JFMS Special Collection 2024: Be More Confident Managing Feline Pain

In the November episode of Chattering with ISFM, we’re diving into the complexities of feline pain management to help you feel more empowered and informed. Our episode highlights the Journal of Feline Medicine and Surgery (JFMS) Special Collection 2024 on pain and pain management in cats, bringing together some of the latest research, insights, and expert perspectives in the field.

To start, Yaiza Gomez-Mejias speaks with Sabrine Marangoni, who shares key findings from her award-winning study on pain behaviours in kittens undergoing ovariohysterectomy. They discuss the importance of recognizing subtle pain indicators in young cats, the effectiveness of multimodal analgesia approaches, and the broader implications of untreated pain.

In the second half, Kelly St. Denis sits down with Mark Epstein, Co-Chair of the AAHA/AAFP 2014 Pain Management Guidelines Task Force, to explore the progress made in feline pain management. They discuss how the field has evolved, the persistent challenges veterinarians face in assessing and managing pain in cats, and what the future holds in terms of new research and treatments.

For further reading material please visit:

2024 ISFM FELINE CONGRESS ABSTRACTS

Cat Pain Management: YouTube Channel

JFMS Special Collection 2024: Pain and Pain Management In Cats

View The Transcript Here

For ISFM members, full recordings of each episode of the podcast is available for you to listen to at portal.icatcare.org. To become an ISFM member, or find out more about our Cat Friendly schemes, visit icatcare.org


Host: 

Nathalie Dowgray, BVSc, MANZCVS, PgDip, MRCVS, PhD, Head of ISFM, International Society of Feline Medicine, International Cat Care, Tisbury, Wiltshire, UK 

Speakers:
Yaiza Gomez-Mejias, LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal Clinician

Sabrine Marangoni,LdaVet MANZCVS (Medicine of Cats) CertAP (SAM-F) Acr AVEPA, ISFM Community Coordinator and Small Animal Clinician

Kelly St. Denis, MSc, DVM, DABVP (Feline), Co-editor of the Journal of Feline Medicine and Surgery and JFMS Open Reports, St Denis Veterinary Professional Corporation, Powassan, Ontario, Canada

Mark Epstein, DVM, DABVP, CVPP, Education Co-Chair at International Veterinary Academy of Pain Management, Co-Chair of the AAHA/AAFP 2014 Pain Management Guidelines Task Force

Creators and Guests

Host

Nathalie Dowgray

What is Chattering with iCatCare?

Welcome to Chattering With iCatCare, the official monthly podcast of International Cat Care, hosted by Yaiza Gomez-Mejias (Veterinary Community Co-ordinator). Each month, we chatter about cats and cat-friendly practices with industry experts and contributors to The Journal of Feline Medicine and Surgery. Each episode contains highlights from our longer discussions and interviews, which are accessible to iCatCare members at portal.icatcare.org. If you would like access to our full episodes, would like to become an iCatCare Veterinary Society Member, or find out more about our Cat-Friendly schemes, visit icatcare.org.

Hello, and welcome to the November
episode of Chattering with ISFM.

I'm Nathalie Dowgray, Head of ISFM
and host of this month's podcast.

Our spotlight this month is on
pain and pain management in cats.

Kelly St.

Denis is speaking with Mark
Epstein, our JFMS guest editor,

for the pain special collection.

But first up, Yaiza Gomez Mejias is
speaking with Sabrine Marangoni on

her 2024 ISFM Congress award winning
abstract, Characterisation of Pain

Behaviours in Kittens Undergoing
Ovariohysterectomy Using Video Assessment.

So Sabrina Marongoni is a PhD candidate
at the University of Montreal, research

assistant at the City University
of Hong Kong, and this year she won

two ISFM awards at the conference
in Malta, so congratulations.

Thank you very much, Yaiza.

It's a real pleasure to be here.

Thanks for having me.

So, I believe you have done
some work on pain in kittens

undergoing ovariohysterectomy.

Could you talk a little bit
about the findings you find more

relevant for general practitioners?

Yes, of course.

This experiment, it's part of a large
experiment divided into three segments.

Unfortunately, we know that adequate
pain management in kittens under

ovariohysterectomy sometimes is
not always provided due to lack of

drug availability or training in
pain assessment in young kittens.

Also early discharge maybe, or even
neglecting that kittens feel less

pain or can cope better with pain
after such common procedures such as

castration and ovariohysterectomys.

So that's the reason that Dr Steagall
created this pain free kitten project.

So, first, from this main study,
which was a prospective clinical

trial with the objective of comparing
an opioid free protocol with or

without multimodal analgesia, right?

So to evaluate if it's effective or not.

So briefly, the results of this main
study was that the prevalence of

rescue analgesia in control cats, which
received only ketamine, midazolam,

and dexmedetomidine, was really
higher in comparison to the multimodal

group that received the same injected
protocol, but with the addition of

one single shot of NSAs, meloxicam,
and also intraperitoneal anaesthesia.

So this protocol of injectable
anaesthesia with multimodal

analgesia almost eliminates the
requirement of rescue analgesia in

those patients, which is great and in
addition to that, we also evaluate in

that study the food intake of those
kittens undergoing a ovariohysterectomy.

And it was found out that the
control group, the painful

kittens, has a reduced food intake.

For the third segment, which is the
study that I just presented in the last

ISFM Congress, we look into the pain
related behaviours of those kittens.

So from the video recordings that
we collected during the study pre

and post op, we found out that pain
related behaviours that have been

described already in adult cats, such as
lowered head position, no attention to

surroundings, and eyes partially closed,
were also observed in painful kittens,

and the administration of analgesia
changed the duration of these behaviours.

So after giving the rescue analgesia,
those kittens were more attentive

to surroundings, they were more
playful, they had the eyes fully open.

The duration of playing was
significantly lower post op in

painful kittens in comparison to
multimodal and pain free kittens.

So we know that decreased
playfulness can be considered a

behavioural indicator of pain.

Of course, it is very variable between
cats, but we know that kittens, it's

intrinsically of their nature to play.

So this study shows that play is
affected by pain in kittens, and

may represent a behavioural positive
welfare status in the clinical setting.

So one can infer that a playful kitten
after surgery is likely not painful.

So we want to see our
kittens play in the practice.

Exactly.

That would be great.

And now Kelly St Denis is going
to be talking about the evolution

of pain and pain management in
veterinary medicine with Mark Epstein.

You've seen a lot of changes.

I graduated in 1999 and I've
seen a lot of changes in pain

management in our feline species.

What do you think are some of our best
changes and improvements over that time?

The high-level answer is the recognition
of pain and the culture of pain

management that had to be invented,
poor cats, we're trailing dogs.

We didn't have products
for them for so many years.

Cats are less accommodating, and we
didn't understand their nonverbal cues.

That's the overarching change.

And then of course we have a number
of therapeutics that are in the

market now, specifically for cats.

We've certainly learned a lot
about extra label use for cats.

The recognition and assessment of
pain in cats is light years beyond

what it was even just a few years ago.

Where do you think we
still have room to grow?

I think I'm going to answer
that by citing a paper.

It was a comprehensive survey about
their perception about medicating

their cats, among other things.

But, news alert, shockingly, they
hate it, having to give oral meds.

So as we move in the direction of
therapeutics, these are going to

be some of the maybe longer acting
ones parenterally administered and

transdermals, and things like that.

Again, your listeners probably
know more than most is that when

you're chasing after your cat,
you start to break the bond.

So whatever we can do that's hands off
for them and not forcing oral meds is

probably the direction we need to go.

If our listeners aren't totally
familiar with our special collections,

about once a year the journal will
put together a special collection.

Last year it was on
accessible veterinary care.

And essentially we are taking
maybe published articles

that were already published.

So in this case it's on
pain, pain management.

But we're also reaching out to people
that maybe would contribute an article.

In there already we have exciting
articles like a video based compilation

of acute pain behaviour in cats.

And I think that was out of
the Paulo Steagall's lab.

We have a really nice article
on neuropathic pain in cats.

We have our consensus guidelines on
NSAIDs and even the FGS for kittens.

And they have something of the order
of, help me Kelly, maybe 20, 21 papers

in this special collection so far?

Yeah.

There's over 10 so far already published,
what are some of the topics coming?

We often focus on therapeutics, right?

Drugs.

Because it's easy to
wrap our minds around.

But we have papers coming that
are going to be talking about

physical rehab for the cat.

These are non pharmacologic things.

One for acupuncture.

One for cannabinoids and
a few others like that.

So, it's gonna be about as robust a
kind of collection I think may exist.

I'm not aware of anything
else similar to this.

It's a really nice collection of articles.

Let's talk about therapeutics in
cats, multimodal pain management

and where we're at with that with
cats in terms of the drugs that we

can use even post operatively, but
acute pain or even chronic pain.

Where do you see those
fitting in with our medicine?

Not to put too fine a point on
it, but we should redefine them.

I know your listeners know multimodal.

We've been using that phrase for 20 years.

It's probably worthy of a minute
to talk about why we're doing that.

First, you are hitting the pain processing
pathway and receptors at different places.

So if you're doing that
in multiple places, you're

going to have more efficacy.

Number two, is if you are doing a little
bit of a few things rather than leaning

heavily into one thing, like just
opioids, the adverse effect profile drops.

Use a little bit of several things
instead of a lot of any one thing.

In the post surgical domain, we try
to dial back on the opioids, not just

because we had gone through a shortage of
opioids at one point and not too terribly

long ago, although that may have passed.

And not just because there is an
opioid epidemic on the human field,

which has changed the face of the
way opioids have used on the human

side, although we overlap with that
a little bit on the Venn diagram and

we have our responsibilities too.

So it's just trying to steer, not steer
away from, but mitigate the, particularly

the use of the full new agonists,
because it can also, those particular

opioids can have adverse effects.

There's no ceiling effect on the
analgesia, but, some of those have no

ceiling effect on the adverse effects.

You can get more methadone or
morphine fentanyl to be fatal,

it can pop the appetite and cause
dysphoria, constipation, other things.

So for all those reasons together,
we were trying to use multi modal

balanced analgesic approaches so that
we don't have to use, in the kind of

peri-surgical setting, quite so much
in the way these full new agonists.

Lastly, is that there's a subset of
patients that either have or at risk

for hypersensitisation, and your
listeners may know this a little better

by its vernacular wind up, right?

And it's where the pain gets exaggerated
in intensity, scope and duration.

Even the field, like if, and not to put
too fine a point on it, but this was for

those of you have been out in practice
long enough to have done declaws early

in your career, there were always the
cats that would limp and hold up a paw.

That was from amputating a
nerve, that is a classic example.

These cats may not even
have pain just in the foot.

That may be their whole arm for example.

That's an example of an expanded field.

So sensitisation and wind up is
unaddressed by the simple use of

opioid or the simple use of NSAIDs.

And so there are other therapeutics and
other things we need to do to address

that particular dimension of pain.

Yes.

And that's a scary part of pain.

Like when we think about any
surgical procedure on a human or

a cat or a dog where, not just
amputations, but we're always cutting

nerves when we make a cut, right?

I just wanted to say thank you.

And I don't know if you have any last
words for us before we close off.

No, I just want to thank you again
for the opportunity to be the special

editor here and to call in some
favours from my friends and colleagues.

And I'm looking forward
to the final product.

It'll be very robust and fascinating.

And I hope you're, you're listeners
and your readers will enjoy.

Thank you.

And don't forget everyone.

You can see any article on the Journal
of Feline Medicine and Surgery and OR.

at Open Access.

So, you don't need to be behind a paywall.

All there for everyone to have a look at.

Have a check our pain
management collection.

Thank you for listening.

If you're an ISFM member, don't forget
you can access the full version of

the podcast and all the other ISFM
member benefits, including congress

recordings, monthly webinars, the
clinical club, the discussion forum,

and much, much more at icatcare.org.

If you're looking for more free CPD from
ISFM in December, on the 5th we have a

webinar on triditis with Fabio Procoli
and that's brought to you by IDEXX.

We'll be back again next month
with more from the world of

feline medicine and JFMS.