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Education: Creating an Environment for Success Primary care practices should be committed to educating the healthcare team and its clients about prevention, recognition, assessment, and treatment of pain. A team approach and consistent TABLE 3 Signs of Degenerative Joint Disease (DJD) in Cats Behavioral component Indicators of DJD Interaction with others Withdrawal, hiding, increased ‘‘clinginess,’’ irritability when touched, aggression toward other cats or humans Sleep and rest Decreases, feigning sleep, restless, trying to find a comfortable position, laying in an unusual position (e.g., not curled up) Appetite Declines but cat continues to eat Posture Hunched, head lowered, sitting or lying abnormally, squinting, facial expression indicating discomfort Grooming Declines, matting of fur, over-grooming of painful area Litter box use Decline in bowel movements, house soiling, inability to get into box Play Reduced overall, reduced jumping Vocalization Increased but decreased greeting and other pleasant vocalizations, hissing if touched on painful area, squinting if acute pain Mobility Not jumping as often or as high, hesitant to jump, difficulty going up or down stairs, squinting, stiffness, less active, difficulty getting into or out of litter box, sleeping in more easily accessible locations DJD, degenerative joint disease. 78 JAAHA | 51:2 Mar/Apr 2015 pain-management messages directed at clients will help ensure patient comfort at all stages of treatment. The client is often considered the most important member of the healthcare team. Each healthcare team member should be able to recognize pain-associated behavior in animals as described earlier in this document and know how to respond appropriately. Table 4 provides examples of how healthcare team members should respond to patients experiencing pain. Staff Training and Education Ideally, every healthcare team member should have a defined role in managing animal pain. Staff and client education should address conditions associated with pain; its prevention and treatment; and appropriate interaction, handling, and nursing care involving the patient. Medical rounds and staff meetings are effective tools in making sure that all staff members are aware of the individualized pain management needs of every hospitalized patient. Having a patient advocate for each hospitalized animal will enable a highly accurate and individualized evaluation of the patient and ensure successful treatment. Recall that Table 1 lists pain indices relying on observation and input by clinical personnel. Those assessment tools complement the pain-scoring instruments based on owner observation and input, which are listed in Table 2. Client Education and Instructions With each pain management plan, it is important that the client be given specific instructions, both verbally and in writing. Potential adverse drug effects and action to be taken should be emphasized. It is advisable to provide a hands-on demonstration on how to administer medications and handle the pet at home.1 To reinforce verbal information about pain assessment, provide handouts that discuss general information about animal pain and any side effects of medications. Compliance will improve if the pet owner understands the treatment schedule and a demonstration of how to administer oral medications is given. Clients should be encouraged to address their concerns about the pet’s condition and treatment plan via e-mail, phone, or follow-up consultations. Conclusion Effective pain management is an essential component of companion animal medicine. It reduces disease morbidity, facilitates recovery, enhances quality of life, and solidifies the relationship among the veterinarian, client, and pet. Behavioral changes are the principal indicator of pain and its resolution, for which there are now several validated, clinical scoring instruments. Pain is not an isolated event but instead exists either as a continuum of causation, progression, and resolution or as a chronic condition.Thus, treatment of pain should consist of a continuum of care in the form of anticipatory analgesia through the anticipated pain period followed by longer-term or even chronic treatment that relies on periodic reassessment of the patient’s response. Effective pain management is integrative in two respects. First, it does not rely solely on pharmacologic methods but also uses a variety of nonpharmacologic modalities. Not least of those is gentle handling and nursing care of the patient in the context of a stressfree physical environment. When considering either nonpharmacologic methods or hospice care that may be outside the immediate skills or services provided by the primary practice, the veterinarian TABLE 4 Healthcare Team Member Responsibilities for Pain Management Healthcare team member Pain management responsibilities Veterinarian Assess pain in every patient regardless of appointment type (e.g., wellness, sick, follow up) Develop standard operating procedures for the practice to prevent pain, including the following: Weight optimization and prevention of dental disease Handling and hospitalization to prevent fear and pain PLATTER (see Figure 1) to follow up and modify plan. Provide staff education on: Effective client communication and education Preventive pain strategies Recognition and assessment of pain Drug interactions and adverse effects Technician Obtain medication history Anticipate painful procedures Recognize signs of pain and alert veterinarian Treat as directed by a veterinarian and update records Assess postoperative patients and record pain score Assess chronic-pain patients and record pain score Maintain effective client communication and education Patient-care personnel Prior to examination: Note possible causes of pain Note any patient behavioral changes During the examination: Proper handling Other stress/anxiety-relieving techniques Following the examination: Monitor patient’s behavior Contact client about questions or concerns Set follow-up appointment Housing should be stress/anxiety-relieving JAAHA.ORG 79 Pain Management Guidelines for Dogs and Cats should have a list of experts for