website. And with that, when you log in with your cat and then you can go back and put its numbers in,
00:54:49
Speaker
as often as you want to. There's several that I think are out there. And in the WASAVA guidelines, again, there's a fullness. I don't know all of them that are out there, but there's some others that can be used. In both dogs and cats, the client-specific outcome measure, the CSOM, it was just used for approval of some of the new chronic pain drugs. And what that is, I really like that because you ask the owner to identify some behaviors that were normal for their cat or dog before pain, and then
00:55:19
Speaker
Okay, we want to watch for changes in those activities those parameters to say that the pain drugs are working What's nice about that is then we don't say this is what I want you to see I want you to see in your cat Because what if we picked I want your cat to play with the laser pointer and the cat never likes the laser pointer, right? So this is the owner can say my cat used to jump up in this windowsill Or my cat used to groom better or my cat played with this toy and same with dogs, right? Whatever the dog used to do and
00:55:46
Speaker
So those are actually really quite useful. And then with dogs, I mentioned the feline musculoskeletal pain scoring. With dogs, there's again several that are out there. The canine brief pain inventory is another good one that involves the owner.
00:56:04
Speaker
There's some like the Helsinki, the Liverpool, some other scales. I want to share information from two companies. Both the Lancome and Zoetis have some good chronic pain scoring tools on their websites. It's because, of course, they manufacture and sell chronic pain drugs, but good. That makes them want to be invested in
00:56:26
Speaker
all of us being able to
00:56:41
Speaker
Of course, that's a big important part of our patients getting treated. And then I don't know that Zoez has a name for their screening tools, but they have behavior changes and mobility. The two things we're looking for, as you and I have talked about, behavior and mobility, checklist for the dog and the cat. So there's a website so maybe we could put up for people to utilize. Those are the ones I use the most. And then really, again, as we've talked about, just talking about the behavior and mobility
00:57:11
Speaker
the pet parents and so sometimes it doesn't get put into a tool unfortunately it's just a kind of obvious change which ones do you use for chronic pain you know i don't use personally my daily practice on a chronic pain scales because i don't do a lot of chronic pain evaluation in my daily practice you know i mostly do.
00:57:31
Speaker
perioperative anesthesia. So I'm always curious to hear people's opinions on that. The only recommendation that I have made to some practices is to find a chronic pain scale and use that when you are talking to owners, especially in older animals, maybe, you know, nine years and older when they're coming in for a well visits to use those types of pain scales as part of
00:57:56
Speaker
your questionnaire when you're asking pet parents how the animal's doing to incorporate some of those questions into your general history gathering. And the other thing I've recommended is some practices when you walk in, there's like a TV screen that's playing some things in the waiting room. And it might show like, this is, you know, this is why you need to give a board of televaccine, you know, just like very,
00:58:23
Speaker
generic information that's coming up on a computer screen. Sometimes I'll recommend, maybe you should put a slide up there about what to look for in pain in their dogs or their cats. So when the owner's in the waiting room, not doing anything, they can look up at the TV screen and there's just a small little video that plays about pain recognition or something like that. Because I agree with you, pet parents need to be the ones who are heavily invested in looking for changes in their animal at home.
00:58:52
Speaker
Right, because that's where they're going to manifest the signs of chronic pain. Maybe if it's limping in a dog, we'll see that when it walks in the clinic, but we wouldn't see necessarily mild musculoskeletal pain. And like you've already said, they can override that just from fear, anxiety, stress, response. And with cats, of course, they don't even get out of the carrier, so we won't even see lameness.
00:59:15
Speaker
I love your idea of putting something in the lobby, teaching that parents to see that what pain looks like because I already said and it's kind of goofy, but if you don't know what pain looks like, how would you know what pain looks like? You have to see the behavior and mobility changes. They're not going to tell us.
00:59:33
Speaker
And we have to get pet parents past the fact that if a dog or a cat is not crying, then it's not in pain, right? They always say, it's not crying, Doc. They only do that with acute pain. And cats maybe not do it at all. And then the other thing is they're still eating, Doc, so they're not in pain. So getting pet parents to see that just because they're eating doesn't mean there's not pain. If they stop eating, yes, that's a big sign of something wrong. But because they are eating, maybe that's not that useful.
01:00:03
Speaker
So getting past that and educating those pet parents what it looks like, it really changes the conversation to, first of all, we become more efficient at identifying the pain if the owners come in and say there's something that looks like this and we go, oh, it could be pain if the owners come in with that question because we're also busy in that annual physical exam. You know, is your cat still eating? Yeah. Okay. It's one of our questions. Is cat still eating? Yeah.
01:00:28
Speaker
Any changes since last year? Nope. You're happy? Yep. Okay. Vaccinated and off you go. And we're not asking pain questions because we're busy. So we need to learn to ask pain questions. And then, and you said it earlier in the podcast, we should be doing a quick pain assessment as part of the physical exam. It doesn't take long.
01:00:47
Speaker
And teaching the pet parents to what it looks like, they come in with the right questions. Again, my dog is doing this. Could it be pain? And when they come in with the right questions, that helps us a lot. It makes it more efficient. So it's worth our time to educate them for the pet. Of course, we want the pet to be pain free. We are good vets, but also for the pet parents understanding what it looks like.
01:01:10
Speaker
And that's why I like some of the websites like Zoetis has and like Alenco has. And I'm sure other companies too, I just happen to be familiar with those too. And a lot of their focus is educating the pet parents. And I think that should be one of our missions as veterinarians.
01:01:26
Speaker
is to drive pet parents to scientifically valid websites. Otherwise, they go and do a Google search about what's going on with their cat or dog, and good for them, they're trying, right? They want to be invested, they want to be part of the solution, but they come up with things like, don't go to your vet, vets kill cats or something, random, ludicrous. So if we send them to good websites with good information, then they come in with the right questions. And I think that should be one of our missions, no matter what the disease,
01:01:54
Speaker
whether it's chronic pain as a disease or diabetes or whatever, we should be sending them to good websites and putting them in our lobbies. I love, love, love that. Yeah, something else. I had Dr. Kristin Kirby Shaw on the podcast and something she said that I think really resonated with me is that a lot of times, for example, the question you just posed, is your cat eating? Yes, no. Sometimes that exists on a sliding scale.
01:02:23
Speaker
It's the same thing with jumping. You know, people will say like, Oh, is your cat like jumping up on services? Yeah, it's jumping up on services. Okay. Yes, no. And sometimes it's not as black and white. Sometimes it's a sliding scale. Well, my cat jumps up on the countertop because the food's on the countertop. So we'll jump up to eat, but I haven't noticed it jumping up, you know, when it doesn't want to eat. And so it can be so subtle as, as that, for example. So.
01:02:51
Speaker
you need to be asking more nuanced questions if you're specifically trying to look for chronic pain changes.
01:03:00
Speaker
Right, absolutely. And I love that, the nuanced questions. That's perfect. In the sliding scale, absolutely. Is it doing this more or less than it used to do? Is it a lot more important than just, is it doing it or not? And again, if we have that out for the pet parents to identify, then they come in with that thought, maybe my cat or dog has pain. And that's been an easier conversation versus your cat or dog has pain. And they say, no, it doesn't. I can't believe it.
01:03:28
Speaker
They come in with that idea. So giving them those nuance changes is perfect. And also grooming, failure to groom is a failure to thrive kind of thing, especially in cats. So could it be pain? Yes. Do pet parents know that? Probably not, unless we ask those nuanced questions. And if we're organized, we're teaching the clients and then we're also having our checklist of questions to ask. We can do this. We can squeeze this into an annual physical exam.
01:03:56
Speaker
And you mentioned this earlier, also identifying those pets that might be at risk. So aging cats, overweight dogs, right? So we can also profile a little bit and focus our pain questions and exam and those patients that are at risk patients. Can you provide your top three suggestions to veterinary practitioners that are listening to this podcast on things they can do tomorrow?
01:04:24
Speaker
to improve upon their pain recognition skills. Yeah, and it's really a summary of what we've been talking about. So tomorrow, please go to the resources that you're going to put in the podcast library and look through those pain scores and pick one. Pick one. We gave you several.
01:04:44
Speaker
Pick one that would work in your clinic, and then implement it. Get everybody together at a team meeting. So first of all, learn about it. So one is pick one. Two is read the guidelines, know how to use it. And then three, get the team together and implement it. Make it a mission of your practice that this is what we're going to do. Give your nurses or technicians time to do it. It doesn't take a lot of time, but give them that time.
01:05:08
Speaker
Listen to your nurses or technicians give them the power to come to you and say I know we do a good job at pain management in our practice, but I think this cat needs more pain relief and the duck to say Why do you think that and now the nurse or technician can say because on the feline grimace scale? It's got scored higher than before right? It gives them power. So just pick one Implement it and then really use it in your practice. Everyone should use it and everyone should be behind it
01:05:38
Speaker
I love that. I love the idea of empowering our nursing staff to provide appropriate input. That's so important because they're going to be the ones sitting by the cage side for those animals. So I love that idea as well.
01:05:55
Speaker
Well, you know, I want to thank you so much because we talked for a very long time today about something that I'm passionate about and it sounds like you're also very passionate about. So thank you so much for spending time talking with me today about pain assessment. I just really appreciate it.
01:06:12
Speaker
Thank you for having me. It was great fun. I appreciate it too. I really appreciate Navas and all the education Navas is doing and the forum to reach people. We haven't had that in the past. And so really love everything that's going on and a chance to be a part of it. And then I just wanted to add that I am president elect of the International Veterinary Academy of Pain Management, IVAPM, which many people are familiar with.
01:06:35
Speaker
And I wanted to throw out there that September is Animal Pain Awareness Month. So just like there's other kinds of months, we have Animal Pain Awareness Month. It's a one health initiative that we kind of adopted from the IASP because September is also Human Pain Awareness Month.
01:06:53
Speaker
So it's a great time to focus on pain education of colleagues, of co-workers, of pet parents. And that should be every month, but at least for sure we have September to focus on. So don't forget Animal Pain Awareness Month. And thank you so very much for having me in a fun conversation.
01:07:20
Speaker
If you like what you heard today, I encourage you to check out NavAss and consider becoming a member. As a member of the North American Veterinary Anesthesia Society, you get tons of benefits, including access to CE events, focusing on anesthesia and pain management, blog posts, fireside chats with boarded anesthesiologists, as well as specialty technicians, and just so much more.
01:07:43
Speaker
visit www.mynavast.org to advance your anesthesia journey today. If you have been listening and enjoying this podcast, I would sincerely appreciate it if you could give us a like or subscribe to our podcast, write a review, or simply just tell a friend about this podcast.
01:08:02
Speaker
We appreciate any and all listeners' support. If you have any questions about this week's episode, or the NAVAS podcast in general, or if you want to suggest topics that you would like for us to discuss in future episodes, please reach out to us at education at mynavas.org. We would love to hear from all of you.
01:08:23
Speaker
Also, a huge thank you to our sponsor, Decra, without whom this podcast would not be possible. Visit their website, www.decra-us.com to learn more about their line of veterinary products.
01:08:39
Speaker
This podcast was produced and edited by Chris Webster of Chris Webster Production. I want to thank our guest, Dr. Tammy Grubb, for this insightful discussion on pain recognition in companion animals. If you're interested in learning more about pain management and recognition in animals, please check out the IVAPAM website at IVAPM.org.
01:09:03
Speaker
And a huge thank you to all of you, all the gas pastors out there who choose to spend their time with me today on the NavVis podcast. Becoming a skilled anesthetist is a lifelong journey of learning and self-discovery, so I hope you consider listening in the future. Until next time, I'm your host, Dr. Bonnie Gatson, and thank you for listening. I hope you consider tuning in next month for another episode of the NavVis podcast.