Hyperaesthesia and self mutilation

RE: Hyperaesthesia and self mutilation

Roland Bulkyn-Rackowe — Mon, 06 Feb 2017 14:36:53 GMT

+1 for ketamine. I have used this with a couple of Burmese cats with Orofacial pain and it seems to have helped. Another possibility might be to try some local anaesthetic (bupivocaine perhaps). I've had the odd case where that seems to be the only effective analgesic.

RE: Hyperaesthesia and self mutilation

Anthony Todd — Thu, 19 Jan 2017 15:40:12 GMT

[quote user="Anthony Dennison"]'short form glasgow composite pain scale for cats[/quote]

Did that and, apart from the exam and assessment of the wound, all the rest could come under "pissed off", nervous, unhappy etc. and not pain IMHO.

Or only pain score them at home and base it on the owners assessment where the "pissed off" factor should be zero?

I'd love to pain score cats just stuffed into a hospital cage; "stuffed" being used deliberately, and the same cat after, an op., particularly if it's a ward with dogs, let alone barking dogs.

I think the best "assessment" was someone on here who said the cat may be in pain; who knows, so why don't give pain relief anyway, which makes the most sense to me.

PS and no score available at all for appetite, drinking or anorexia [say after a big orthopaedic op.......??

in my anecdote, on palpation the cat wasn't painful, but had a facial expression that could be interpreted as painful if you look at the pain scoring guidelines. It turned out it wasn't painful, just narked off with the buster collar, as when it was removed his demeanour improved and he started eating, without adding in further analgesia.

You make my case well!!

RE: Hyperaesthesia and self mutilation

Anthony Dennison — Thu, 19 Jan 2017 15:22:00 GMT

[quote user="Anthony Todd"]

Are you saying that you can differentiate a " pissed off" cat from a "cat in pain" by their relative "pain scores"; "pissed off" cat will be zero, and "cat in pain" will be high?

My understanding from that single anecdote was that the vet couldn't??

[/quote]

It's probably me getting my wires crossed and not being clear tbh. A pain score combines looking at the cat from afar as well as examining it and palpating surgical wounds/abdomens. Google 'colorado pain scale for cats' or 'short form glasgow composite pain scale for cats' and you'll see what I mean.

In my anecdote, on palpation the cat wasn't painful, but had a facial expression that could be interpreted as painful if you look at the pain scoring guidelines. It turned out it wasn't painful, just narked off with the buster collar, as when it was removed his demeanour improved and he started eating, without adding in further analgesia.

It may be one of the reasons things like arthritis is often underdiagnosed in cats (there was one study in JFMS I think that said up to 80% of cats over the age of 3 had OA) - the cat looks grumpy, but in fact is actually painful. Something we as vets might be able to notice but owners cant.

RE: Hyperaesthesia and self mutilation

Anthony Todd — Thu, 19 Jan 2017 10:14:51 GMT

[quote user="Anthony Dennison"]Thing is Anthony, standardised pain scores give much lower inter-observer variability. Without a pain score, where one person might think the cat is sore, another may think it is just 'pissed off', leading to two different outcomes.[/quote]

I've probably misunderstood then.

Are you saying that you can differentiate a " pissed off" cat from a "cat in pain" by their relative "pain scores"; "pissed off" cat will be zero, and "cat in pain" will be high?

My understanding from that single anecdote was that the vet couldn't??

RE: Hyperaesthesia and self mutilation

Anthony Todd — Thu, 19 Jan 2017 10:06:11 GMT

[quote user="Lucy Fleming"]I'm not really sure what you're getting at here Anthony. Pain scores aren't perfect, but we have to use something to try to assess pain levels. [/quote]

No, and I thought I made it obvious, I'm saying that it may be that a "pain score" could just be a "pissed off" score in a cat, and it may be that pain scores should only be made in cats without a collar on.

But, and we've only had one "anecdote", this may not be given anymore credence if we don't get any more supporting anecdotal evidence.

Even as it stands I would suggest that pain scores are measured without collars and without "cat pissing off factors" like a dog yapping next to the cat being assessed.

Don't most cats look "pissed off", in many cases, even when put in a hospital cage or even a cat basket?

RE: Hyperaesthesia and self mutilation

Anthony Dennison — Thu, 19 Jan 2017 09:55:55 GMT

[quote user="Anthony Todd"]

Surprising illogic from my new steroidophilic friend.

Collar on cat; "looks in pain", ie would/might have a high pain score.

Collar off; all bright and happy, cat was just "pissed off"

A significant anecdote, at worst, and more, hopefully confirming this will follow.

Equally tmaybe that "cats in pain" always look "pissed off" as you or I probably do as well......

Equally, and it sounds possible, some pain scores could, with more anecdotes, be a load of crap t too!

[/quote]

Thing is Anthony, standardised pain scores give much lower inter-observer variability. Without a pain score, where one person might think the cat is sore, another may think it is just 'pissed off', leading to two different outcomes.

Also helps with paperwork and traceability - if pain scores are standardised and put in the notes, we can spot trends earlier.

RE: Hyperaesthesia and self mutilation

Lucy Fleming — Thu, 19 Jan 2017 08:46:33 GMT

[quote user="Anthony Todd"]

Collar on cat; "looks in pain", ie would/might have a high pain score.

Collar off; all bright and happy, cat was just "pissed off"

A significant anecdote, at worst, and more, hopefully confirming this will follow.

Equally tmaybe that "cats in pain" always look "pissed off" as you or I probably do as well......

Equally, and it sounds possible, some pain scores could, with more anecdotes, be a load of crap t too!

[/quote]

I'm not really sure what you're getting at here Anthony. Pain scores aren't perfect, but we have to use something to try to assess pain levels. Are you suggesting that they are yet another pointless modern aberration (like diagnostic testing?)

RE: Hyperaesthesia and self mutilation

Anthony Todd — Thu, 19 Jan 2017 08:09:56 GMT

[quote user="David Mills"]No one knows. It's a nice theory but with zero evidence.[/quote]

Surprising illogic from my new steroidophilic friend.

Collar on cat; "looks in pain", ie would/might have a high pain score.

Collar off; all bright and happy, cat was just "pissed off"

A significant anecdote, at worst, and more, hopefully, confirming this will follow.

Equally tmaybe that "cats in pain" always look "pissed off" as you or I probably do as well......

Equally, and it sounds possible, some pain scores could, with more anecdotes, could turn out to be a load of crap too!

RE: Hyperaesthesia and self mutilation

David Mills — Thu, 19 Jan 2017 02:17:38 GMT

[quote user="Anthony Dennison"]

Do one off injections work? I had a post-enterotomy cat in over the weekend that was looking pretty painful and I was considering a ketamine CRI (the dilution calculations at 10pm at night took my brain a while...).

Luckily it turned out the cat was just pissed off about having a buster collar on. He brightened up and started eating without it on!

[/quote]

No one knows. It's a nice theory but with zero evidence.

N = 1 it's a load of crap.

RE: Hyperaesthesia and self mutilation

Rob Davis — Wed, 18 Jan 2017 14:25:02 GMT

[quote user="Julie Innes"] Had been on long term depomed from previous vet, but developed diabetes (which resolved when depo was stopped, but meant we needed another option[/quote]

Anthony Todd

RE: Hyperaesthesia and self mutilation

janine redman — Tue, 17 Jan 2017 23:57:39 GMT

Thanks, its my next option if she can get cat to take them.

and as my own doctor prescribed it for my neck pain this morning I will see what it does for me too.

RE: Hyperaesthesia and self mutilation

Anthony Todd — Tue, 17 Jan 2017 16:43:00 GMT

[quote user="Anthony Dennison"]Fair enough [/quote]

I wasn't having a shot at you; just that "pissed off" cats, and they do look exactly that, may not always be in pain, ie after a spay or minor procedure, so I wonder if "pain scoring" cats is always accurate.

Some cats look "pissed off" ie would pain-score "in pain" when they are only "pissed off" 'cos of the yappy dog next to them in the waiting room.

RE: Hyperaesthesia and self mutilation

Julie Innes — Tue, 17 Jan 2017 16:36:17 GMT

I had a great response to amitryptilline with one of these- cat was clawing itself to bits around the neck (I've always seen them at the neck, so collars are no use!) Had been on long term depomed from previous vet, but developed diabetes (which resolved when depo was stopped, but meant we needed another option) Amitryptilline was last desperate measure, O was considering PTS, and I was amazed how well it worked. On it for a couple of months, owner reported she was a different cat, much more relaxed. Eventually the owner weaned her off it about a year ago, and we've had no recurrence....touch wood!

RE: Hyperaesthesia and self mutilation

Anthony Dennison — Tue, 17 Jan 2017 13:13:14 GMT

[quote user="Anthony Todd"]

Sorry, but this is what you said:

[quote user="Anthony Dennison"]

Luckily it turned out the cat was just pissed off about having a buster collar on. He brightened up and started eating without it on!

[/quote]

Fair enough - we thought he was looking painful because he was hunched up in his litter tray, but on palpation was fine. Turned out he wasn't looking painful, just cheesed off. He started eating, purring and rubbing himself around the kennel once the buster collar was taken off.

RE: Hyperaesthesia and self mutilation

Anthony Todd — Tue, 17 Jan 2017 10:11:32 GMT

Sorry, but this is what you said:

[quote user="Anthony Dennison"]

Luckily it turned out the cat was just pissed off about having a buster collar on. He brightened up and started eating without it on!

[/quote]

RE: Hyperaesthesia and self mutilation

Anthony Dennison — Tue, 17 Jan 2017 09:47:22 GMT

[quote user="Anthony Todd"]Did you pain score it?[/quote]

Yes of course. That's why we tried him without the buster collar because he seemed fine otherwise.

RE: Hyperaesthesia and self mutilation

Anthony Todd — Mon, 16 Jan 2017 19:49:40 GMT

[quote user="Anthony Dennison"]Luckily it turned out the cat was just pissed off about having a buster collar on. He brightened up and started eating without it on![/quote]

Did you pain score it?

RE: Hyperaesthesia and self mutilation

Anthony Dennison — Mon, 16 Jan 2017 16:43:50 GMT

Luckily it turned out the cat was just pissed off about having a buster collar on. He brightened up and started eating without it on!

RE: Hyperaesthesia and self mutilation

Rob Davis — Mon, 16 Jan 2017 12:29:58 GMT

[quote user="Marie Kubiak"]Not sure if this is relevant to cats but in rabbits I have used low dose ketamine (1-2mf/kg sc) as a one off injection for managing poorly controlled pain[/quote]

Have used this successfully in dogs, but never tried it in a cat

RE: Hyperaesthesia and self mutilation

Anthony Dennison — Sat, 14 Jan 2017 12:12:04 GMT

I agree with the orofacial pain syndrome line of thinking. Could there be some sort of nerve damage from the surgeries?

RE: Hyperaesthesia and self mutilation

janine redman — Sat, 14 Jan 2017 01:11:55 GMT

Does that have a central or local ?

The reaction is on a level with the oro facial pain syndrome, which I had not thought off. dosing every eight hours would be challenging but anything which would allow the cat to self groom even if only for part of the day would be great.

RE: Hyperaesthesia and self mutilation

grumpyoldman — Fri, 13 Jan 2017 23:24:38 GMT

Levitiracetam 20mg/kg tid . Seem to remember a faciomaxillary pain syndrome associated with partial seizure activity being reported somewhere.

RE: Hyperaesthesia and self mutilation

Marie Kubiak — Fri, 13 Jan 2017 22:17:28 GMT

Not sure if this is relevant to cats but in rabbits I have used low dose ketamine (1-2mf/kg sc) as a one off injection for managing poorly controlled pain. The theory I believe is that it resets pain receptors after established wind up but does rely on underlying painful focus diminishing at the same time. May not be useful as this is a more complicated situation but may be worth trying if options are limited?

Marie

RE: Hyperaesthesia and self mutilation

janine redman — Fri, 13 Jan 2017 22:09:14 GMT

Depomedrone and collar has got me this far, but not enough on its own. Phenobarbitone and aminotryptilline worth a consideration . Thanks. Cat difficult to medicate .

RE: Hyperaesthesia and self mutilation

Anthony Todd — Fri, 13 Jan 2017 22:00:33 GMT

[quote user="Nicola M"]Was going to suggest phenobarb liquid[/quote]

Please try Dmed first, rather than just suppressing the response, and the cat, without having any action on the possible logical aetiology.

They inject Dmed into so many humans' spines on the flimsyest evidence at about £200 a jab.....

I'd be very surprised if it didn't help.