AAHA’s updated Pain Management Guidelines: A paradigm shift in managing pain

The 2022 AAHA Pain Management Guidelines for Dogs and Cats are out.

This marks the first update of the guidelines since 2015 and there have been some big changes. To find out what they are, NEWStat spoke to Pain Management Guidelines task force cochair Duncan Lascelles, BSc, BVSc, PhD, CertVA, DSAS(ST), DECVS, DACVS, FRCVS.

A professor of Translational Pain Research and Management at North Carolina State University’s (NCSU) College of Veterinary Medicine, Lascelles told NEWSTat there are several significant changes: “First, there’s the incorporation of the last 8 or 9 years of research and development and understanding in pain management.”

Second, there’s a much better balance now between species-specific pain management recommendations for dogs and cats—in large part because there’s been so much new research and information on feline pain management. “The new guidelines truly are for dogs and cats,” he adds.  

Third, the guidelines include a tiered decision tree that prioritizes the use of the most efficacious therapeutic modalities for the treatment of acute and chronic pain.

Lascelles thinks this might be a first.

“All other pain management publications have essentially said: ‘Here are the options,’ and then discussed them,” he said. “We’ve created a tiered approach to decision-making which, for the first time, allows veterinarians to get a sense of ‘Okay, this is where I should be. These are the treatments I should be considering first, because this is where the weight of evidence is around efficacy.”  

Lascelles said the new guidelines also provide important updates and clear recommendations around pain assessment tools: “There's been a lot of work done in the area of creating valid pain assessment tools and we’ve provided links to those.” 

But maybe the most important change: “The shift of emphasis on not just the veterinary team playing an important role in pain management, but that team being extended to include the [pet] owner and a strong acknowledgement of the need for owner education for the profession to engage owners, to have them as part of a team, to embrace them as part of a team, and to proactively educate them.” 

Lascelles thinks the shift to really embracing the pet owner as a critical component of the pain management team has been driven to a large extent by the latest research into pain management, particularly chronic pain management, and the clear understanding that chronic pain—longstanding pain—relies on an assessment of behavior: “It’s no accident that my coauthor is a boarded behaviorist,” he adds.

That would be Guidelines Task Force cochair Margaret Gruen, DVM, MVPH, PhD, DACVB, a professor in the NCSU Department of Clinical Sciences.

Gruen told NEWStat that the guidelines focus on the need for a team approach across the clinic, and how teams can engage owners in watching for signs of pain and monitoring response to treatment. “This is true for dogs, but especially true for cats as they are unlikely to show their normal range of behaviors in the clinic,” Gruen says. “That means we need to think creatively about how to ‘extend the exam room’  by gathering videos and systematic information from owners.” 

Gruen adds: “To me, the most exciting information is really the focus on specific recommendations for cats and the emphasis on making owners a larger part of the treatment team.”

“This is really important,” Lascelles agrees. “We can’t appropriately assess longstanding pain without the help of the owners. We need to provide materials for them. Which means we need to provide information for them about what to look for.” 

Lascelles calls the new guidelines more practical than previous editions. Pithy, even: “They cut to the chase,” he said. “Instead of just saying it's good to practice good pain management, we’re also saying here's how you do it: Here's the approach to pain assessment. Here are the tools you need. And here's a tiered treatment approach. There are a lot of things to choose from. This is what we recommend first. This second.” 

Summing up, Lascelles says, “Someone can sit down and read this and think, okay, I’ve got a plan here of how to actually instigate pain management, as well as understand the importance of pain management.” 

Find out more about the 2022 AAHA Pain Management Guidelines for Dogs and Cats.

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