by Mark Stewart

 For more and more vets, evaluating pain has become less and less of guessing game

As judgment calls go, it is one of the most difficult in veterinary medicine. A dog in pain can’t speak for itself—we know that—but without accurately gauging the nature and severity of a canine’s discomfort, even the most gifted vets may find themselves at a loss when determining a course of treatment. Compounding this dilemma is the fact that dogs rarely display the pain they are experiencing at home on a trip to the animal hospital. Their adrenaline is pumping, their senses are under assault, and many experience off-the-charts anxiety—all of which can mask their pain once they hit the examining table. So what’s a vet to do? Keep score. They now can do so thanks to an elegantly simple document called the Canine Brief Pain Inventory (aka CBPI), which was developed at the University Pennsylvania School of Veterinary Medicine. The two-page evaluation sheet contains 11 carefully constructed questions, each of which can be answered on a sliding scale from 1 to 10—not by the doctor or (obviously) the patient, but by the dog owner. The result is a score which, over years of trials, has proven to be remarkably accurate. Why the dog owner? The answer would seem to be a no-brainer. After all, who better to report on a pet’s condition than the person who sees that pet more than anyone? But there’s the rub. The idea of taking what is purely observational data and then translating that into unimpeachable science is not always an easy sell. It’s not weaving straw into gold, mind you, but to some it has a little of that flavor. Not so says the CBPI’s creator, Dr. Dorothy Cimino Brown, Professor and Chief of Surgery at Penn who also has a practice within the university. “There is a whole scientific method surrounding how you build a numbers-based assessment tool from something that is inherently subjective,” she says. “It is a multi-step process during which you develop interview questions and then determine what and how they should be asked, and also how the answers should be recorded. We knew that the signs and behaviors associated with chronic pain in dogs can be non-dramatic, and therefore would be best known by dog owners. That is why we devoted five years and $500,000 on studies and focus groups in order to develop a scientifically reliable instrument.” According to Dr. Brown, there was a lot of tweaking during CBPI’s first two years, and mostly fine-tuning over the last three. Some of the questions to be included seemed obvious to everyone, such as How is your dog hopping into the car or getting upstairs? One development that surprised the researchers was a sleep question. Dogs experiencing pain related to cancer have trouble sleeping, so everyone assumed a sleep question would make the final cut. “It didn’t,” says Dr. Brown. “In building a question about sleep we could never get it to mathematically behave. So we eliminated it. The problem was that not all owners sleep in the same room as their dog, so we dropped it from the inventory.” Brown’s team is pleased with the acceptance of the CBPI within the veterinary community. The form is available on the Internet at no charge, and it already has been downloaded more than 500 times; there is no way to track how often it is emailed or disseminated in other ways. After some initial resistance, the CBPI received glowing reviews in veterinary publications and today companies seeking FDA approval for canine pain medicine are using the CBPI to determine whether a drug is doing what it is supposed to do. Will the CBPI achieve “industry standard” status? From a research standpoint, it’s already a superb one. Considering that many local practitioners don’t use anything—they will ask how a dog is doing, but they don’t quantify it longitudinally—often a change in medication or treatment is based solely on feel. Old dogs can learn new tricks, as can vets who might initially resist an instrument such as the CBPI. From a patient record-keeping standpoint alone, says Dr. Brown, it just makes sense. “We recognize that the idea you can build an objective tool for a subjective situation is something new for veterinarians,” she offers. “But you can’t just pull six questions out of the air and expect to get a real evaluation.” EDGE  

Editor’s Note: Mark Stewart grabbed this story assignment for selfish reasons. He is the owner of an arthritic collie named Clementine. On his next vet visit, he will have a completed CBPI in hand. Mark also authored New Jersey Plants and Animals and All Around New Jersey: Regions & Resources; both books are now in their second hardcover printings.