“It is not just about drugs”
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!
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!
