Pain Scoring
Introduction
Apart from pain scoring our patients being an integral part of our job as a veterinary nurse, it is also one of the five animal welfare needs – be protected from pain, suffering, injury and disease. As veterinary nurses, we have a huge role to play when it comes to this. We are expected to be able to pain score adequately and know when to notify the veterinary surgeon that the patient may require more analgesia.
Learning outcomes
· To have a better understanding of pain scoring
· To feel more confident noticing when a patient may require more analgesia
· To feel confident using a pain score chart
Pain related behaviours
Each patient should be pain scored individually as, like humans, each animal experiences pain differently. Examples of this include Labradors being more stoical (enduring pain without complaining) whilst Whippets can be a little bit more sensitive and vocalise their pain [1]. The species should also be taken into consideration as it is common for prey animals, such as rabbits, to ‘freeze’ and display no signs of pain at first look.
Typical pain related behaviours in dogs[2]:
Common behaviours in dogs experiencing pain include a sudden development of aggression, guarding the injury site/tissue damage, biting and scratching, licking their wound during the post-operative period, changes in their sleep pattern, restlessness, having a hunched posture or being in the ‘praying’ position which is a typical position of abdominal pain, anorexia, vocalising, whimpering, barking, growling, abnormal movement, facial expression which includes looking at their ears and eyes, weak tail wag.
Typical pain related behaviours in cats [3]:
Common behaviours in cats experiencing pain include being in the hunched position rather than their usual curled up position, anorexia, sudden aggression, self-mutilation, lack of grooming, facial expression, vocalising and hissing, sitting at the back of the kennel and hiding.
Are there physiological effects of pain?
Yes. These include tachycardia, hypertension, tachypnoea, changes in the respiratory pattern, pyrexia, pupillary dilation, shaking, shivering, panting and salivation [4].
However, these changes can be the reaction from other factors such as stress and can also be significantly affected by drug administration. So, if a patient has been in for a surgical procedure, it is important to be aware of the medication that has been administered and their effects.
Commonly used pain score charts - these charts can be seen at the end of this article:
· Colorado State University Pain Score for Cats
· Colorado State University Pain Score for Dogs
· Glasgow Composite Pain Score for Cats
· Glasgow Composite Pain Score for Dogs
The Glasgow pain scores are scored out of 20. If the pain score is greater than 5, it is usually recommended that analgesia is administered.
The Colorado pain scores are scored out of 16. If the pain score is greater than 5, it is usually recommended that analgesia is administered.
Links to pain score charts available to print:
Colorado (cats): https://vetmedbiosci.colostate.edu/vth/wp-content/uploads/sites/7/2020/12/feline-pain-scale.pdf
Colorado (dogs): https://www.vasg.org/pdfs/CSU_Acute_Pain_Scale_Puppy.pdf
Glasgow (cats): https://www.aprvt.com/uploads/5/3/0/5/5305564/cmp_feline_eng.pdf
Glasgow (dogs): http://www.isvra.org/PDF/SF-GCPS%20eng%20owner.pdf
Pain scoring is subjective so it is recommended that the same nurse is pain scoring the patient throughout their stay. Pain scoring should be started before approaching the patient. This can be done by looking through the ward door at them, before opening the kennel door and before touching them. Once the initial checks of looking at their positioning and facial expressions without being approached have been completed, then we should continue to pain score whilst checking their TPRs and touching around the area of the wound.
Conclusion
It is vital for a veterinary nurse to have a good understanding of pain score, any medication the patient is having (whether it be medication being administered at home or what has been given in practice) and to be knowledgeable and observant about when a patient may require analgesia (or further analgesia).
Canine Pain Score Chart - Colorado State:
Feline Pain Score Chart - Colorado State:
References and further reading:
1. Jo Murrell; Vicky Ford-Fennah. Anaesthesia and Analgesia. BSAVA Texbook of Veterinary Nurse 6th Edition. Edited by: Barbara Cooper, Elizabeth Mullineaux, Lynn Turner. British Small Animal Veterinary Association: Gloucester, England, 2020. Page 679.
2. Jo Murrell; Vicky Ford-Fennah. Anaesthesia and Analgesia. BSAVA Texbook of Veterinary Nurse 6th Edition. Edited by: Barbara Cooper, Elizabeth Mullineaux, Lynn Turner. British Small Animal Veterinary Association: Gloucester, England, 2020. Page 679.
3. Jo Murrell; Vicky Ford-Fennah. Anaesthesia and Analgesia. BSAVA Texbook of Veterinary Nurse 6th Edition. Edited by: Barbara Cooper, Elizabeth Mullineaux, Lynn Turner. British Small Animal Veterinary Association: Gloucester, England, 2020. Page 679.
4. Jo Murrell; Vicky Ford-Fennah. Anaesthesia and Analgesia. BSAVA Texbook of Veterinary Nurse 6th Edition. Edited by: Barbara Cooper, Elizabeth Mullineaux, Lynn Turner. British Small Animal Veterinary Association: Gloucester, England, 2020. Page 680.