As a Vet, I spend quite a lot of my time reading the body language of my patients, because strangely enough they cannot speak. It would be very helpful if my patients where suddenly able to speak and tell me exactly where it hurt, how long it had been sore for and what had helped to relive their pain. Instead I speak to their owner, examine the patient and with a mix of experience and knowledge come up with a differential list which may require further possible diagnostic tests. And sometimes the body language of the animal gives me the biggest clues of all.
This blog post is inspired by my recent time in hospital, where I underwent a series of tests and had major abdominal surgery. At its most acute the pain was so overwhelming, I was unable to communicate exactly where it hurt. I had given my history so many times to so many different professionals I was uncertain what I had said when, I became withdrawn, hunched up to one side and was crying out in distress. I finally said that unless they were going to learn something new they were not allowed to palpate my abdomen for the umpteenth time that day because every time they did I wanted them to stop immediately. Sound familiar? Seems like a dog or cat with an acute abdomen to me. Luckily for the doctors biting generally was impossible in the state I was in.
After the offending body part had been removed and finally the morphine was working, I had time to reflect. I talked to my anaesthetists and pain nurse, who were interested on my take on human treatment vs animal knowing that I was a vet. We discussed drugs that we used (not so different), the way we gave general anaesthetics (not so different) and the way we look at pain and its severity (Again not so differently). This has caused me to consider our current pain scoring and the pain relief regime that we use here, not a bad thing to open your mind and challenge a few preconceptions.
Management of pain acute and chronic, I think forms a large part in both human and veterinary medicine as it greatly affects the quality of life of our patients. If you consider animal’s behaviour and responses to be equivalent to a young child, then adapting a human pain score like “The non-verbal pain assessment FLACC” and “The paediatric facial (Wong Baker) pain score is not going to be that far out. Many of these parameters are easy to recognise require no other equipment than your eyes, knowledge and are easy to standardise. I think on reading the following extract you will see that pain recognition and signs for pain are not that diverse between the species, and anyone who has had occasion to experience these things will find them familiar. I think that in the end our inner animal is not buried that deeply under our sophisticated exterior……
Below I have included an excerpt from the WSAVA Global Pain Council document – Guidelines for recognition, assessment and treatment of pain in the Cat
“Pain assessment and recognition
Take into consideration the type, anatomical location and duration of surgery, the environment, individual variation, age, and health status. The cat should be observed from a distance then, if possible, the caregiver should interact with the cat and palpate the painful area to fully assess the cat’s pain. A good knowledge of the cat’s normal behaviour is very helpful as changes in behaviour (absence of normal behaviours such as grooming and climbing into the litter box) and presence of new behaviours (a previously friendly cat becoming aggressive, hiding or trying to escape) may provide helpful clues. Some cats may not display clear overt behaviour indicative of pain, especially in the presence of human beings, other animals or in stressful situations. Cats should not be awakened to check their pain status; rest and sleep are good signs of comfort but one should ensure the cat is resting or sleeping in a normal posture (relaxed, curled up). In some cases cats will remain very still because they are afraid or it is too painful to move, and some cats feign sleep when stressed.
Facial expressions and postures: these can be altered in cats experiencing pain: furrowed brow, orbital squeezing (squinted eyes) and a hanging head (head down) can be indicators of pain. Following abdominal surgery a hunched position and/or a tense abdomen is indicative of pain. Abnormal gait or shifting of weight and sitting or lying in abnormal positions may reflect discomfort and protection of an injured area. Comfortable cats should display normal facial expressions, postures and movement after successful analgesic therapy.
Behavioural changes associated with acute pain in cats: reduced activity, loss of appetite, quietness, hiding, hissing and growling (vocalization), excessive licking of a specific area of the body (usually involving surgical wounds), guarding behaviour, cessation of grooming, tail flicking and aggression may be observed. Cats in severe pain are usually depressed, immobile and silent. They will appear tense and distant from their environment.”