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can be caused by trauma, surgery, and medical FIGURE 1 The PLATTER Approach to Pain Management The PLATTER method provides individualized pain management for any patient and is devised not on a static basis but according to a continuous cycle of plan-treat-evaluate based on the patient’s response. The PLATTER approach involves the following: PLan: Every case should start with a patient-specific pain assessment and treatment plan. Anticipate: The patient’s pain management needs should be anticipated whenever possible so that preventive analgesia can either be provided or, in the case of preexisting pain, so that it can be treated as soon as possible. TreatT: Appropriate treatment should be provided that is commensurate with the type, severity, and duration of pain that is expected. Evaluate: The efficacy and appropriateness of treatment should be evaluated, in many cases, using either a client questionnaire or an in-clinic scoring system. Return: It can be argued that this is the most important step. This action takes us back to the patient where the treatment is either modified or discontinued based on an evaluation of the patient’s response. FIGURE 2 Behavioral Keys to Pain Assessment When assessing an animal for pain, the following behavioral keys should be considered: Maintenance of normal behaviors. Loss of normal behaviors. Development of new behaviors. JAAHA.ORG 69 Pain Management Guidelines for Dogs and Cats conditions or diseases. These guidelines will focus on recognition, prevention, and treatment of postsurgical pain. Multifactorial Clinical Measurement Instruments (CMIs) for Acute, Postsurgical Pain For dogs, a validated, widely used, multifactorial CMI for acute pain is the Glasgow short form composite measure pain score. The 4AVet is another composite measure pain score for dogs, reportedly with more interobserver variability than the Glasgow short form but less biased by sedation.7,8 Simple, online, practicefriendly numerical rating scales (0 to 4) for acute canine and feline pain have been developed (but not yet validated) by Colorado State University. In cats, a currently validated assessment tool is the UNESP-Botucatu multidimensional composite pain scale.9,10 That scale and video examples of how it is applied in clinical practice can be downloaded online, and a description of Colorado State’s acute pain scales are included in Table 1. A Practical Approach to Postoperative Pain Assessment Validated CMIs are the foundation of rational pain assessment. Those assessment tools provide a simplified approach that encourages regular use by all healthcare members and are based on the following features: Observing the patient without interaction (i.e., the patient’s orientation in the cage, posture, movement, facial expression, activity level, and attitude). Observing the patient while interacting with a caregiver (e.g., what occurs when the cage door is opened or an animal is coaxed to move). Observing the patient’s response to palpation of the surgical site. Assigning a numerical score using a dynamic interactive visual analog scale (e.g., from a 0 for no pain to a 10 for the worst possible pain for that procedure). The re-evaluation interval will depend on the procedure, expected duration of the chosen intervention, and previous pain score. Variability by different observers can be minimized by having the same team member assess the patient throughout the evaluation period. Ideally, the individual patient’s normal temperament should be known for purposes of comparison with postsurgical appearance and behavior. Chronic Pain: Characteristics and Causes Chronic pain is usually described as either pain that persists beyond the normal healing time or pain that persists in conditions where healing has not or will not occur. In some cases, pain signaling persists in the absence of gross tissue pathology. The following basic principles are relevant to chronic pain in companion animals: Pet owners may not appreciate their pet’s behavior as an indicator of chronic pain; however, what they might see is increasingly diminished function and mobility that indicate progressive disability. Examples include: * Diminished exercise tolerance and general activity * Difficulty standing, walking, taking stairs, jumping, or getting up * Decreased grooming (cats especially) * Changes in either urination or defecation habits Under-recognized and undermanaged chronic pain can result in premature euthanasia.11 Conversely, proper recognition TABLE 1 Acute Postoperative Pain Scales Resource Internet Address Content Colorado State University Canine Acute Pain Scale http://www.csuanimalcancercenter.org/assets/files/csu_acute_ pain_scale_canine.pdf Psychological and behavioral indicators of pain Response to palpation Colorado State University Feline Acute Pain Scale http://csuanimalcancercenter.org/assets/files/csu_acute_ pain_scale_feline.pdf Same as above University of Glasgow Short Form Composite Pain Score http://www.newmetrica.com/cmps/ Clinical decision-making tool for dogs in acute pain Indicator of analgesic requirement Includes 30 descriptors and 6 behavioral indicators of pain UNESP-Botucatu Multidimensional Composite Pain Scale http://www.animalpain.com.br/en-us/avaliacao-da-dorem-gatos.php Assesses postoperative pain in cats Includes 10 indicators of pain ranked numerically 70 JAAHA | 51:2 Mar/Apr 2015 and management of chronic pain can be as life preserving as any other medical treatment in veterinary medicine. Degenerative joint disease (DJD) is the inclusive terminology that includes osteoarthritis (OA). Although DJD and OA are often used interchangeably in the literature and in practice, the broader term, DJD, will be used throughout these guidelines. Multifactorial Clinical Measurement Instruments for Chronic Pain Observation or reports (e.g., in a pre-examination questionnaire) of behavioral changes or abnormalities is the first consideration in recognizing and assessing pain. Thereafter, several standardized, multifactorial CMIs for chronic pain are available to veterinarians as summarized