Owner survey suggests cats may be undertreated for pain compared to dogs after an elective ovariohysterectomy or orchiectomy

Laura R. Adams Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Kirk A. Muñoz Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH

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 DVM, MSc, DACVAA https://orcid.org/0009-0002-2147-964X

Abstract

OBJECTIVE

To investigate differences in pain management between dogs and cats after surgical sterilization. We hypothesized that dogs would be more likely to be discharged with analgesics after sterilization compared to cats and that owner compliance would be better in dogs.

ANIMALS

175 respondents owning 92 dogs and 83 cats from a high-volume, low-cost veterinary clinic in Michigan during August 2022.

METHODS

Owners received an online survey designed to assess their pet’s postoperative analgesic care. They were asked demographic information about themselves and their pets. Additionally, they were asked if their pet was discharged with analgesics, if they were administered as prescribed, and if their pet was painful at home. Dogs and cats were included if they were sterilized within 6 months of survey completion and in the owner’s care at the time of the procedure.

RESULTS

The survey was distributed to 5,241 owners and received 227 responses, a response rate of 4.4%. Analgesics were prescribed for 19 of 162 (12%) pets: 14 of 88 (16%) dogs and 5 of 74 (6.7%) cats. There was no difference in the prescription of analgesics between dogs and cats after ovariohysterectomy (P = .09) or orchiectomy (P = .73). 15 of 19 owners reported their compliance in administering analgesics at 78.9%. Owners’ subjective assessments showed that 24 of 86 (28%) dogs and 12 of 68 (17%) cats appeared painful at home.

CLINICAL RELEVANCE

Postoperative pain in cats may not be appropriately managed.

Abstract

OBJECTIVE

To investigate differences in pain management between dogs and cats after surgical sterilization. We hypothesized that dogs would be more likely to be discharged with analgesics after sterilization compared to cats and that owner compliance would be better in dogs.

ANIMALS

175 respondents owning 92 dogs and 83 cats from a high-volume, low-cost veterinary clinic in Michigan during August 2022.

METHODS

Owners received an online survey designed to assess their pet’s postoperative analgesic care. They were asked demographic information about themselves and their pets. Additionally, they were asked if their pet was discharged with analgesics, if they were administered as prescribed, and if their pet was painful at home. Dogs and cats were included if they were sterilized within 6 months of survey completion and in the owner’s care at the time of the procedure.

RESULTS

The survey was distributed to 5,241 owners and received 227 responses, a response rate of 4.4%. Analgesics were prescribed for 19 of 162 (12%) pets: 14 of 88 (16%) dogs and 5 of 74 (6.7%) cats. There was no difference in the prescription of analgesics between dogs and cats after ovariohysterectomy (P = .09) or orchiectomy (P = .73). 15 of 19 owners reported their compliance in administering analgesics at 78.9%. Owners’ subjective assessments showed that 24 of 86 (28%) dogs and 12 of 68 (17%) cats appeared painful at home.

CLINICAL RELEVANCE

Postoperative pain in cats may not be appropriately managed.

In veterinary medicine, surgical sterilization is one of the most commonly performed procedures in companion animals.1 Surgical sterilization, such as ovariohysterectomy and orchiectomy, is performed to control the companion animal pet population and to prevent diseases associated with reproductive organs.2 For female dogs and cats, this includes eliminating the risk of uterine cystic hyperplasia associated with a pyometra,3 unwanted pregnancies, and uterine and ovarian neoplasia4 and reducing the risk of developing mammary neoplasia.3 In male dogs, orchiectomy eliminates the risk of testicular neoplasia and reduces the risk of benign prostatic hyperplasia and prostatitis.5,6 Surgical sterilization has also been proven to decrease unwanted behaviors in pets. After orchiectomy in dogs, Neilson et al7 reported a significant decrease in urine marking, mounting, and roaming behaviors. In cats, orchiectomy prior to 5.5 months of age is associated with decreased sexual behavior, urine spraying, and aggression toward veterinarians.8

As with any surgical procedure, appropriate perioperative pain management is essential for surgical sterilization.9 Many owners consider pain management vital for their pets just as they do with family members.10 A variety of analgesics, such as opioids, NSAIDs, and other adjuvant analgesics, such as gabapentin, are commonly used in veterinary medicine to manage pain in the postoperative period.1113

In many veterinary practices, owners take their pets home either the day of surgery or the following day, which increases owner involvement in postoperative care.14,15 In human medicine, increased doctor-patient communication promoted compliance and improved outcomes in the pain management of patients with chronic pain.16 Increased communication with veterinary clients may have similar benefits to dogs and cats recovering from surgery at home. A previous study investigated perceptions and opinions of Canadian pet owners about pain and surgery and found that owners rated knowing what to expect during surgery, being informed about procedures and risk, and knowing what to expect during recovery from a surgery or illness as very important, further emphasizing the importance of client communication and expectations for surgical procedures.17

The objectives of this study were to 1) determine if dogs were more likely to be discharged with analgesics after an ovariohysterectomy or orchiectomy compared to cats, 2) determine owners’ perception of pain in their pet after ovariohysterectomy or orchiectomy, and 3) assess owner compliance in administering analgesics as prescribed. It was hypothesized that dogs will be more likely to be discharged with analgesics after ovariohysterectomy and orchiectomy compared to cats, that pets’ pain management following a surgical procedure is very important to their owners, and that dog owners are more compliant with administering analgesics as compared to cat owners.

Methods

The approval for the use of humans in research was granted by Michigan State University’s Office of Regulatory Affairs and Institutional Review Boards and approved for exemption of a full review under category Exempt 2(i). An online survey was created and distributed via the Qualtrics survey platform.

Survey distribution

The survey was distributed to clients of one of the largest high-quality, high-volume, low-cost (HQHVLC) ovariohysterectomy and orchiectomy clinics18 in western Michigan via email. The policy at this clinic is that all dogs are discharged the day of surgery, but cats are discharged the following morning as their procedures start later in the day, and they are not recovered from anesthesia in time to be released the day of surgery. Respondents completed the survey between August 15, 2022, and August 21, 2022.

Inclusion criteria

Pet owners were included in the study if 1) they owned a dog or cat that was sterilized within 6 months from the time they responded to the survey and 2) the dog or cat was owned and cared for after surgery by the same person completing the survey.

Survey design

A pilot survey was created and distributed to 6 individuals with and without a veterinary background. Feedback was used to improve content clarity. The final survey consisted of 36 questions with the following formats: multiple choice (n = 23), multiple choice with open-ended questions (n = 5), matrix questions (n = 2), select all that apply (n = 3), and open-ended questions (n = 3). There were 4 main sections in this survey: 1) owner demographic information, including gender, age, and education level; 2) a section asking owners if they had a painful health condition and how it was being managed, asking specifically about integrative medicine therapies and prescribed analgesics; 3) pet demographic information, including species, gender, breed, and age at which the ovariohysterectomy or orchiectomy was performed and if the surgery was performed due to an urgent medical issue; and 4) a pain section as it related to owners’ perception and management of their pets’ pain following surgery. Owners were asked on a scale from 0 to 10, with 10 being well controlled and very important and 0 being poorly controlled or not important, to rate how well they thought their pet’s pain was managed and how important adequate pain management was to them. They were also asked if analgesics were prescribed for their pet following surgery and if prescribed analgesics were administered as directed. If analgesics were not administered as directed, clients were asked to share their reasoning for making that decision. Owners were also asked how frequently they believed that they observed common signs of pain such as: whimpering, unwillingness to move, decrease in appetite, or not acting themselves,19 and if any intervention was taken to alleviate this pain. Utilization of a pain scale by owners at home was also investigated in the survey (Supplementary Material S1).

Statistical analysis

The Shapiro-Wilk test was used to determine the normality of the data. The Kruskal-Wallis test was used to compare the level of education and owner’s age between genders, if they thought their pet was in pain, and if they initiated an intervention to address signs of pain. Chi-squared analysis was used to compare the gender of the owner and if their pet was perceived to be painful, the effect of species on if the pet was sent home with analgesics, the importance of pain management for their pet after surgery, the use of a pain scale, if owners with pain were more likely to think their pet was painful, and the use of integrative medicine for their pet after surgery. The Fisher exact test was used to assess if owners’ gender and species of their pet influenced if they administered the prescribed analgesics to their pet. The Spearman rank correlation coefficient was used to compare the age of the owner and level of education with the importance of pain management and how well their pet’s pain was controlled after surgery. A t test was used to determine if the level of education and age of the owner affected if they administered prescribed analgesics to their pets. Data are presented as number and percentage. Statistical significance was set at P < .05.

Results

The survey was distributed via email to 5,241 pet owners, with 227 responses being evaluated: an overall response rate of 4.4%. Responses from 175 owners fit the inclusion criteria and were included in the study. Some participants chose not to answer all of the questions, and as such all available data were analyzed and reported.

Owner demographic data

There were more female than male owners that chose to complete the survey. The majority of pet owners were between 18 and 44 years old, with the fewest responses from owners over the age of 45. Most owners’ highest level of education was a high school diploma/General Education Development, followed by a bachelor’s degree, associate’s degree, and master’s degree (Table 1).

Table 1

Responses to a survey in August 2022 on demographic profile of dog and cat owners from a high-quality, high-volume, low-cost ovariohysterectomy and orchiectomy clinic in Michigan.

Gender Number of respondents out of 175 (%)
   Female 136 (78)
   Male 36 (20)
   Nonbinary 3 (2)
Age (y) Number of respondents out of 175 (%)
   18–24 54 (31)
   25–34 42 (24)
   35–44 40 (23)
   45–54 18 (10)
   55–64 14 (8)
   >65 7 (4)
Education Number of respondents out of 175 (%)
   Less than high school diploma/GED 3 (2)
   High school diploma/GED 55 (32)
   Associate’s degree 36 (20)
   Bachelor’s degree 51 (29)
   Master’s degree 23 (13)
   Doctoral or professional degree 7 (4)

Data are presented as number (%) of respondents.

GED = General Education Development.

The survey evaluated owners’ perception of pain management in their canine and feline pets after ovariohysterectomy or orchiectomy and their compliance with the administration of prescribed analgesics.

Pet demographic data

A total of 92 dogs and 83 cats were included in the study, with a near equal distribution of females (n = 82) and males (n = 88). There were 48 male dogs, 44 female dogs, 40 male cats, and 38 female cats. Most of the pets (112/169 [66%]) were surgically sterilized between 6 and 36 months of age, followed by pets that were less than 6 months of age (n = 44/169 [26%]), and the remaining 13 of 169 (8%) were over 36 months of age. These were all elective procedures; none were performed to address an urgent medical problem.

Owner perception and management of pain

The average rank of owners’ level of importance of pain management in their pets after an ovariohysterectomy and orchiectomy was 8.8 out of 10, and their perception that there was adequate pain control in their pets after ovariohysterectomy and orchiectomy was 8.65 out of 10 (Table 2). Owners reported that 24 of 86 (28%) of dogs and 12 of 68 (17.6%) of cats appeared painful at home. Of the dogs that seemed painful to their owners, most were reported to appear painful within the first 12 hours, with only 2 dogs appearing painful between 12 and 48 hours after returning home. Of the cats that seemed painful to their owners, most also appeared to be painful within the first 12 hours of returning home, and only 1 appeared to be painful between 12 and 24 hours after it returned home from the clinic (Table 3). Owners did not use a validated pain scoring system to assess pain in their pet at home. There was no correlation between if the owner perceived the pet to be in pain when compared to the following: age of the owner (P = .51), gender of the owner (P = .89), the owners’ level of education (P = .68), and if the owner had a painful condition (P = .13).

Table 2

Responses to a survey in August 2022 that evaluated owners’ perception of pain management in their pets after ovariohysterectomy or orchiectomy at a high-quality, high-volume, low-cost clinic in Michigan.

Importance of adequate pain management Number of respondents out of 167 (%)
   0 1(0.5)
   1 0 (0)
   2 1 (0.5)
   3 1 (0.5)
   4 0 (0)
   5 8 (4.8)
   6 7 (4.2)
   7 9 (5.4)
   8 33 (20)
   9 16 (9.6)
   10 91 (54.5)
Adequacy of pain management Number of respondents out of 167 (%)
   0 2 (1.2)
   1 0 (0)
   2 2 (1.2)
   3 1 (0.6)
   4 0 (0)
   5 8 (4.8)
   6 4 (2.3)
   7 16 (9.6)
   8 25 (15)
   9 28 (16.8)
   10 81 (48.5)

Data are presented as number (%) of respondents.

On a scale from 0 to 10, with 0 being not important or not controlled and 10 being extremely important or extremely well controlled, owners were asked to rank the importance of pain management after a surgical sterilization procedure and rank how well their pets’ pain was controlled in the postoperative period. See Table 1 for more study description.

Table 3

Responses to a survey in August 2022 that asked owners about the length of time they thought that their dog or cat was painful after an ovariohysterectomy or orchiectomy procedure.

Species
Dogs Cats
Length of time painful behavior was present Number of dogs out of 86 (%) Number of cats out of 68 (%)
Less than 2 h after returning home 14 (17) 5 (7)
2–12 h after returning home 8 (9) 6 (9)
12–24 h after returning home 1 (1) 1 (1)
24–48 h after returning home 1 (1) 0 (0)
More than 48 h after returning home 0 (0) 0 (0)
Owner did not note signs of pain at home 62 (72) 56 (83)

Data are presented as number (%) of responses.

See Table 1 for more study description.

Analgesics for use at home were prescribed for 19 of 162 (12%) dogs and cats, after surgical sterilization, with no statistically significant difference between dogs (14 of 88 [16%]) and cats (5 of 74 [6.7%]); P = .07. Analgesics were prescribed to 10 of 75 (13.3%) pets undergoing an ovariohysterectomy and 9 of 87 (1.3%) pets undergoing an orchiectomy. There was no significant difference between prescription of analgesics between ovariohysterectomy and orchiectomy in dogs (P = .29) or in cats (P > .99) or between dogs and cats for an ovariohysterectomy (P = .09) or an orchiectomy (P = .73). There were 15 of 19 (78.9%) owners who reported that they administered analgesics to their pet at home as directed by their veterinarian; this represented 11 of 14 (78.6%) dogs and 4 of 5 (80%) cats that were prescribed analgesics. One cat and one dog owner did not respond to this question, one dog owner did not remember if they gave the prescribed carprofen, and another dog owner said that they did not give their dog the prescribed analgesic. Owners in the 55 to 64 age group and owners with a doctoral or professional degree did not administer prescribed analgesics to their pet as compared to owners in the other categories; P < .0001 (1/16) and P < .0001 (1/16), respectively. Level of education had no significant effect on if owners thought their pet was painful after surgery (P = .68) or if intervention was initiated to address any signs of pain in their pets (P = .84). There was no significant difference of perception of pain in pets (P = .13) or analgesic administration compliance (P > .99) between owners with painful health conditions compared to owners without painful health conditions (Table 4).

Table 4

Responses to a survey in August 2022 that assessed the influence of owner demographic on if they thought their pet was painful after surgery and if owners administered analgesics as prescribed by their veterinarian.

Did pet appear painful after surgery at home Did owner administer analgesics as prescribed
Total responses: 159 Total responses: 16
No Yes Not sure P value No Yes P value
Gender of owner .89 .19
   Female 90 (57) 30 (19) 4 (3) 0 (0) 13 (81)
   Male 23 (14) 8 (5) 1 (0.6) 1 (6) 2 (13)
   Nonbinary 3 (2) 0 (0) 0 (0) 0 (0) 0 (0)
Age of owner (y) .51 .04
   18–24 31 (19) 13 (8) 2 (1) 0 (0) 4 (25)
   25–34 29 (18) 8 (5) 2 (1) 0 (0) 6 (38)
   35–44 27 (17) 9 (6) 0 (0) 0 (0) 4 (25)
   45–54 13 (8) 4 (3) 1 (0.6) 0 (0) 1 (6)
   55–64 11 (7) 2 (1) 0 (0) 1 (6) 0 (0)
   >65 5 (3) 2 (1) 0 (0) 0 (0) 0 (0)
Education .68 < .001
   Less than high school diploma/GED 2 (1) 1 (0.6) 0 (0) 0 (0) 0 (0)
   High school diploma/GED 32 (2) 14 (9) 1 (0.6) 0 (0) 4 (25)
   Associate’s degree 22 (14) 8 (5) 2 (1) 0 (0) 3 (19)
   Bachelor’s degree 41 (26) 6 (4) 2 (1) 0 (0) 5 (31)
   Master’s degree 13 (8) 8 (5) 0 (0) 0 (0) 2 (13)
   Doctoral or professional degree 6 (4) 1 (0.6) 0 (0) 1 (6) 1 (6)
Owner with painful condition .13 > .99
   No 94 (59) 26 (16) 5 (3) 1 (6) 13 (81)
   Yes 22 (14) 12 (8) 0 (0) 0 (0) 2 (13)

Data are presented as number (%) of responses.

GED = General Education Development.

The owners were clients of a high-quality, high-volume, low-cost clinic in Michigan. See Table 1 for more study description.

There were 15 of 27 (55.6%) dog owners and 4 of 11 (36.4%) cat owners who did not intervene when they thought their pet was in pain. Of the dogs that received analgesics, 9 of 14 (64%) received an NSAID, 4 of 14 (29%) owners were unsure which medication was prescribed, and 1 owner opted not to respond to this question. Of the cats that received analgesics, 2 of 5 (40%) received an NSAID, 2 of 5 (40%) owners were unsure which medication was prescribed, and 1 owner opted not to respond to this question. There was no significant difference between species of pet and if oral analgesics were administered as directed (P > .99).

Discussion

While there was no statistically significant difference in the overall analgesic prescription plan between dogs and cats, it was found that analgesics were prescribed significantly less frequently to cats (6.7%) after surgical sterilization as compared to dogs (16%), a more than 50% difference between the 2 species. These findings correlate with previous studies20,21 that reported that cats are sometimes not adequately treated for pain.

A few theories exist as to the potential reasoning for these findings. Cats are notoriously challenging to medicate orally due to spitting out tablets, refusing medication in food, biting or scratching while attempting to medicate them, and running away at medication times.22 Tramadol is an effective analgesic in cats due to their ability to produce sufficient amounts of the O-desmethyl-tramadol metabolite, but the oral formulation is often difficult to administer because cats appear to dislike the taste of the tablet.23 There are also longer lasting analgesic options, such as Simbadol and Zorbium, that are approved for use in cats, thereby removing the need for owners to have to administer analgesics at home. Simbadol’s duration of action is approximately 24 hours, whereas Zorbium’s duration of action can be up to 4 days, both of which can be administered at the veterinary practice before cats are discharged.24 However, these analgesics were not available at this HQHVLC clinic due to the nominal fee charged to clients for these surgical procedures and the ability to continue to provide these procedures at affordable prices for clients in the region.

Although cats were prescribed analgesics less often than dogs, there was no statistically significant difference in the reported administration of analgesics by owners. This was an interesting finding as administration of oral medications was expected to be higher in dogs compared to cats due to the challenges associated with orally medicating cats.22,25 Cats may be prescribed analgesics less often than dogs due to differences in their behavior, which can make it more challenging to determine if they are painful as compared to dogs. A study by Merola and Mills26 in 2017 found that only 3 clinical signs were reliably linked to acute pain in cats, which included panting, pupil dilation, and blepharospasm, whereas no clinical signs were reliably linked to chronic pain. This lack of reliability of signs of pain in cats increased the likelihood of owners thinking that their cats are less painful or experience pain less than dogs.26 Changes in mobility can be interpreted as a sign of pain in both dogs and cats but may be more difficult for owners to recognize in cats due to behavioral differences between the species as well as the likelihood of dogs going for walks with their owners as compared to cats.27

Since cats are known to manifest signs of pain differently as compared to dogs, detecting pain in this species may be more challenging if objective pain scoring tools are not used.28,29 This statement is further supported by a previous study30 that asked veterinary nurses to rate surgical procedures involving dogs and cats using a numerical rating scale from 1 to 10, with 1 being least painful and 10 being most painful. Coleman and Slingsby30 found that veterinary nurses rated procedures involving dogs as more painful compared to cats, even if the same procedure was performed. Veterinary nurses rated surgical sterilization in dogs, both ovariohysterectomy and orchiectomy, as more painful compared to cats.30 In that same study, out of 517 veterinary nurses, 96% reported that they needed more training in the assessment of pain.

Postoperative analgesics were not administered as directed by 4 of 19 (21.1%) owners. Some owners in this study population did not perceive their pets to be in pain and thought that analgesics were not needed. A previous study17 found that most owners (550/849 [64.7%]) disagreed or partly disagreed with the statement “pain in animals is easy to recognize.” The results of Steagall et al’s17 study interpreted with the results of this study suggest that pain in pets may be difficult for owners to identify, and therefore owners may miss some or all of these signs. This further emphasizes the need for the use of an objective validated pain scale to ensure that postoperative pain in pets is addressed and not left untreated. There is also a need to consider owners’ interpretation of the phrase “administer as directed.” It is postulated that some owners may have initially administered analgesics as directed but may have missed a dose or stopped the oral analgesic early, which would have lowered the compliance rate. In the current study, 15 of 19 owners reported a 78.9% compliance rate when administering analgesics as directed by their veterinarian. A study by Adams et al31 found that when owners self-reported on the administration of antibiotics to their pets, they tended to overestimate their level of compliance. This suggests that the 78.9% compliance rate in the present study may have been an overestimation of the actual compliance rate.

In the current study, owners in the age range of 55 to 64 years old were found to be less compliant in administering analgesics to their pets as directed. In human medicine, medication nonadherence is a common problem among elderly patients.32 It is therefore likely that elderly pet owners may be less compliant with administering their pets’ analgesics just as they are with their own medications. Although there was no significant correlation in people over the age of 65 and administration of analgesics in their pets, this may be limited by sample size as only 7 of 175 (4%) owners in the study population were over 65 years old.

There was no significant correlation between owners’ perception of pain and owner demographics, including age, gender, and if the owner had a painful condition. Davis et al33 found that owners with chronically painful conditions had greater empathy for pain in their pets, which was not a similar finding in the current study. These findings may have been affected by the low numbers of owners who reported being afflicted by a chronically painful condition. A study investigating the perception of pain in dogs by Norwegian dog owners found that female owners rated medical conditions as more painful compared to male owners, and higher education levels were associated with lower pain ratings.34 In the current study, there was no significant difference in the way male and female owners reported their perception of pain in their pet. However, due to the small sample size and the low number of male versus female respondents, it is challenging to draw any conclusions in this area. A larger number and a more equal distribution of male and female respondents may have shown a difference in how owners in each category perceived and reported pain in their pets. Interestingly, in the current study the highest education level, doctoral or professional degree, was found to be associated with a lower compliance rate as it relates to the administration of analgesics to their pet. The results of the current study interpreted with the results of the study by Ellingsen et al34 suggests that owners with higher education levels may perceive pain in their pets differently than those with lower education levels; therefore, they may not administer analgesics as directed.

In this study, it was found that pet owners perceived the level of pain in their pets to be mostly well controlled following their surgical sterilization procedure and that pain management was important to them. The rating of the importance of pain management in this study agrees with the findings of a study17 on the perception of pets’ pain by owners in Canada, in which owners wanted to be assured that their pet received all necessary analgesics and techniques to keep them comfortable after their surgical procedure. Although pain management was found to be very important to owners, the determination of pain by the owners was a subjective assessment. The subjective assessments by the owners of their pets being painful after surgery was based on their recall of how their pet behaved at home after the surgical procedure and the use of a unidimensional numerical pain scoring system provided within the survey. Owners did not use a validated pain scoring scale to objectively score their pet’s level of pain. The welfare of the dogs and cats in this study could have been improved by the use of validated pain scales by owners to ensure that their pet’s pain was being well managed in the postoperative period at home.9,35

There are several pain scales available to assess acute pain in both dogs and cats. For dogs, these include the Colorado Acute Pain Scale Canine and the Glasgow Composite Short Form Scale.9 For cats, these include the Colorado Acute Pain Scale Feline, the Glasgow Feline Composite Measure Pain Scale, and the Feline Grimace Scale.9 However, these pain scales are designed for use by veterinary professionals to assess acute postoperative pain and not by owners for use at home. In addition, only the Glasgow pain scales for both dogs and cats and the Feline Grimace Scale have been validated.9 The Helsinki Chronic Pain Index is a validated pain scale developed for use by pet owners to assess chronic pain in dogs. The use of a validated pain scale is important as it allows the user to track changes in pain repeatedly and accurately over time, which allows for the evaluation of the efficacy of their pain management protocol.36 There is a need for the development of pain scales for acute pain in both dogs and cats that is intended for use by pet owners. Until such a pain scale is developed, veterinarians could consider teaching pet owners to use a pain scale such as the Feline Grimace Scale, or the Glasgow Short Form Scale for dogs, when discharging patients after surgical procedures. The Feline Grimace Scale has been tested with a group of cat owners with very good agreement between pain scores of cat owners and veterinary professionals, and as such veterinary professionals should consider educating cat owners on the use of this scale at home.36

A previous study37 found that only about 70 of 147 (50%) small animal practices surveyed reported the use of pain scales as part of their routine workflow. The most commonly used pain scales by veterinary professionals were the Colorado State University Pain Scale, a unidimensional numerical rating, the Glasgow Composite Short Form Scale, and a Dynamic Interactive Visual Analog Scale. Staff not being trained to use pain scales and a busy caseload are the 2 most commonly reported reasons for not routinely pain scoring animals.37 This study by Costa et al37 also found that many veterinary professionals believe pain scales to be unreliable in accurately recognizing pain in animals. This may be due to the use of unidimensional pain scales that may vary among individual scorers and lead to erroneous results. These unreliable pain scores may have resulted from the inclusion of vocalization in pain scoring or difficulty distinguishing anxious behaviors from painful behaviors.37 Costa et al37 describes the use of a multidimensional pain scale to be reliable, especially when compared to unidimensional pain scales if used correctly, as they incorporate specific descriptors that reduce user bias. The use of validated pain scales by owners is highly encouraged; however, veterinary professionals should become more consistent in pain scoring in the clinic to enable the team to feel more comfortable teaching clients to pain score their pets at home.

There are some limitations to this study. The small sample number of responses may have introduced a type II error, which may have limited the ability to conclude if there were correlations between some client demographics and perception of importance or adequacy of pets’ pain management. Some of the results of this survey may have been skewed as clients may not have provided accurate information on administration of pain medications to their pets at home, and as such the compliance rate of 78.9% (15/19) may be falsely high. Owners also may have underreported pain if they felt ashamed to report that their pets were in pain, but they did not act due to a variety of reasons, one of which being financial limitations. Only owners from 1 clinic were sampled; however, it was the largest HQHVLC ovariohysterectomy and orchiectomy clinic in the region. Information provided by owners may not have been completely accurate as the data provided depended on their ability to recall information from within a 6-month period.

In conclusion, while not statistically significant, cats were prescribed analgesics less often than dogs. This suggests that cats’ pain may not be well appreciated by pet owners and veterinary professionals, and therefore may not be always appropriately managed. Most owners thought that their pets’ pain was well controlled following surgical sterilization. However, these assessments were subjective and possibly influenced by individual variation and beliefs. Validated objective pain scales are a valuable tool and can enhance the level of care animals receive by ensuring that their analgesic needs are identified. Educating owners on the need to administer analgesics as prescribed also plays a significant role in the postoperative care of these pets at home. Future studies should include a larger, more diverse sample size, including a comparison between clients of primary care clinics and clients of other HQHVLC veterinary clinics across the country. This may account for potential differences in veterinary clinic protocols for pain management after surgical sterilization. A study investigating veterinary professionals’ perception of adequacy of pain control after surgical sterilization in dogs and cats could be pursued to evaluate differences in perception of pain management between pet owners and veterinary professionals.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org.

Acknowledgments

The authors would like to thank Dr. Joe Hauptman for his assistance with the statistical analysis of the data and Dr. Jeff Adams for his assistance with the study.

Disclosures

The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

Funding for statistical analysis was provided by the Department of Small Animal Clinical Science, College of Veterinary Medicine, Michigan State University.

References

  • 1.

    Howe LM. Current perspectives on the optimal age to spay/castrate dogs and cats. Vet Med (Auckl). 2015;6:171180. doi:10.2147/VMRR.S53264

    • Search Google Scholar
    • Export Citation
  • 2.

    Reichler IM. Gonadectomy in cats and dogs: a review of risks and benefits. Reprod Domest Anim. 2009;44(suppl 2):2935. doi:10.1111/j.1439-0531.2009.01437.x

    • Search Google Scholar
    • Export Citation
  • 3.

    Dow C. The cystic hyperplasia-pyometra complex in the bitch. J Comp Pathol. 1958;69:237250. doi:10.1016/S0368-1742(59)80023-0

  • 4.

    DeTora M, McCarthy RJ. Ovariohysterectomy versus ovariectomy for elective sterilization of female dogs and cats: is removal of the uterus necessary? J Am Vet Med Assoc. 2011;239(11):14091412. doi:10.2460/javma.239.11.1409

    • Search Google Scholar
    • Export Citation
  • 5.

    Berry SJ, Coffey DS, Strandberg JD, Ewing LL. Effect of age, castration, and testosterone replacement on the development and restoration of canine benign prostatic hyperplasia. Prostate. 1986;9(3):295302. doi:10.1002/pros.2990090308

    • Search Google Scholar
    • Export Citation
  • 6.

    Ruetten H, Wehber M, Murphy M, et al. A retrospective review of canine benign prostatic hyperplasia with and without prostatitis. Clin Theriogenology. 2021;13(4):360366.

    • Search Google Scholar
    • Export Citation
  • 7.

    Neilson JC, Eckstein RA, Hart BL. Effects of castration on problem behaviors in male dogs with reference to age and duration of behavior. J Am Vet Med Assoc. 1997;211(2):180182. doi:10.2460/javma.1997.211.02.180

    • Search Google Scholar
    • Export Citation
  • 8.

    Spain CV, Scarlett JM, Houpt KA. Long-term risks and benefits of early-age gonadectomy in cats. J Am Vet Med Assoc. 2004;224(3):372379. doi:10.2460/javma.2004.224.372

    • Search Google Scholar
    • Export Citation
  • 9.

    Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA pain management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2022;58(2):5576. doi:10.5326/JAAHA-MS-7292

    • Search Google Scholar
    • Export Citation
  • 10.

    Simon BT, Scallan EM, Von Pfeil DJF, et al. Perceptions and opinions of pet owners in the United Sates about surgery, pain management, and anesthesia in dogs and cats. Vet Surg. 2018;47(2):277284. doi:10.1111/vsu.12753

    • Search Google Scholar
    • Export Citation
  • 11.

    Mathews KA. Nonsteroidal anti-inflammatory analgesics. Indications and contraindications for pain management in dogs and cats. Vet Clin North Am Small Anim Pract. 2000;30(4):783–807. doi:10.1016/S0195-5616(08)70007-X

    • Search Google Scholar
    • Export Citation
  • 12.

    Ruel HLM, Steagall PV. Adjuvant analgesics in acute pain management. Vet Clin North Am Small Anim Pract. 2019;49(6):11271141. doi:10.1016/j.cvsm.2019.07.005

    • Search Google Scholar
    • Export Citation
  • 13.

    Steagall PV, Monteiro-Steagall BP, Taylor PM. A review of the studies using buprenorphine in cats. J Vet Intern Med. 2014;28(3):762770. doi:10.1111/jvim.12346

    • Search Google Scholar
    • Export Citation
  • 14.

    Pereira MAA, Gonçalves LA, Evangelista MC, et al. Postoperative pain and short-term complications after two elective sterilization techniques: ovariohysterectomy or ovariectomy in cats. BMC Vet Res. 2018;14(1):335. doi:10.1186/s12917-018-1657-z

    • Search Google Scholar
    • Export Citation
  • 15.

    Posner LP, Applegate J, Cannedy A, et al. Total injectable anesthesia of dogs and cats for remote location veterinary sterilization clinic. BMC Vet Res. 2020;16(1):304. doi:10.1186/s12917-020-02525-x

    • Search Google Scholar
    • Export Citation
  • 16.

    Butow P, Sharpe L. The impact of communication on adherence in pain management. Pain. 2013;154(suppl 1):S101S107. doi:10.1016/j.pain.2013.07.048

    • Search Google Scholar
    • Export Citation
  • 17.

    Steagall PV, Monteiro BP, Ruel HLM, et al. Perceptions and opinions of Canadian pet owners about anaesthesia, pain and surgery in small animals. J Small Anim Pract. 2017;58(7):380388. doi:10.1111/jsap.12674

    • Search Google Scholar
    • Export Citation
  • 18.

    Bushby PA. High-quality, high-volume spay-neuter: access to care and the challenge to private practitioners. J Feline Med Surg. 2020;22(3):208215. doi:10.1177/1098612X20903600

    • Search Google Scholar
    • Export Citation
  • 19.

    Frank D. Recognizing behavioral signs of pain and disease: a guide for practitioners. Vet Clin North Am Small Anim Pract. 2014;44(3):507524. doi:10.1016/j.cvsm.2014.01.002

    • Search Google Scholar
    • Export Citation
  • 20.

    Capner CA, Lascelles BD, Waterman-Pearson AE. Current British veterinary attitudes to perioperative analgesia for dogs. Vet Rec. 1999;145(4):9599. doi:10.1136/vr.145.4.95

    • Search Google Scholar
    • Export Citation
  • 21.

    Dohoo SE, Dohoo IR. Postoperative use of analgesics in dogs and cats by Canadian veterinarians. Can Vet J. 1996;37(9):546551.

  • 22.

    Taylor S, Caney S, Bessant C, Gunn-Moore D. Online survey of owners’ experiences of medicating their cats at home. J Feline Med Surg. 2022;24(12):12831293. doi:10.1177/1098612X221083752

    • Search Google Scholar
    • Export Citation
  • 23.

    Monteiro BP, Klinck MP, Moreau M, et al. Analgesic efficacy of tramadol in cats with naturally occurring osteoarthritis. PLoS One. 2017;12(4):e0175565. doi:10.1371/journal.pone.0175565

    • Search Google Scholar
    • Export Citation
  • 24.

    Clark TP. The history and pharmacology of buprenorphine: new advances in cats. J Vet Pharmacol Ther. 2022;45(suppl 1):S1S30. doi:10.1111/jvp.13073

    • Search Google Scholar
    • Export Citation
  • 25.

    Sivén M, Savolainen S, Räntilä S, et al. Difficulties in administration of oral medication formulations to pet cats: an e-survey of cat owners. Vet Rec. 2017;180(10):250. doi:10.1136/vr.103991

    • Search Google Scholar
    • Export Citation
  • 26.

    Merola I, Mills DS. Behavioural signs of pain in cats: an expert consensus. PLoS One. 2016;11(2):e0150040. doi:10.1371/journal.pone.0150040

    • Search Google Scholar
    • Export Citation
  • 27.

    Mills DS, Demontigny-Bédard I, Gruen M, et al. Pain and problem behavior in cats and dogs. Animals (Basel). 2020;10(2):318. doi:10.3390/ani10020318

    • Search Google Scholar
    • Export Citation
  • 28.

    Cambridge AJ, Tobias KM, Newberry RC, Sarkar DK. Subjective and objective measurements of postoperative pain in cats. J Am Vet Med Assoc. 2000;217(5):685690. doi:10.2460/javma.2000.217.685

    • Search Google Scholar
    • Export Citation
  • 29.

    Taylor PM, Robertson SA. Pain management in cats–past, present and future. Part 1. The cat is unique. J Feline Med Surg. 2004;6(5):313320. doi:10.1016/j.jfms.2003.10.003

    • Search Google Scholar
    • Export Citation
  • 30.

    Coleman DL, Slingsby LS. Attitudes of veterinary nurses to the assessment of pain and the use of pain scales. Vet Rec. 2007;160(16):541544. doi:10.1136/vr.160.16.541

    • Search Google Scholar
    • Export Citation
  • 31.

    Adams VJ, Campbell JR, Waldner CL, Dowling PM, Shmon CL. Evaluation of client compliance with short-term administration of antimicrobials to dogs. J Am Vet Med Assoc. 2005;226(4):567574. doi:10.2460/javma.2005.226.567

    • Search Google Scholar
    • Export Citation
  • 32.

    Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9(1):1123. doi:10.1016/j.amjopharm.2011.02.004

    • Search Google Scholar
    • Export Citation
  • 33.

    Davis KN, Hellyer PW, Carr ECJ, Wallace JE, Kogan LR. Qualitative study of owner perceptions of chronic pain in their dogs. J Am Vet Med Assoc. 2019;254(1):8892. doi:10.2460/javma.254.1.88

    • Search Google Scholar
    • Export Citation
  • 34.

    Ellingsen K, Zanella AJ, Bjerkas E, Indrebo A. The relationship between empathy, perception of pain, and attitudes toward pets among Norwegian dog owners. Anthrozoos 2010;23:231243. doi:10.2752/175303710X12750451258931

    • Search Google Scholar
    • Export Citation
  • 35.

    Conzemius MG, Hill CM, Sammarco JL, Perkowski SZ. Correlation between subjective and objective measures used to determine severity of postoperative pain in dogs. J Am Vet Med Assoc. 1997;210(11):16191622. doi:10.2460/javma.1997.210.11.1619

    • Search Google Scholar
    • Export Citation
  • 36.

    Rousseau-Blass F, O’Toole E, Marcoux J, Pang DSJ. Prevalence and management of pain in dogs in the emergency service of a veterinary teaching hospital. Can Vet J. 2020;61(3):294300.

    • Search Google Scholar
    • Export Citation
  • 37.

    Costa RS, Hassur RL, Jones T, Stein A. The use of pain scales in small animal veterinary practices in the USA. J Small Anim Pract. 2023;64(4):265269. doi:10.1111/jsap.13581

    • Search Google Scholar
    • Export Citation

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