A survey study on the recognition and treatment of pain in dogs and cats by Slovenian veterinarians

Abstract

Objective

To obtain information on pain management in dogs and cats by Slovenian veterinarians, and to compare it with reports from other countries.

Study design

Prospective online survey.

Methods

The questions were uploaded using open source survey software and pertained to demographic data, self-evaluation of acquired and current knowledge, attitude towards pain and evaluation of actual knowledge, assessment of chronic and acute pain and pain due to surgery or medical conditions, and the use of analgesics. Descriptive statistics were used to summarize frequency distribution. Wilcoxon signed rank test, Mann-Whitney U test and Spearman’s rho were applied where appropriate.

Results

The response rate was 11%. From 680 registered members of the Veterinary Chamber of Slovenia, 73 veterinarians completed the survey. Most of the respondents were women (71.2%) working in small (60.3%) or mixed (21.9%) animal practices. A more recent year of graduation was positively correlated to the self-reporting of knowledge acquired during undergraduate studies (r_s = 0.339, p = 0.003) and to current knowledge about the topic (r_s = 0.293, p = 0.012). Cats were assigned higher scores than dogs for signs of acute (p < 0.001) pain. Female respondents assigned higher scores than male respondents for chronic pain in dogs. Dogs were assigned higher pain scores than cats for surgical procedures and medical conditions. The most frequently used non-steroidal anti-inflammatory drugs (NSAIDs) in dogs and cats were meloxicam and carprofen, and butorphanol was the most commonly used opioid. The choice of NSAID was influenced by perceived effectiveness, experience with use and anti-inflammatory effect. Opioid use was influenced by experience with use and perceived effectiveness.

Conclusions and clinical relevance

Slovenian veterinarians acknowledged the importance of pain management as reported for other European countries. However, the use of multimodal analgesia is limited, and inadequacies remain in the pain management of cats.

Introduction

The concept of pain management in animals has evolved since the 1990s owing to the evolution of new techniques for the prevention and treatment of pain and to the knowledge acquired in clinical practice. It has become clear that good pain management leads to better recovery after surgical procedures and injuries and enhances the quality of life in dogs and cats with painful chronic conditions (Hellyer et al. 2007; Epstein et al. 2015). The 2015 American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) Pain Management Guidelines for Dogs and Cats state that pain assessment should be a component of every physical examination, and a pain score is considered the ‘fourth vital sign’ after body temperature, pulse rate and respiratory rate (Epstein et al. 2015).

Increased awareness of the importance of pain management has resulted in numerous methods of pain assessment to help veterinary practitioners in the objective evaluation of acute and chronic pain in dogs and cats and to solicit responsible use of analgesics (Mich et al. 2010; Dawson et al. 2017; Goldberg 2017; Bradbrook & Clark 2018a,b; Hernandez-Avalos et al. 2019; Monteiro & Steagall 2019; Steagall & Monteiro 2019). Nevertheless, some misconceptions and uncertainties may still be present in practices where in-service training is undervalued and the introduction of new drugs and techniques is limited.

Numerous studies have evaluated the attitude of veterinarians towards pain recognition and pain management, and the results differ depending on the cultural and geographic background of the veterinary practitioners (Dohoo & Dohoo 1996a,b; Capner et al. 1999; Lascelles et al. 1999; Joubert 2001; Raekallio et al. 2003; Hugonnard et al. 2004; Williams et al. 2005; Hewson et al. 2006; Joubert 2006; Weber et al. 2012; Lorena et al. 2014; Perret-Gentil et al. 2014; Hunt et al. 2015; Beswick et al. 2016; Catanzaro et al. 2016; Kongara et al. 2016; Reimann et al. 2017; Morales-Vallecilla et al. 2019).

However, so far, except for Switzerland (Perret-Gentil et al. 2014), no survey on the attitude of veterinarians towards pain in dogs and cats has been conducted in central European countries. The present study qualifies Slovenia, a central European country located at the crossroads of the main European cultural and trade routes, as the second exception. Slovenes have been influenced by other Slavic, Germanic and Romance cultures throughout history, which is reflected in their attitude towards animal welfare, characterized by responsible ownership of dogs and cats, similarly to other central and western European countries. Approximately 250,000 dogs are registered in Slovenia (which is equivalent to approximately one dog per eight citizens), but there are no official data on the number of cats because registration of cats is not mandatory in Slovenia.

This survey study was set out to obtain information on the attitude of Slovenian veterinarians towards pain management in dogs and cats and to compare it with that reported from other countries with an emphasis on the European region.