Vet Technicians Can Play Vital Role In Improving Pain Control

October 6, 2016
Erin White

Behavioral model reveals subconscious beliefs that restrict good pain management

Recognizing that an animal is in pain can be difficult, and may lead to inadequate pain management; as a result, new guidelines have been issued in the to improve the standard of care. Veterinary technician Aneesa Malik and veterinary surgeon Ailsa Guenevere (Guen) Bradbury suggest that insights gained from behavioural science—used increasingly in the field of medicine–can offer new strategies to improve pain management in the veterinary clinic.

Guen Bradbury was a clinical anaesthetist at the Royal (Dick) School of Veterinary Studies in Edinburgh, Scotland. She explains: “We simply don’t know how most species show that they are in pain. We have good evidence to back up pain scoring systems in dogs, and some evidence for pain scoring systems in cats and a few rodent species, but generally, knowledge is weak or virtually non-existent.

“Vet students in the United States and United Kingdom are now taught about the importance of managing pain. However, those that have not received this training may not know how to assess the level of pain, or understand why it is vital to reduce pain, and are therefore less likely to treat pain effectively. As a result, analgesia is underused in many small animal clinics.”

New guidelines developed by the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) reflect the consensus of current scientific thinking and acknowledge that pain management is central to veterinary practices across the world.

Effective pain management not only alleviates pain, but also speeds up healing and can improve the animal’s quality of life. However, the effective management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response in each individual animal. Veterinary surgeons try to make rational decisions, but, like all humans, our behavior may be affected by different subconscious factors, so pain management may often be imperfect.

Vets and vet technicians have different perspectives on pain management, as a result of their roles and training. The researchers have identified that a more integrated, multidisciplinary approach would promote better care.

Bradbury explains: “Vets have less ongoing contact with animals in the hospital, they have to make tough choices about the immediate procedure (which will often cause transient suffering), and also make hard decisions about future treatment based on various factors, such as quality and length of life and the owner’s financial situation. By contrast, technicians provide care during hospitalisation and create a bond with the animal to reduce the stress of the animal during its time in the hospital. The AAHA/AAFP guidelines stress the importance of these nonpharmacologic interventions.

“There is plenty of evidence that good pain control improves medical outcomes. Additionally, it’s been shown that just the presence of a technician increases the likelihood of a vet giving analgesia. We therefore looked at how technicians could consciously help to create a culture of care where pain management is the responsibility of the whole veterinary team.”

Now working at Innovia Technology, Bradbury has gained an understanding of how behavioural science can be used to determine and understand behaviour in the workplace, revealing the underlying factors influencing decision-making.

Bradbury and Malik used the COM-B behavioural model (see Figure), which provides an objective framework, to assess the underlying drivers behind the use of analgesics at veterinary practices.

The model, which is more frequently applied in human medicine, suggests that three conditions are essential for a person to perform a specific behaviour: capability, opportunity and motivation.

Bradbury continues: “Although veterinary technicians are not able to prescribe drugs directly, they can have a positive effect with deliberate interventions that increase the likelihood of veterinary surgeons prescribing analgesics, either consciously or subconsciously.

“The COM-B framework drew together the conscious and subconscious barriers to good pain management.”

Consciously, vets were worried about potential side effects, that the drugs would mask the symptoms, and that the cost of the drugs would be unacceptable to the owner. Vets often overestimated these risks while underestimating the benefit that the animal would receive from the treatment. Subconsciously, ‘species prejudice,’ where a moral status (pet, pest, food) is given to an animal, influences the empathy of vets and therefore their administration of pain relief.

By using the model Bradbury and Malik were able to objectively analyze the situation in the veterinary clinic and to identify where there were opportunities for interventions to positively affect behavior. As the role of veterinary technician may vary between countries, this can also apply to other para-veterinary staff who cannot prescribe pain relief.

Recommendations included: organizing education in pain management; guiding practice policy on pain assessment and routine analgesic use; creating a compassionate clinical environment; and encouraging two-way communication on pain assessment. These measures can help practices to implement the new AAHA/AAFP guidelines.

Although there might be subtle cultural differences between the United States and Europe, Bradbury believes that there is not enough applicable research, at this point in time, to construct a model based only on work published in just one country:

“Our paper uses references from North America, the UK, New Zealand and more, placing it at a higher level than should be affected by local variations.”

Bradbury suggests that behavioral science could be used to support other areas within veterinary practice, such as strengthening the relationship with clients and communicating more effectively to improve animal welfare.

She says: “The medical world is now beginning to embrace behavioural science to improve physician performance and patient outcomes, and where the medical world leads, the veterinary world is not far behind. I look forward to the application of behavioural science in many areas of veterinary practice.”

See link to paper: http://dx.doi.org/10.1080/17415349.2016.1153989

About Innovia Technology:

Innovia Technology is a world-leading breakthrough innovation consultancy, working with the best companies in the world on their most important innovation challenges. Over 16 years and 800 projects, supporting market leaders such as Bayer, Boeing, DBApparel, Ford, Kraft, LEGO, Procter & Gamble, SABMiller and Shell, Innovia has built a unique combination of analytical capability and creative insight that allows it to solve some of industry’s most intractable problems. Innovia is headquartered in Cambridge, UK. 90% of its current workload is repeat business for satisfied clients.