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An Introduction to Quality-of-Life Scales

and Pain Scales

Elizabeth Andree, DVM, CHPV(Dr. Liz)

Quality of Life

• Broad & complex topic• Can be very subjective

Britannica definition:• The degree to which an individual

is healthy, comfortable, and able to participate in or enjoy life events

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Quality-of-Life Scales

• Caregiver and veterinary team should determine which elements of QOL are especially important to the patient

• Focused on the patient, but the caregiver’s QOL is a factor

• Useful for adjusting treatment plan according to the observations • Helpful in determining if euthanasia is a valid decision• Tool to assist; not the only factor in decision making• Provides a visual for families

• Various components to each scale

QOL Scales - Components

• Patient• Activity

• Level of play, movement/mobility • Behaviour

• Interaction, sleeping, enjoyment of life, change in behaviour, hiding, nighttime activity

• Pain• Obvious pain, panting, trembling

• Physical symptoms• GI, weight changes, urination, appearance, hydration

• Appetite/Thirst• Autonomy

• Assistance for movement, soiling, confusion/mental health • Favourite things

• Caregiver

Quality-of-Life Scale –Pawspice/HHHHHMM

https://pawspice.com/q-of-l-care/new-page.html

• One of the first QOL scales developed/widely distributed• Dr. Alice Villalobos is a pioneer in pet hospice• Numerical value

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Source: Veterinary Practice News

Quality-of-Life Scale - OSU

https://vet.osu.edu/vmc/sites/default/files/import/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

• Preparation questions• Visual scale• Tips for “how do I know when it’s time”

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Quality-of-Life Scales – Lap of Love

https://www.lapoflove.com/Quality-of-life/Quality-of-life-Scoring-Tools

• Numerical value produced• Major proponents of the veterinary hospice movement in USA• Dr. Gardner and Dr. McVety

• Dr. G – daily diary• Dr. M – includes family’s concerns and discussions to have as a family &

with the veterinary team

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Quality-of-Life Scales - Journaling

• Grey Muzzle - App• Pet Hospice Journal - Online• Calendar• Paper & Pen

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Quality-of-Life Scales – When?

• How often should families complete a QOL scale?• Senior pet wellness appointments• After a diagnosis has been made• Sick pet appointments without diagnostics

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Pain

Definition (Merriam-Webster): • A localized or generalized unpleasant bodily sensation or complex

of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease)

• A basic bodily sensation that is induced by a noxious stimulus, is received by naked nerve endings, is associated with actual or potential tissue damage, is characterized by physical discomfort (such as pricking, throbbing, or aching), and typically leads to evasive action

• Mental or emotional distress or suffering

Pain

From IVAPM: • “Pain comes in many forms: surgical pain, arthritis and cancer

related pain, just to name a few. • Acute pain is obvious and distressing. • Chronic pain can be subtle, and masked as “getting old” or

“slowing down.” Old age is not a disease, but pain is. • There are many options to treat the various causes of pain in

animals including pain medications, physical rehabilitation, acupuncture, laser therapy, and therapeutic massage.”

https://ivapm.org/animal-owners/animal-pain-awareness/

Pain

From IVAPM:

• The most common signs of pain:

• Decreased activity• Not going up or down stairs • Reluctance to jump onto surfaces • Difficulty standing after laying down • Decreased appetite• Over grooming or licking a particular area

https://ivapm.org/animal-owners/animal-pain-awareness/

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Pain Scales

Components:• Behavioural

• General appearance• Face shape• Attention to wound/injury• Vocalization• Appetite• Interactions

• Response to (Noxious) Stimuli• Touch• Ability to ambulate

• Physiological• Blood Pressure

Pain Scales - Acute

Colorado State University

• Most familiar in clinic• Good visuals• Fairly easy for clients to follow• Instruct clients what “analgesia” means

Pain Scales - Acute

• CSU

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Pain Scales - Acute

Glasgow Pain Scale

• Clinically validated • Numerical value/Questionnaire style• Intervene at score of 5/20 or higher (cats) and 6/24 (dogs)

Pain Scales - Acute

UNESP-Botucatu Multidimensional Composite Pain Scale

• Clinically validated• For use in cats• Calculated value where:

• 0 = no pain • 30 = maximum pain

• Intervention recommended when ≥ 8

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Pain Scales – Acute (Chronic?)

Feline Grimace Scale

• Measures the absence or presence of signs of 5 facial expressions/indicators

• Relatively new• Validated scientifically • ≥ 4 should receive intervention• Used in many species

• Too much variability in dog breeds to have standardized a scale

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Pain Scales - Chronic

BEAP – PetHospice• Species specific – dogs and cats• Developed by a hospice veterinarian for pet owners’ use• Visual

• B: breathing• E: eyes• A: ambulation, activity, appetite/thirst, attitude • P: posture, palpation

Pain Scales – Summary

• Pros & Cons to each type of scale• Chronic pain scale (BEAP) is most appropriate for most

pain assessments regarding QOL• Important to go through with the family to ensure they

understand each parameter/factor• Frequency:

• Acute: multiple times per day• Chronic: dependent on the disease/expected survival time

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Final Thoughts

• Assessing QOL and Pain in our patients is extremely important for their welfare

• We are advocates for our patients• We can teach pet families how to

do the assessments• We can share important resources

with our clients to help them understand what their pet is experiencing

More Education

• IAAHPC: Certified Hospice and Palliative Care Technologist (100+ CE hours)

• https://iaahpc.org/veterinary-certification/

• AAHA: Animal Hospice and Palliative Care Certificate Program (6 CE hours)

• https://www.aaha.org/education/online-training/animal-hospice--palliative-care-certificate-program/

• HABRI/NAVC: Human Animal Bond Certified (22 CE hours)• https://navc.com/certifications/human-animal-bond-certification/

More Info

• Textbook: Hospice and Palliative Care for Companion Animals: Principles and Practice –Shanan, Pierce & Shearer

• Textbook: Palliative Medicine and Hospice Care, An Issue of Veterinary Clinics: Small Animal Practice

• International Veterinary Academy of Pain Management

• https://ivapm.org/

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Contact Me

Email: drliz@sunsetvetcare.ca

Instagram: @drlizvet @sunsetvetcare

Facebook: Sunset Veterinary Care

References

• IAAHPC – iaahpc.org• CHPV Certification Course Notes 2018-19• Hospice and Palliative Care for Companion Animals: Principles and Practice – Shanan, Pierce

& Shearer• University of Glasgow, Glasgow Pain Scales - http://www.newmetrica.com/wp-content/uploads/2016/09/Reid-et-al-2007.pdf

and http://www.aprvt.com/uploads/5/3/0/5/5305564/cmp_feline_eng.pdf

• Animal Pain, UNESP-Botucatu Pain Scale - http://www.animalpain.com.br/en-us/avaliacao-da-dor-em-gatos.php#:~:text=The%20English%20version%20of%20the,blood%20pressure%2C%20appetite%20and%20vocalization.

• Feline Grimace Scale - https://www.felinegrimacescale.com/

• OSU, “How Do I Know When It’s Time” -https://vet.osu.edu/vmc/sites/default/files/import/assets/pdf/hospital/companionAnimals/HonoringtheBond/HowDoIKnowWhen.pdf

• PetHospice, BEAP Pain Scales • CSU, Acute Pain Scales - http://csu-cvmbs.colostate.edu/Documents/anesthesia-pain-management-pain-score-canine.pdf and http://csu-

cvmbs.colostate.edu/Documents/anesthesia-pain-management-pain-score-feline.pdf

• Veterinary Practice News, HHHHHMM Scale - https://www.veterinarypracticenews.com/quality-of-life-scale-pdf/

• Lap of Love, QOL Scoring Tools - https://www.lapoflove.com/Quality-of-life/Quality-of-life-Scoring-Tools

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