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Pain Physiology and Assessment

in Small Animals

Emma Archer RVN Dip AVN Surgical VTS Anesthesia

Anaesthesia Technician

Animal Health Trust

Why is pain assessment important?

There are many answers to this question…

The most obvious answer to this question is because our patients are unable to

talk, so it is up to us to read and interpret their body language.

This is not always an easy task, and requires knowledge of different species,

breeds, and ideally of the individual patient themselves. Sometimes they may be

trying to tell us they are in pain, and we need to interpret the signs they are giving

and their body language. Equally, they may be trying to hide their suffering from

us – something some species have evolved over thousands of years to do.

Another reason is that it is part of our duty of care, and part of our responsibility

as nurses. We owe it to our patients to look after them as a whole, not just a

series of body parts and systems – this is where the holistic approach comes into

its own and is what makes someone a good nurse.

Treating pain makes patients more co-operative and less aggressive and

facilitates procedures such as intravenous (IV) catheter placement and

radiography.

Identifying and treating pain is important because…

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Pain contributes to stress, which can cause immunosuppression, fluid retention,

increased risk of gastroduodenal ulceration and delayed wound healing. These

lead to longer hospital stays, unhappy patients and higher costs. A patient in pain

is less likely to eat, leading to anorexia, negative energy balance and catabolism,

ileus in rabbits and electrolyte imbalances.

Reduced mobility due to pain increases the risk of decubital ulcers,

thromboembolism, lung atelactasis and pneumonia.

Acute pain that is left untreated can develop into chronic pain, which is much

more difficult to manage.

The pain pathway is flexible or ‘plastic’ and is able to change. Repeated

activation of the nociceptive pathway results in sensitisation, causing an

increased sensitivity to noxious stimuli (hyperalgesia), and stimuli that were

previously non-painful to become painful (allodynia). Therefore it is obviously

best avoided in the first place.

Pain will cause behaviour changes that are likely to make the patient more difficult

to nurse. These behaviours may become associated with the clinic and cause

problems on future visits. A patient that experiences a pain-free hospital stay is

likely to be much more manageable, and occasionally even relish their visits to

see the veterinary staff who gave them so much fuss and TLC!

Pain is NEVER beneficial to the patient.

Physiology of Pain

Understanding the pain pathway, and the changes that occur in response to repeated

painful stimuli is important to manage pain effectively in our patients.

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Nociception refers to the detection of a noxious (unpleasant) or painful stimulus,

whereas ‘pain’ implies an actual perception and emotional response to pain, after input

to the brain from the spinal cord and periphery.

Pain pathway

There are several parts to the pain pathway; nociception which is the detection of a

painful stimulus. This is made up of 3 parts; transduction, transmission and

modulation), and perception. The pain pathway starts in the body tissues, where

nociceptors, (which are nerve endings located throughout the skin, muscles, blood

vessels, periosteum, viscera and the peritoneum), detect and respond to noxious

chemical, mechanical or thermal stimuli. Transduction is the conversion of this noxious

stimulus into a nerve impulse by nocieptors. There is a threshold which must be

exceeded for the impulse to be activated, preventing it from being activated by non-

painful stimulus. Transmission is the carriage of impulses along the nerve fibres to the

central nervous system (CNS). Animals have an intrinsic analgesic system, this inhibits

some of the afferent pain signals and the perception of pain (modulation). Perception

occurs in the brain and is the conscious and emotional experience of pain produced by

nociceptor information and many other body inputs.

Sensitisation

Because the pain pathway has plasticity (ie, is flexible) rather than being rigid, once the

pain pathway has been stimulated it can change the way it responds to further painful

stimuli.

Peripheral sensitisation

After a tissue is damaged by a noxious stimuli, inflammation occurs. The damaged

tissue releases many different chemicals and inflammatory mediators, such as

prostaglandins and histamine. This ‘inflammatory soup’ stimulates more nociceptors in

the area, widening the painful area, but it also lowers the nociceptor threshold. This

results in the pain pathway responding more violently to a noxious stimulus, so a

previously non-painful stimulus becomes painful as it is now reaches the new lower

nociceptor threshold (allodynia), and a painful stimulus provokes a greater and more

prolonged pain (hyperalgesia).

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Central Sensitisation

A bombardment of painful impulses causes changes in the dorsal horn neurones in the

spinal cord. This causes the neurones to become hyperexcitable and exaggerate further

pain impulses. The neurones start to process non-painful inputs as pain signals.

Central sensitisation also results in secondary peripheral hyperalgesia where further

nociceptors are recruited in undamaged tissue causing a more intense and more

prolonged pain response. The result is a larger area that feels pain and a massive

intensification of pain, which is very difficult to control. Activation of the N-methyl-D-

aspartate (NMDA) receptor in the spinal cord, is an important event in central

sensitization. The NMDA receptor contributes to the transmission of noxious input from

the periphery to the CNS following repeated input of noxious stimuli. It is not activated

initially, but after repeated noxious stimulus activation occurs and there is a sudden

increase in the amount of noxious input to the spinal cord and on to the brain where it is

perceived as pain.

Assessing pain in small animals

Assessing whether or not an animal is in pain sounds like it should be quite a simple

subject but it is actually very complex.

Most species of animals have evolved over thousands of years to hide the fact that they

are suffering. A rabbit in the wild will soon be picked off by a hungry fox if it is squealing,

or obviously lame. Cats are incredibly good at masking pain and it is well known that

when they are hurt, e.g. after a road traffic accident (RTA) many cats with horrible

injuries manage to take themselves off somewhere to find solitude and lick their wounds.

Loyal dogs that wag their tails to greet their owners just hours after major surgery may

be doing so because this is how they behave, not because they are pain free.

Because of these differences in behaviour compared to how us humans would act, many

myths have developed over the years. The three most perpetuated are:

1. “Animals don’t feel pain like we do”

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This is not true, they have the same neurological pathways as us, and they can also

remember previous painful incidents. It is only their behaviours for expressing pain that

are different to ours.

2. “Animals can cope so much better with pain than us”

Something to remember here is “an animal tolerating pain is not the same as an animal

free of pain”. Stoic breeds such as Labradors have the same nerve pathways as the

more sensitive breeds such as Greyhounds, but they express their behaviours very

differently. Of course there will be some animals that have a greater tolerance of pain

than others, just as the same is true for people, but it doesn’t mean they should cope

without analgesia.

Also, severe acute pain, such as after falling from a balcony, may not be felt at the

moment of injury, but will definitely kick in within a matter of hours once the adrenaline

wears off.

3. “If they are too comfortable they will move around too much and further hurt

themselves”

This is just an excuse for poor veterinary care! Pain should never be used to restrain an

animal when we have bandages, crates or kennels and sedatives. Pain actually delays

healing, and in fact an animal in pain is more likely to chew at the wound and self-

traumatise than a comfortable patient.

Another argument against this viewpoint is that analgesics are unlikely to completely

block the pain sensation anyway. They make the patient more comfortable but if they

get up and bound around on their broken leg, even after morphine it’s probably going to

hurt. In fact only local anaesthetics are truly analgesic, the rest would maybe be better

described as hypoalgesic.

Fortunately the number of people believing these myths is decreasing and pain

management is now a very popular topic for continuing professional development. The

number of available analgesic drugs has also increased.

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The veterinary nurse is likely to be the first to notice the hospitalised animal in pain, we

are at the forefront and it is up to us to understand the topic, notice the signs, inform the

veterinary surgeon, and if necessary badger them to prescribe analgesics.

Being in the practice environment changes the way animals behave and this may mask

signs of pain. Try and get a good history and if possible observe the patient before an

elective surgery so that it is easier to spot signs of pain.

The most common signs of pain that seem to be shared by most species are decreased

appetite and decreased activity. Activity in this sense does not just mean

walking/running, but applies to general daily behaviours such as grooming and playing

etc.

In addition to the above, there are typical behaviours that may be associated with

different levels of pain:

1. Escape behaviour +/- vocalisation – Acute pain/injury

2. Protective, guarded, can’t seem to settle in one position – General/post op

pain or discomfort.

3. Depression, lethargy, body condition loss – Chronic pain.

Of course any change in behaviour can be associated with disease too, but if pain is

suspected it is worth remembering these signs.

The smaller animal are probably the most under-diagnosed and under-treated for pain.

Decreased normal activities and loss of appetite remain the most prominent signs. They

may also become immobile and possibly squeak or squeal when handled.

With rabbits and guinea pigs anorexia can lead to gut stasis so must be addressed as a

priority. Other signs of a rabbit in pain include teeth grinding, hunching, lack of interest

in their environment/owner, paying lots of attention to one area (licking, scratching),

possibly aggression and closing their eyes.

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Rats may lie low to the floor, arch their backs or twitch while resting. You may notice an

increase in porphyrin secretion around the eyes and nose, which could be due to

increased stress and/or decreased grooming. Exotics are a very specialist area and

may be best referred!

The best way to approach whether or not you think any species may be in pain is to use

the ‘Principle of Analogy’. This is basically if you think a procedure or situation would

cause a human pain then it will cause an animal pain too. There will be some

procedures we just cannot relate to (e.g. tail docking) so you must also take a scientific

approach and consider which types of tissue have been traumatised, how bad the

wound is, and if there has been any nerve damage.

A person’s own experiences of pain will always affect this approach to a certain extent,

as well as how much natural empathy they have. Also some things are more obviously

painful, e.g. a squealing puppy with a corneal foreign body compared to a stoic old

Labrador with arthritic hips. Young animals tend to show pain more readily too.

Everyone (hopefully) would give analgesics to a victim of an RTA, stick injury or burn,

but what about the less obvious conditions? Otitis externa, glaucoma, corneal ulcers,

renal disease, and meningitis– these are all likely to be very painful and need both the

disease and the pain treated together, but the pain is often overlooked.

Pain will also inhibit sleep, so next time you recover a patient that seems to wake up

unexpectedly fast, immediately stands up, is probably panting and maybe looking tired

but refusing to lie down, it is probably in pain. Do a pain check and also take into

account they may need the toilet, or maybe the bedding is unsuitable. So if pain inhibits

sleep it follows that if an animal is sleeping soundly (not just resting or catnapping) don’t

wake them up to do a pain check.

It has been shown in humans that there is also a strong psychological element to pain,

and that negative emotions such as fear, isolation, separation anxiety, rage and

frustration travel along similar pathways to the brain as pain does. It is reasonable to

assume the same in animals. Anything that adds to a patient’s discomfort such as being

hungry or thirsty, feeling sick, unsuitable bedding and excessive environmental noise will

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all have the same detrimental effect as pain. This is again where empathy and a holistic

nursing approach are needed.

Good hospital record keeping is essential for both carrying out the pain assessment, and

assessing the effect of any analgesia given. This should be done throughout the

animals stay, and also at the post-op checks. Many people place far too much

significance on vocalisation when in fact this is rarely demonstrated until the pain is

already severe. Also they may not realise that dogs may wag their tails, and a cat may

purr despite being in pain.

Common signs of pain

Cats

Dogs

Rabbits

Hunched in sternal

recumbency

Reduce appetite/anorexia Reduced appetite

Unusual aggression Unusual aggression Hunched position

Reduced or absent appetite Seeking more contact than

usual

Immobility

Reluctance to move Low head carriage Teeth grinding

Failure to use litter tray Over grooming/ self trauma squinting

Squinting eyes Inability to settle Rapid respiratory rate

Flattened ears Lack of good quality sleep Over grooming/chewing

painful area

Failure to groom Guarding of painful area Unusual aggression

Over grooming or chewing

painful area

Tense abdomen Vocalisation

Withdrawal from contact Lameness

Vocalisation vocalisation

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Chronic Pain

Chronic pain remains overlooked and under-treated in many animals. It is also very

difficult to manage once established. As a profession we are still getting to grips with

chronic pain in animals, and we need to work with the public and educate owners as we

learn ourselves.

Cats probably come off worse at the moment. One study (Hardie et al 2002) showed that 90%

of cats over the age of 12 years have Degenerative Joint Disease (DJD). It is often

joked that this is difficult to spot in cats, as one of the main signs is becoming less active

– hard to notice in an animal that spends 16-20 hours out of 24 asleep! But you may

notice that they pull themselves up on the sofa rather than jump up, and maybe they are

not sleeping on the top of the wardrobe like they used to. Perhaps they don’t seek your

company as much and are not as ‘chatty’ as they once were. If a client mentions an

apparent behaviour problem in that their cat passes faeces near the litter tray but not

quite in it, then consider osteoarthritis. The poor cat either cannot quite climb into the

litter tray, or just manages to make it into the tray but cannot physically squat so it pops

out over the side!

Chronic renal and dental pain can also go a long time undetected, observe for cats

pawing at the mouth or under-grooming. Conversely over-grooming, such as a dog

developing a lick granuloma on their carpus from constantly licking, may be a sign of

pain in that area.

Chronic pain, which is pain that lasts longer than expected for a particular disease or

after an injury has healed (or as a rough guide lasts for over 3 months) can actually

shorten an animal’s life, and the longer it goes on the harder it will be to control, so it’s

important to start analgesics sooner rather than later. Also consider complementary

methods of pain relief such as physiotherapy, acupuncture, hydrotherapy and heat.

Pain scoring

Pain scoring systems are useful not only to detect the presence of pain, but also to help

select the appropriate type, dose, frequency and adequacy of analgesia, and the timings

for additional requirements. Pain scores standardize pain assessments and reduces

inter-observer variability as well as providing a written record of pain assessment. There

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are many different pain scoring systems that can be used, or adapted for use in your

practice depending on your requirements. It is important to remember when pain

scoring that each animal is different and reacts differently to pain. The ideal pain scoring

system should not only be able to detect the presence of pain, but also the magnitude

(intense, throbbing, etc) and type of pain (neuropathic, visceral etc) as well as how it

makes that animal feel (scared, depressed etc). It should be reliable, sensitive, easy to

use and interpret, multidimensional (preferably looking at undisturbed behaviour,

behaviour on interaction and physiological parameters) and ideally, validated. Pain

scoring is very difficult in animals and the perfect pain score system does not yet exist,

although there is lots of ongoing work in human and veterinary fields to establish an

ideal scoring system. Animal pain scoring systems are adapted from human pain

management and are mainly for management of acute pain. Regardless of the type of

scoring system used, assessment should occur regularly and be performed by a person

experienced in understanding signs of pain. Where possible consecutive scores should

be performed by the same person, to minimize observer variation, it is also useful to

have observed the dogs normal temperament and behavior prior to the painful stimulus.

Simple descriptive scale (SDS)

An SDS is the most basic type of pain scoring system, which looks at the patients’

behaviour. There are normally 3-5 grades of pain defined by a short description. It is

very simple, and therefore user friendly, but not very good at detecting small changes or

differences in pain, and it is very subjective.

Example of an SDS

0 No pain

1 Happy, but slight flinch on wound palpation

2 Happy, but tense & flinches on stroking around wound

3 Hunched, looks uncomfortable, but can touch wound

4 Painful, hunched, depressed, vocalising, unable to stroke

or touch near wound

Visual Analogue Scale (VAS)

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Consisits of a line 100 mm in length, with ‘no pain at all’ on one end, and the other end

corresponding with ‘the worst possible pain’. The observer marks a point on the line that

corresponds to the pain intensity for that patient. It is more sensitive than the SDS,

although still very subjective. It is used widely in both human pain management and

veterinary studies, although it does require an experienced observer to give a reliable

score. .

Dynamic & Interactive Visual Analogue Scale

This a modified VAS, where the observer marks a point on the 100mm line, and the

distance from the start of the line in mm is the pain score. It normally incorporates

undisturbed behaviour, with behaviour on interaction and wound palpation, so is more

sensitive than the basic VAS. This is important as a dog lying asleep in their kennel may

not demonstrate signs of pain, but after interaction and manipulation it may become

clear that pain is present.

Numerical Rating Scale (NRS)

This is similar to VAS but the observer chooses a number on a scale

Glasgow Composite Pain Score

Is a multidimensional pain scoring system, taking into account both undisturbed

behaviour and behaviour on interaction. It is a more complex version of an NRS. It tries

to take into account emotional effects and intensity of pain. It is made up of a number of

No pain at

all

Worst possible

pain

Worst possible

pain

0 1 2 3 4 5 6 7 8 9 10 No pain at all

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separate assessments of different aspects of behaviour that can be associated with

pain. Each category has 4-6 descriptions, and each score is added up to give an overall

score. It is currently the only validated pain score in dogs (none are validated in cats), so

it is perhaps the scoring system of choice for acute main management, although it is

quite time consuming and knowledge of pain is required. It also does not take into

account physiological parameters. It was, and still is, being developed at Glasgow vet

school, and can be downloaded from the Glasgow university website, where they

recommend giving analgesia if a pain score is > 6/24.

www.gla.ac.uk/faculties/vet/smallanimalhospital/ourservices/painmanagementandacupu

ncture/

University of Melbourne Pain Scale

This is a variable rating scale taking into account both undisturbed behaviour, and

behaviour on interaction, as well as physiological parameters, such as pulse rate,

respiratory rate, pupil size, salivation and body temperature. Initial work implies that it is

effective, and it looks like it will be validated for use in dogs soon, although it is quite

time consuming and complex and knowledge of pain assessment is required.

Physiological parameters are often not included in pain scores because interpretation

can be affected by other factors including, the patient’s cardiovascular status (ie

hypovolaemia), fear and sedatives.

To summarise, most patients in your practice will have had some sort of injury or surgery

resulting in pain. Regular and effective assessment of pain, then treatment, is vital for a

successful outcome in critical patients.

Reference

Hardie EM, Roe SC, Martin FR. Radiographic evidence of degenerative joint disease in

geriatric cats: 100 cats (1994-1997). J Am Vet Med Assoc 2002; 220(5): 628-632

Further Reading

Pain Management in Small Animals- A Manual for Veterinary Nurses and Technicians.

Grant D (2006) Butterworth Heinemann;

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Pain Management for the Small Animal Practicioner (2000). Tranquilli WJ, Grimm KA,

Lamont LA. Part of the Teton New Media ‘Made Easy’ Series.

Anaesthesia for Veterinary Nurses. Welsh E. (2003) 1st Edition Oxford: Blackwell

Science

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PAIN EVALUATION CHART – DOGS

Patient name _____________________________________________________

Case number _____________________________________________________

Analgesics _____________________________________________________

Date(s) _____________________________________________________

Please tick the answer that you feel is appropriate to the dog you are assessing. If more than one

answer is appropriate, tick all that apply.

From outside the kennel, look at the dog’s behaviour and answer the following questions.

1. Look at the dog’s posture, does it seem…

Rigid

Hunched or Tense

Neither of these

2. Does the dog seem to be…

Restless

Settled

3. If the dog is vocalising, is it…

Screaming

Groaning

Crying or whimpering

Not vocalising/none of

these

4. Look at the dog’s chart, has it…

Not eaten anything

Picked at it’s food

Eaten well

5. If the dog is paying/trying to pay attention to it’s wound (even if it has a collar on),

is it…

Chewing

Licking, looking or

rubbing

Ignoring the wound

6. Does the dog seem to be…

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Aggressive

Depressed

Disinterested

Nervous, anxious or

fearful

Quiet or indifferent

Happy and content

Happy and bouncy

*READ LAMINATED SHEET – INSTRUCTION A (Ophthalmology patients only)

7. Assess the following conditions and give a score for each…

Blepharospasm

Blinks (no. in 30

seconds)

Lacrimation

Conjunctival hyperaemia

TIME

INITIALS

* READ LAMINATED SHEET – INSTRUCTION B

8. Does the dog seem to be…

Aggressive

Depressed

Disinterested

Nervous, anxious or

fearful

Quiet or indifferent

Happy and content

Happy and bouncy

*READ LAMINATED SHEET – INSTRUCTION C

9. During this procedure did the dog seem to be…

Stiff

Slow/reluctant to rise or

sit

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Lame

None of these

Assessment not carried

out

*READ LAMINATED SHEET – INSTRUCTION D

10. When touched did the dog…

Snap

Growl or guard the area

Cry

Flinch/become tense

Look round sharply

None of these

11. In your opinion, would you classify the dog as…

Painful

Uncomfortable

Comfortable

Taking everything you’ve assessed into account, and using the guide below, allocate a

number between 1-10 for how painful you consider the dog to be, and tick if pain relief

was given.

It is also worth reading the NCP to see how the dog has been in itself.

Any additional comments you would like to make can be written on the patient’s kennel

chart.

▲ 1 2 3 4 5 6 7 8 9 10

▲

No pain Low pain Painful Very painful Extreme pain

PAIN SCORE

PAIN RELIEF

GIVEN?

TIME

INITIALS

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ADDITONAL

COMMENTS/NOTES

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PAIN EVALUATION CHART – CATS

Patient name _____________________________________________________

Case number _____________________________________________________

Analgesics _____________________________________________________

Date _____________________________________________________

Please tick the answer that you feel is appropriate to the dog you are assessing. If

more than one answer is appropriate, tick all that apply.

From outside the cat’s pod, look at the cat’s behaviour and answer the following questions.

2. Look at the cat’s posture, does it seem…

Crouched or rigid

Hunched or Tense

Neither of these

2. Does the cat seem to be…

Restless

Settled

3. Is the cat…

Sitting in the litter tray

Meowing abnormally

None of these

12. Look at the cat’s chart, has it…

Not eaten anything

Picked at it’s food

Eaten well

13. If the cat is paying/trying to pay attention to it’s wound (even if it has a collar on), is

it…

Chewing

Licking, looking or

rubbing

Ignoring the wound

14. Does the cat seem to be…

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Aggressive/hissing/spitti

ng

Depressed

Disinterested

Nervous, anxious or

fearful

Quiet or indifferent

Contented

Happy and affectionate

*READ LAMINATED SHEET – INSTRUCTION A (Ophthalmology patients only)

7. Assess the following conditions and give a score for each…

Blepharospasm

Blinks (no. in 30

seconds)

Lacrimation

Conjunctival hyperaemia

TIME

INITIALS

* READ LAMINATED SHEET – INSTRUCTION B

8. Does the cat seem to be…

Aggressive/hissing/spitti

ng

Depressed

Disinterested

Nervous, anxious or

fearful

Quiet or indifferent

Contented

Happy and affectionate

*READ LAMINATED SHEET – INSTRUCTION C

9. During this procedure did the cat seem to be…

Stiff

Slow/reluctant to rise or

sit

20

Lame

None of these

Assessment not carried

out

*READ LAMINATED SHEET – INSTRUCTION D

10. When touched did the cat…

Become defensive

Hiss

Growl or guard the

wound

Flinch/become tense

Look round sharply

None of these

11. In your opinion, would you classify the cat as…

Painful

Uncomfortable

Comfortable

Taking everything you’ve assessed into account, and using the guide below, allocate a

number between 1-10 for how painful you consider the cat to be, and tick if pain relief

was given.

It is also worth reading the NCP to see how the cat has been in itself.

Any additional comments you would like to make can be written on the patient’s kennel

chart.

▲ 1 2 3 4 5 6 7 8 9 10

No pain Low pain Painful Very painful Extreme pain

PAIN SCORE

PAIN RELIEF

GIVEN?

TIME

INITIALS

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ADDITONAL

COMMENTS/NOTES

AHT Pain scoring instructions

DOGS

INSTRUCTION A.

Observing the animal, use the following scoring system to assess the level of discomfort

(0 = none, 1 = mild, 2 = moderate, 3 = severe)

Blepharospasm Score 0, 1, 2, 3

Blinks Count the number in 30 seconds

Lacrimation Score 0, 1, 2, 3

Conjunctival hyperaemia Score 0, 1, 2, 3

INSTRUCTION B.

Now approach the kennel door and call the dog’s name. Then, if the patient’s condition allows,

open the door and encourage the dog to come to you. From the dog’s reaction to you try and

assess their character.

INSTRUCTION C.

Now look at the dog’s response to stimuli. If a mobility assessment is possible, open the kennel

and put a lead on the dog. If the dog is sitting down, encourage it to stand and then come out of

the kennel. Walk slowly up and down the area outside the kennel. If the dog was standing up in

the kennel and has undergone a procedure that may be painful in the perianal area, ask the dog to

sit down.

INSTRUCTION D.

Assess the dog’s response to touch. If the dog has a wound, apply gentle pressure using two

fingers in an area approximately 2 inches around it. If the position of the wound is impossible to

touch, then apply the pressure to the closest point to the wound. If there is no wound, apply the

same pressure to the stifle and surrounding area.

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1 2 3 4 5 6 7 8 9 10

No pain Low pain Painful Very painful Extreme pain

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AHT Pain scoring instructions

CATS

INSTRUCTION A.

Observing the animal, use the following scoring system to assess the level of

discomfort

(0 = none, 1 = mild, 2 = moderate, 3 = severe)

Blepharospasm Score 0, 1, 2, 3

Blinks Count the number in 30 seconds

Lacrimation Score 0, 1, 2, 3

Conjunctival hyperaemia Score 0, 1, 2, 3

INSTRUCTION B.

Now approach the pod door and call the cat’s name. Then, if the patient’s condition allows, open

the door and encourage the cat to come to you. From the cat’s reaction to you try and assess their

character.

INSTRUCTION C.

Now look at the cat’s response to stimuli. If a mobility assessment is possible, open the pod and

lift the cat out onto the floor or table. If the cat is lying down, encourage it to stand and then come

out of the pod. If the cat was standing up in the kennel and has undergone a procedure that may

be painful in the perianal area, observe if the cat is able to sit down.

INSTRUCTION D.

Assess the cat’s response to touch. If the cat has a wound, apply gentle pressure using two fingers

in an area approximately 2 inches around it. If the position of the wound is impossible to touch,

then apply the pressure to the closest point to the wound. If there is no wound, apply the same

pressure to the stifle and surrounding area.

1 2 3 4 5 6 7 8 9 10

No pain Low pain Painful Very painful Extreme pain

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