2015 AAHA/AAFP pain management guidelines for dogs and cats

Abstract

Rationale: The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge.

Relevance: Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian-client-patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care.

Approaches: The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals.

Evidence base: The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

Image 1

(a,b) Signs of acute pain include squinting, and a hunched or tucked-up position instead of sleeping in a normal curled-up position (see Image 2). Images courtesy of Sheilah Robertson

Image 2

Cats normally sleep in a curled-up position, as seen in this patient, when provided with adequate analgesia. Courtesy of Sheilah Robertson

Image 3

Following assessment from a distance, palpation of the surgical site is performed to further assess acute pain. Courtesy of Sheilah Robertson

Image 4

Lack of normal behaviors, such as reduced grooming, is commonly seen in painful cats. Image iStock/jvoisey

Image 5

Cats may start to perform abnormal behaviors secondary to pain, such as defecating outside of the litter box, either because the cat cannot get downstairs to the box or it cannot jump into the box. Courtesy of Sheilah Robertson

Image 6

Note how comfortable cats usually are for acupuncture therapy. Courtesy of Sheilah Robertson

Image 7

Environmental management is needed in addition to medical management for cats with DJD. Providing a stool (a,b), ramp or step(s) (c) allows the cat to reach favored areas. Pet steps are commercially available or can be built; those pictured in (c) were built by Dr Robert Wright of The Cat Doctor in Portland ME, USA. Images courtesy of Deb Givin

Image 8

(a) Muscle wasting over affected legs is a common sign of DJD, as seen in this orange tabby, (b) Close-up of the front limbs of the cat, showing deformities secondary to DJD. Images courtesy of Ilona Rodan

Image 9

Since DJD is ubiquitous, can occur in cats of all ages, and can be difficult to detect, every effort should be made to incorporate gentle handling techniques for all cats. For example, gently pushing the front leg forward from behind the humerus, instead of pulling on the front foot, will help to prevent elbow pain. Courtesy of Ilona Rodan

Image 10

Instead of stretching and pulling hind legs back tightly, gently place one or more fingers between the hind feet and hold without stretching. This prevents exacerbation of lumbar, lumbosacral, knee and hip pain. Courtesy of Ilona Rodan

Image 11

(a) Note this cat’s uncomfortable stance while eating caused by DJD. (b) Raising the food onto a low shelf allows the cat to sit normally and eat comfortably. Images courtesy of Margie Scherk

Image 12

The gray and white cat in (a) is seen as gregarious and is choosing to climb to higher locations. Image (b) shows the same cat with DJD and the inability to jump. Provision of a step allows the cat in image (c) to perch in a favored place. Images courtesy of Sheilah Robertson