Pain and quality of life
Routine HealthCare Examination: Pain and Quality of Life assessments
Both assessing quality of life and assessing pain are important aspects of the clinical and welfare evaluation of cats when disease is present that may be associated with pain or with compromised quality of life (QoL).There are no perfect systems for measuring either pain or QoL but progress has been made in assessing both of these and wherever relevant, they should be incorporated as part of the routine health assessment. Importantly, unless pain and QoL are evaluated and assessed their contribution to suffering and welfare may go unnoticed and appropriate interventions may not be made.
Pain scoring in cats
Pain is a complex experience that has both sensory and emotional components and is an extremely important cause of suffering. Pain can be either acute of chronic (the latter is variously defined as, for example, pain persisting for >3 months, pain persisting beyond the normal healing process, or pain persisting where normal healing has not occurred). The severity of pain varies hugely, and pain may be persistent or intermittent, depending on the underlying cause
Acute pain can result from trauma, surgery or disease, and is generally of relatively short duration. Methods have been developed to help in the assessment of acute pain in cats, the acute pain scoring chart can be used in clinic to aid in the assessment of acute pain recognition.
Chronic pain may be more difficult to identify and assess in many situations, but there is a growing recognition of its importance. Pain may be associated with chronic diseases states (such as osteoarthritis, neoplasia, inflammatory bowel disease) or may persist beyond the presence of disease or trauma such as neuropathic pain associated with limb amputation or onychectomy). In general, the changes associated with chronic pain may be more subtle and more difficult to recognise. Underlying pain should always be considered as a possible cause of alterations in normal behaviour patterns. There is important overlap between chronic pain and quality of life, and if assessments of quality of life (see below) suggest this is compromised further evaluation of potential chronic pain is warranted. Osteoarthritis is one of the most common types of chronic pain seen in cats and the mobility check list can aid in identifying this.
Assessing response to pain management
Critical aspects of pain scoring and pain management in cats are not only the initial awareness and assessment of pain but making appropriate assessments after intervention to ensure treatment is adequately addressing the disease and the associated pain.
Assessing quality of life (QoL)
Assessment of QoL is an imprecise science and is unlikely to be assessed routinely without an easily used template. Validated health related QoL tools in cats have been developed. A challenge with the use of these is that assessment of QoL is largely to do with perceptions, emotions and feelings and as cats cannot always express these in a manner that is understandable by humans, we have to make assessments on their behalf using tools and assessments which are considered important proxy measures of QoL.