INTERVIEW: JAVIER BENITO DE LA VÍBORA LV(DVM), PhD, MSc, DES, ACVAA Board Eligible, ECLAM Board Eligible on Assessment of Pain in Cats

            “It is not just about drugs”

 Click here to hear the interview in Spanish

Javier is from Madrid. He works as a researcher and clinical instructor at the Montreal University. He has published a long list of papers related to medicine of cats. He has became a member of the GREFA’s Environmental and Wild Life Protection Centre ethics committee through his interest in the medicine of Laboratory Animals.

We start this interview talking about a paper about chronic pain in cats that was recently published in the Journal of Feline Medicine and Surgery.

ABOUT THE DIAGNOSTIC APPROACH TO DEGENERATIVE JOINT DISEASE

During the interview, Javier confirms that there is no clear correlation between radiographical findings and clinical signs. However he recommends to take X-rays , performing a complete orthopaedic and neurological examination and laboratory tests to obtain a minimum database. He highlights how important it is to get information about the patient before the consultation. A questionnaire asking about the cat’s lifestyle and changes in its habits helps owners to have all the necessary information ready just before the appointment and allows vets to obtain much more information during the history taking. Questions about grooming habits, type of litter or activity changes may be considered among others.

ABOUT PAIN MEASUREMENT AND SCALES

The greatest difficulties he has observed during the creation process of scales are those involved in their reliability. Validating a scale is a tough job. Once it is validated however, even the language matters. FMPI is a popular scale he worked at for a long time, but it has to be used in English, as if it is used in a different language after direct translation it stops being validated.  

However, even without validation, some of them can be very useful. DIVAs (Dynamic Interactive Visual Analog Scales) are a good example. These scales are not validated, but they give us the chance of evaluating pain related behavioural changes over time.

Another inconvenience he has observed is the time required to complete the form. It is not practical to give veterinarians and nurses a 15 minute task when they are already busy. Currently, the teams involved in the creation of scales work towards simple forms that can be filled relatively quickly.

A sometimes missed aspect of questionnaires is that they help to educate owners. Some owners may not be able to recognise certain signs of disease. E.g, an owner who has realised that the cat does not jump onto the kitchen worktop any more when the food is being prepared …However he/she does not associate this observation with loss of quality of life.

During the interview, Javier mentioned a variety of scales (http://www.newmetrica.com/acute-pain-measurement among others). However he drew special attention to simple ways to assess pain, such as identifying four or five common activities in a specific cat and monitoring them over time to allow assessment of the pain and the response to the treatment.

He was surprised to find out that whilst studying these activities, owners reported a greater number of activities that did not involve any movement. This means that the way we approach the history-taking should change. We should not only ask about the cat’s ability to jump onto the table, the windowsill or the bed. Some “inactive activities” may involve a previous step that requires movement. E.g if the cat likes to rest on a windowsill, it previously needs to jump onto it. The owner may not be aware of the lack of ability to jump, but is able to perceive that the cat has stopped resting on the windowsill.

ABOUT THE MANAGEMENT OF DJD

Changing the environment to make it easier for the arthritic cat to cope is key. This may even help to avoid drugs in early stages of the degenerative joint disease. He encourages us to use a multimodal approach to manage this painful disease and to consider alternatives such as physiotherapy and acupuncture.

With respect to the medical treatment of chronic pain, he again encourages us to use scales and client specific outcome measures to monitor the response.  This is useful because it allows us to reduce the amount of drug given. He highlights the importance of neurosensitisation and the acute on chronic pain.

There are tools to quantify the amount of pain suffered by the cat. This is called “quantitative sensory testing”. Some devices try to imitate the pressure (not painful but nociceptive) that the clinician applies on the cat during the physical examination. These are only additional aids to assess pain: the clinician’s judgement continues to be the main one.

ABOUT THE FUTURE OF FELINE CHRONIC PAIN

One of the most important things we need to develop are scales to assess the quality of life. It would be beneficial to improve their design and to implement their use in first opinion practice. He considers that it is a researcher’s task to make it interesting for the clinician.

First opinion vets could contribute to research with very useful information. Sometimes, he states, university hospitals lack of the necessary number and variety of cases they need, what is detrimental for their studies about different drugs’ effects and efficacies.

He recognises the value and popularity of Gabapentin, despite its lack of license as a pain killer, and thinks that it might be interesting to repeat the study (REF) in a different country where a different language than English is spoken, as veterinarians’ preferences are influenced by culture and geography. He shows concerns about the underuse of certain drugs like meloxicam, especially in US, where vets avoid it because of its bad reputation due to its potential nephrotoxic effects. .

Finally Javier highlights the need of improving pain management in cats and encourages us again to use a multimodal approach. It is not just about drugs.  



ABOUT ACUTE PAIN...

Have you ever considered intraperitoneal analgesia during ovariohysterectomy?  Find here Javier's paper about the effects of bupivacaine after intraperitoneal adminitration in cats!