|
Case Studies
Welcome to the Pain Assessment Case Study page. The purpose of this area is to help you become familiar with recognizing pain in dogs and to familiarize the veterinary team to the various pain scales available.
This area contains numerous cases, including their history, physical exam, any pertinent diagnostics performed, and anesthetic and analgesic medications administered during their hospital stay. Videos of each dog are provided for you to practice your pain assessment skills. The intent of this area is to help the veterinary team to select the most appropriate category of pain for an animal. We hope this program helps you in further understanding and recognizing pain in dogs. Good luck in your pursuit of canine pain management.
You can practice by using the:
Visual Analog Scale (VAS)
The VAS consists of a straight line, 100 mm long, with "No Pain" on the left end and "Worst Pain Possible" on the right end. The goal is to make a single vertical mark on the scale in the area where you think the animal's pain would rank. The mark is measured from the left end of the scale, and the score is the number of millimeters measured at the mark you have made.
Simple Descriptive Scale (SDS)
The SDS consists of a scale from 0 to 4 with each number representing a different level of pain. 0 = no pain, 1 = mild pain, 2 = moderate pain, 3 = severe pain, and 4 = very severe pain or worst pain possible. You need only to select the number that represents the level of pain you think the animal is experiencing.
Glasgow Composites Measure Pain Scale (short form) (GSF)
The GSF consists of a series of six questions, and each answer has an associated score. Once you have answered all the questions, add up the six scores and the total represents the animal's pain score. The total possible score for a dog that is able to rise and walk is 24 points. However, if the dog is unable to rise and walk, then the total possible score is 20 points. Please note that the form provided is a modified version of the GSF. The information is identical, but we have presented the questions in a different format than the original GSF.
Use of the scale employs both an observational period and a hands-on evaluation of the patient. In general, the assessment begins with quiet observation of the patient in its cage at a relatively unobtrusive distance. Afterwards, the patient as a whole (wound as well as the entire body) is approached to assess reaction to gentle palpation, indicators of muscle tension and heat, response to interaction, etc.
- The scale utilizes a generic 0-4 scale with quarter marks as it's base along with a color scale as a visual cue for progression along with the 5 point scale.
- Realistic artist's renderings of animals at various levels of pain add further visual cues. Additional drawings provide space for recording pain, warmth, and muscle tension; this allows documentation of specific areas of concern in the medical record. A further advantage of these drawings is that the observer is encouraged to assess the overall pain of the patient in addition to focusing on the primary lesion.
- The scale includes psychological and behavioral signs of pain as well as palpation responses. Further, the scale uses body tension as an evaluation tool, a parameter not addressed in other scales.
- There is a provision for non-assessment in the resting patient. To the authors' knowledge this is the only scale that emphasizes the importance of delaying assessment in a sleeping patient while prompting the observer to recognize patients that may be inappropriately obtunded by medication or a more serious health concern.
- Advantages of this scale include ease of use with minimal interpretation required. Specific descriptors for individual behaviors are provided which decreases inter-observer variability.
- A disadvantage of this scale is a lack of validation by clinical studies comparing it to other scales. Further, its use is largely limited to and is intended for use in acute pain.
Click here for a list of videos.
Protocols used to obtain video and information for each case were approved by the CSU Animal Care and Use Committee. Informed Client consent was obtained for each patient prior to performing pain assessments.
This project was supported by an unrestricted educational grant from Pfizer Animal Health.