New Jersey crafts pain, distress guidelines

SPRINGFIELD, N.J. — The New Jersey Veterinary Medical Association (NJVMA) unveils veterinary medicine's first pain management guidelines, beating at least two national groups to the task.

Veterinary leaders insist it's not a race, but NJVMA plans to disseminate this month the nation's only comprehensive report that addresses hospital pain management, staff training and distress and recognition by owners in home settings. The document creates an assessment scale and categorizes acute and chronic pain as well as treatment recommendations. It also outlines tips for veterinarians to recognize and report signs of animal abuse.

The American Association of Feline Practitioner (AAFP), in the coming months, plans to release a pain management panel report. At presstime, the association invited the American Animal Hospital Association (AAHA) to join in on the project. While AAHA's made no commitment, the two groups plan to talk this month during the American Veterinary Medical Association Leadership Conference in Chicago.

"This is going to be one of the most remarkable things AAFP has done," spokesman Dr. Jim Richards says. "We're asking AAHA to collaborate or at least endorse us in this endeavor."

NJVMA's endorsement comes from its Executive Board members, who adopted the guidelines unanimously. While the topic is short of novel, advances are ongoing, says Rick Alampi, the association's executive director. It's the concept of putting together a model for practices to follow that's new, he adds.

"If you've been out of school for 20-plus years, pain management was not a subject that was taught," Alampi says. "Secondly, it's increasingly moving to the forefront in terms of veterinarians' awareness of the need to do as much as they can in the area of pain management. We hope to provide a helpful template for veterinarians to follow or measure their own pain management practices against."

Model for veterinarians

Dr. Beth Hunton plans to use the model in her Clinton, N.J. practice. As chair of NJVMA's Animal Welfare Task Force, Hunton drove the guidelines project, which gathered veterinary medicine's recent advances in pain management and education.

The work fills a void in hospital pain management, she contends.

"There was an absence of guidelines for hospitals on this topic," Hunton says. "We wanted to talk doctor-to-doctor about pain, and create one pain scale that should be part of the medical record."

The guidelines are split in several sections, starting with a strategy for recognizing pain in the hospital setting. In addition to grading pain and mapping out distress behaviors in dogs and cats, the report advocates, "An anthropomorphic approach should be used if the caregiver has difficulty interpreting behavioral characteristics associated with a situation known to cause pain." When in doubt, treat the patient with the appropriate analgesics for the pain likely to be present, the guidelines recommend.

The guidelines also outline pre-emptive pain management, tying procedures to distress levels. While chest drains likely trigger mild to moderate pain, cancer pain is rated moderate to severe. Meningitis and necrotizing pancreatitis causes severe to excruciating pain, the guidelines state.

Drug and procedure recommendations are included for treating the two major pain categories: chronic and acute.

Staff training also is advocated. With the ability to identify pain behaviors, receptionists can prioritize appointments and communicate with clients, for example.

Recognizing animal abuse

While there are countless causes of pain in animals, many distress cases are related to animal abuse, Hunton says. Nearly 80 percent of veterinarians have observed animal abuse and almost 94 percent believe they're ethically obligated to report it, according to a 1999 study on Massachusetts veterinarians' attitudes.

Quoting that statistic, authors of the guidelines added a section devoted to animal abuse recognition. They include environmental and diagnostic abuse indicators as well as reporting procedures. The recommendations range from contacting authorities and conducting forensic medical examinations to analyzing crime-scene data and testifying in court.

The guidelines outline comprehensive patterns for non-accidental injury that link injury types with examination advice and suggested diagnostic processes or tests. For example, with embedded collars, examine for visible trauma signs, foul odor from infection and necrosis. Take photos before and after shaving, measure the wound depth and save the collar, the guidelines suggest.

Client education

Recognizing that pain signs might not be obvious during short exam times, authors created a sample handout to educate clients on identifying distress at home.

"Clients often don't recognize signs of pain in their animals. It's our job to teach them," Hunton says. "This is something I deal with daily. You have to ask the client the questions."

The mock brochure corrects faulty distress indicators, noting that continued appetite, purring and lack of crying or whimpering fails to rule out pain in animals. By contrast, behavioral changes often indicate a problem, the guidelines state.

In the Animal Welfare Task Force's charge to develop standards of care and husbandry for pet owners, the guidelines also include outlines showcasing the responsibility, cost and time involved with taking on a companion animal. "Abandonment and neglect are the leading category of animal abuse in the United States, accounting for 29 percent of reported cases nationwide," the guidelines state.

The work begins with selection measures that incorporate size, activity and pet types, continuing with financial expectations and zoonosis responsibilities. It also includes proper husbandry activities to thwart neglect, a form of animal cruelty.

"We're all uncomfortable dealing with these things, but they need to be discussed," Hunton says. "As veterinarians, we must protect society by educating clients and recognizing abuse."