Pain scoring & quality of life

As you read our pain updates and listen to our webinars you will realise we talk a lot about pain scoring! So I decided to expand a little on the two pain scores I use on a regular basis and the health related quality of life instrument I use.

Canine Brief Pain Inventory

The Canine Brief Pain Inventory is 11 questions, divided into 2 sections. This is an owner completed score. The first section asks how painful the dog is – looking at the last seven days and how the dog is now. The owner assigns a score from 0 to 10 – with 0 being no pain and 10 being a high level of pain. These 4 questions can be summed then averaged to give us an answer out of 10. This gives me an instant idea of how painful the owner thinks the dog is. Remember that these answers are specific to the individual dog, and best used to compare against in the future. I work on the basis that pain is an individual experience and try not to compare the scores from one dog to another.

The second section of the CBPI looks at how the pain interferes with activity on a day to day basis. This includes activities such as walking, running and climbing stairs – yes of course we encourage dogs with OA not to climb stairs – but this is asking about the ability to perform such activities – not recommending them! Again, these 6 questions can be summed and averaged to give an answer out of 10.

Finally the CBPI asks the owner to rate the dog’s QoL. I find as a question this can bring some emotion to the pain score. This is often the first time a connection has been made between pain and quality of life. I do always ask owners what they want to achieve from a consultation with me. Most answer that they want their dog to be as comfortable as possible with a good QoL. You can download the CBPI free here.

The CBPI has been validated for dogs with OA. Reduced pain scores were shown in dogs treated with carprofen, versus dogs treated with placebo. More recently the CBPI has been used in clinical trials of grapiprant (Galliprant) and bedinvetmab (Librela).

Liverpool Osteoarthritis in Dogs

The Liverpool Osteoarthritis in Dogs scale (LOAD) was developed at validated at the University of Liverpool and is available through Elanco.

I like the LOAD score as it gives into more detail about the dog’s exercise regime in the lifestyle section and will reveal aspects that require attention. In this regard I find the LOAD questionnaire a useful aspect of history taking. For example, asking what type of ground exercise takes place on and whether exercise is on or off lead can lead to owners revealing information such as the dog being worse when walked on the pavement versus grass or struggling the day after off lead exercise.

LOAD was developed at the University of Liverpool and has undergone further validation work in over 200 dogs with OA of the elbows, hip and stifles. This work correlated LOAD scores with force plate data. You can read about this validation work here.

LOAD consists of an initial questionnaire to be completed at the first visit and one follow up questionnaire which is filled out at each recheck. Once the owner completes the form, a LOAD score is calculated. You will find instructions and copies of both questionnaires on the My Elanco site.

LOAD consists of 13 questions which generate scores upon completion of mild, moderate, severe and extreme. These provide a useful baseline for us to decide appropriate interventions.

Feline Musculoskeletal Pain Index

A specific pain scale, Feline Musculoskeletal Pain Index (FMPI) exists for cats. I find this a useful component of history taking and many of the questions will be answered from a thorough history. It has been validated for diagnosing and monitoring feline musculoskeletal pain. We know cats are often diagnosed too late and using the FMPI really helps with owner understanding of their cat's pain.

Vetmetrica

Quality of life is something that, as I say, I start to address fairly early on in management of chronic pain. To reliably assess quality of life, I use the VetMetrica health – related quality of life (HRQL) scoring system developed by the same pain researchers who brought us the Glasgow Pain Scores. VetMetrica is an online system that asks owners to rate on a 0-6 scale their pet’s behaviour (22 behaviours in the case of the dog and 20 for the cat) and then converts the answers into scores in 4 HRQL domains for the dog (Energetic and Enthusiastic, Happy and Content, Active and Comfortable and Calm and Relaxed) and 3 for the cat (Vitality, Comfort and Emotional Wellbeing).

The system compares results to the healthy dog or cat population on a scale of 0 – 100, where a score of 50 represents the average healthy dog or cat. In the case of the dog this score is also related to whether or not the dog is ≥ 8yo. 70% of healthy dogs or cats will score above 44.8. In the dog, an improvement of around 7 is considered to indicate a clinically meaningful change and in the cat it varies with the domain (5 for Vitality and Emotional Wellbeing and 7.5 for Comfort).

VetMetrica is a generic HRQL scale which means it will measure the impact of any non acute condition that affects the animal’s QOL, for example OA, CKD, obesity, chronic skin conditions to name but a few and of course chronic pain. It has 3 main applications in clinical practice as follows:

· As a general wellness measure with an alert built in, triggered when the scores fall outwith a predetermined level. This asks the owner to contact their vet. Intended for regular use throughout the animal’s life

· As a therapeutic monitoring tool to measure the efficacy of treatment

· As a means of determining humane endpoints for individual animals, underpinning end of life decisions.

VetMetrica provides an additional communication channel between owner and vet, informing the consultation process, giving the owner some ‘ownership’ of their pet’s healthcare and confidence that veterinary care is continuing remotely, thus strengthening the pet owner/clinician/practice bond. You can access Vetmetrica here.

I hope this pain updates encourages you to use pain scoring for your chronic pain cases.

This post was written by Matt Gurney.

Matt sees referrals in the pain clinic at Anderson Moores Veterinary Specialists. You can also receive telemedicine advice from us here if you have a pain case where you need a helping hand.

Matt & Carl established Zero Pain Philosophy to provide educational resources & telemedicine to veterinary professionals enabling optimal management of pain.

Matt Gurney is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and works at Anderson Moores Veterinary Specialists. Matt is President of the European College of Veterinary Anaesthesia & Analgesia.

Carl Bradbrook is an RCVS & European Specialist in Veterinary Anaesthesia & Analgesia and is President of the Association of Veterinary Anaesthetists. Carl works at Anderson Moores Veterinary Specialists.