Prevalence and characteristics of pain in dogs and cats examined as outpatients at a veterinary teaching hospital

摘要

Pain can be considered the fifth clinical sign, after smperature, pulse rate, respiratory rate, and blood pressure, and is a primary cause of stress. Interest in pain management has moved to center stage in human and veterinary medicine, fueled by an increased awareness and understanding of the role of pain in quality-of-life issues and in the pathophysiology of disease, stress, and distress. The considerable progress that has been made in elucidating the neurobiological mechanisms responsible for pa in has resulted in the development and application of new analgesic techniques and treatments. However, the absence of an objective, universally applicable, clinically relevant pain classification system has made it difficult to conduct and compare resea rch trials, categorize patients, prescribe treatment, and evaluate treatment efficacy. Classic and current pain classification systems, including those based on anatomy, underlying cause, body system, severity, duration, behavior, and expert opinion, fal l short of providing the type of information required for prescribing targeted or effective treatment. In an attempt to improve clinical appreciation of the neurobiological processes responsible for pain and assist in the development of diagnostic method s that target specific treatments, Woolf and Max suggested that a taxonomic approach be considered that takes into consideration the molecular mechanisms responsible for pain. This classification system proposes to identify pain on the basis of the relat ionship between clinical signs, tissue type, disease, and patient response. As a first step, this approach suggests that a mechanism-based classification scheme be used in which pain is identified as inflammatory, neuropathic, 01 both and the presence or absence of peripheral sensitization, central sensitization, allodynia, and hyposensitivity to pain be used to further subcategorize patients and guide therapeutic decisions. Whether this approach will realize its intent has yet to be determined, althoug h it has already improved clinical appreciation of the various processes involved in the development of pain and led to the introduction of multiple preemptive treatments.