Pijnevaluatie met een ‘Composite Pain Scale’ bij postoperatieve koliekpatiënten en schedelpatiënten onder kliniekomstandigheden

Abstract

Animal welfare and health become more and more a subject of debate nowadays. To guarantee animal welfare, it is important to fight pain adequately. Since animals cannot give a description of their pain sensation, it is desirable to evaluate animal pain as objectively as possible. This is particularly important for clinical decision-making. Objective pain evaluation in equine patients is still in its infancy in science. One of the few methods to objectively evaluate pain in patients is the ‘composite pain scale’ (CPS), which was originally developed under experimental conditions. In this actual study, the reliability and applicability were investigated for the CPS under clinical conditions in postoperative colic patients (n=27). This method was validated by the ‘numerical rating scale’ (NRS), which is often used in evaluation of visceral pain in horses. In the clinical cases (n=28), one or two observers performed an evaluation with the aid of both the CPS and NRS, every four hours in the postoperative period. The total scores of the CPS and NRS were compared. The correlation coefficient between the CPS and NRS scores is 0.61. The correlation is significant (P=0.01). The CPS and NRS scores of both observers were compared to determine the inter-observer reliability. The correlation coefficient for the inter-observer reliability is 0.58 for CPS and 0.57 for NRS. Both correlation coefficients are significant (P=0.01). Horses which responded well to the therapy, had low average CPS and NRS scores and could be distinguished from horses with a poor response to the treatment and which had to be humanely euthanized. These patients had high average CPS and NRS scores. The presence or absence of a strangulation and the blood level of lactate being within reference limits or not, are often taken into account in forming a prognoses for a colic patient. For this reason these data were analysed. The group of colic patients was therefore divided into a ‘survivors’ (n=21) and a ‘non survivors’ (n=7) group. The percentage of patients with a strangulation within the non survivors group was three times higher than the percentage of patients with a strangulation within the survivors group. Deviation of the level of lactate in blood from the reference limits, is a less useful criteria in judging a patients’ prognoses, because both patient groups had comparable percentages. Finally, the applicability of the CPS was investigated in patients (n=9) with painful problems at the head or cranium. This type of patients was evaluated two times a day by one observer. The total scores of the CPS and NRS were also compared with each other. The correlation coefficient between the CPS and NRS scores was 0.34. The correlation was significant (P=0,01). For both type of patients, the four most important elements of the CPS system are the same, only in a different order. They are ‘digestive sounds’, ‘heart rate’, ‘pawing on the floor’ and ‘posture’.