Last week I participated in a webinar led by a veterinary oncologist. He introduced us to a tool, called the Canine Brief Pain Inventory or CBPI, which was developed by Dr. Brown and others at University of Pennsylvania. The tool evaluates both the severity of pain in dogs, as well as how much pain is interfering with normal daily life. It has been validated for dogs with osteoarthritis and bone cancer occurring in the legs.
The great thing about this tool is that it’s meant to be completed by you, the dog owner. The first 4 questions relate to how much pain your dog is experiencing, on a scale of 1 to 10. You average the results of the first 4 questions to get a mean severity score. The next 6 questions pertain to how pain interferes with your dog’s typical activities. You average the results of these 6 questions to get a mean interference score. The final question asks you to assess your dog’s overall quality of life. This allows you to judge the relative importance of the pain your dog is experiencing.
When does it make sense to use this tool?
Here is a list of scenarios for dogs with arthritis:
- You note your older dog is having some trouble going up the steps. You schedule a vet visit to have him checked out. Fill out the CBPI before you go and give the completed survey to your vet.
- After your vet prescribes pain medication (often this will be a non-steroidal anti-inflammatory – NSAID), give it to your dog as prescribed and re-take the survey in 14 days. Compare your results to the pre-survey, and if you don’t see any improvement, call your vet to discuss a different strategy.
- Over time (every 2 months or so), as your dog continues on his treatment plan, re-take the survey to ensure his level of pain is not increasing. Bring all of your surveys with you when you visit the vet office so they can be included in your dog’s medical record
Bone cancer in the leg is a very painful condition in dogs. Amputation is typically recommended, and this will relieve pain within days of performing surgery. However, amputation is not always possible, or it may not be recommended if there is evidence of metastasis to the lungs. In this case, aggressive pain management, including a combination of NSAIDs, tramadol, acupuncture, amantadine, gabapentin, bisphosphonates, and local anesthetics, is called for to control pain.
If your dog has been diagnosed with bone cancer, the CBPI can help you put on paper how much pain your dog is in prior to starting pain management. You can complete it again after you’ve begun the plan. The veterinary oncologist in the webinar stated that he wants to see pain controlled in these dogs in no more than one week. This means that if he cannot achieve pain control by increasing doses or adding drugs or other pain relieving modalities within one week’s time, he will have a conversation with his client about euthanasia.
Remember how I wrote last week about signs of pain being subtle in dogs? Click here for a nice handout from the American Animal Hospital Association that can help you assess whether your dog is in pain.
I hope the CBPI will help some of you. If you try it out, leave me a comment about how useful you found it to be.