Bonnie D. Wright, DVM, DACVAA
Pain management is an important topic in companion animal medicine and there exists a wide variation in pain assessment, pain management, and their consistent implementation. The result is often a gap between pain incidence and adequate treatment. Eliminating this "pain incidence-pain treatment gap" is the focus of the WSAVA Global Pain Council (GPC). While access to pain treatment modalities may vary from country to country, the ability to diagnose pain should not. Both assessment and treatment would benefit from educational efforts that encompass all members of the veterinary healthcare team and consider availability of local and regional treatment options.
GPC Vision
An empowered, motivated, and globally unified veterinary profession that effectively recognizes and minimizes pain prevalence and impact.
GPC Mission
To raise global awareness and provide a call to action based upon the understanding that all animals are sentient and can therefore feel pain and suffer from it. Through identification of regionally specific resources for targeted education on recognizing and treating pain, the Global Pain Council strives to elevate the level of confidence and competence in applying pain treatments.
GPC Action Plan
The GPC objectives will be accomplished in three phases, with phase I dedicated to the pain treatise development and global inventory of products and attitudes. Phase II will be focused on developing a prioritized program of pain assessment and management CE while popularizing and broadly disseminating the pain treatise. Phase III will look to update the treatise where needed, refine and further implement the CE plans, and expand into owner education.
GPC members include:
Karol Mathews, DACVECC; VCNA pain issue editor; Canada
Peter Kronen, DECVAA; President AVA; Member of the Board of Directors IVAPM; and Honorary Secretary IASP SIG Non-Human Species; Switzerland
Duncan Lascelles, DACVS; pain researcher and author; USA
Sheilah Robertson, DACVAA, DECVAA; feline pain management and author; USA
Andrea Nolan, DECVPT, DECVAA; pharmacology + pain research; Scotland
Paulo Steagall: anesthesia; IVAPM board; pain researcher and author; Canada
Bonnie Wright, DACVAA; anesthesia, emergency medicine, physical rehabilitation, alternative pain modalities; USA
Kazuto Yamashita: anaesthesiology + pain research; Japan
Walt Ingwersen, WSAVA Honorary Secretary, liaison WSAVA Executive Board liaison
The WSAVA Global Pain Council realized their primary goal of Phase I of their activities with the publication of the WSAVA Global Pain Treatise by the Journal of Small Animal Practice. The Treatise is a succinct overview of pain assessment and management in small animals, including sections on pain pathophysiology, pain assessment for dogs, cats, acute and chronic pain, and one-page overviews of various therapeutic modalities. Its distinct features are tiered analgesic protocols that take into account the variable access to certain pain treatment modalities around the globe. The Treatise and an accompanying JSAP editorial by Dr. Derek Flaherty is available for free access at http://onlinelibrary.wiley.com/doi/10.1111/jsap.12200/abstract
Section 1: Introduction to Pain, Its Recognition and Assessment
1. Understanding pain
2. Physiology and pathophysiology of pain
3. Recognition and assessment of acute pain in cats
4. Recognition and assessment of acute pain in dogs
5. Recognition and assessment of chronic pain in cats
6. Recognition and assessment of chronic pain in dogs
7. Assessing response to treatment of pain in cats and dogs
8. Neuropathic pain
9. Perceived level of pain associated with various conditions
10. Common pain misconceptions
Section 2: Pain Management
11. General approaches to the treatment of pain
12. Opioids
13. Nonsteroidal anti-inflammatory drugs
14. Alpha2 adrenoceptor agonists
15. Local anaesthetics
16. Analgesic delivery techniques and tools
17. Adjunctive drugs
18. Non-analgesic drugs: management of the painful patient
19. Physical rehabilitation
20. Diet and supplements
21. Nursing and supportive care
22. Acupuncture
23. Medical massage
24. Salvage surgical procedures
Section 3: Pain Management Protocols
25. Castration and ovariohysterectomy/ovariectomy in cats
26. Castration and ovariohysterectomy/ovariectomy in dogs
27. Orthopaedic surgery
28. Soft-tissue surgery
29. Locoregional techniques
30. Ophthalmic procedures
31. Dental procedures
32. Emergency and critical care patients
33. Medical pain
34. Pregnant or lactating patients
35. Neonatal or pediatric patients
36. Neuropathic pain
37. Degenerative joint disease
38. Cancer-related pain
39. WSAVA humane euthanasia
The Treatise will be married to the outcome of the Global Pain Survey, which provided a snapshot into pain management attitudes, treatment protocols, and therapeutic modality access from various regions around the globe. Results of the survey can be freely accessed at the GPC pages on the WSAVA website (www.wsava.org/educational/global-pain-council). Findings indicated an overall high degree of knowledge over the occurrence and goal to treat pain, but implementation was hampered by the ability to properly recognize pain, limited product access and user knowledge as to appropriate modality use, particularly for the perioperative setting.
Together, the GPC treatise and Global Pain survey will be the foundation for the GPC Phase II activities: generating and implementing a focused and prioritized continuing education program that provides clinically applicable and relevant information. GPC tracts are already embedded in the WSAVA World Congress scientific program and will also be included within the WSAVA CE Committee activities. The above resources are available on the GPC pages of the WSAVA website and will be enhanced by various clinical tools (www.wsava.org/educational/global-pain-council).
The WSAVA and GPC would like to thank the following sponsors of their activities:
Phase I: Boehringer Ingelheim Animal Health, Elanco, Novartis, Vétoquinol, and Zoetis
Phase II: Novartis, Vétoquinol, and Zoetis