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Practical relevance: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used and are effective for the management of pain in cats. These Guidelines will support veterinarians in decision-making around prescribing NSAIDs in situations of chronic pain, to minimise adverse effects and optimise pain management. Information is provided on mechanism of action, indications for use, screening prior to prescription, use in the presence of comorbidities, monitoring of efficacy, and avoidance and management of adverse effects. Clinical challenges: The cat's unique metabolism should be considered when prescribing any medications, including NSAIDs. Chronic pain may be challenging to detect in this species and comorbidities, particularly chronic kidney disease, are common in senior cats. Management of chronic pain may be complicated by prescription of other drugs with the potential for interactions with NSAIDs. Evidence base: These Guidelines have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM) and American Association of Feline Practitioners (AAFP). Information is based on the available literature, expert opinion and the panel members' experience. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to investigate the construct validity, responsiveness and reliability of the Feline Grimace Scale (FGS) in kittens. Methods: A total of 36 healthy female kittens (aged 10 weeks to 6 months) were included in a prospective, randomized, blinded study. Video recordings of all kittens were made before and 1 and 2 h after ovariohysterectomy using an opioid-free injectable anesthetic protocol with or without multimodal analgesia. Additional recordings were taken before and 1 h after administration of rescue analgesia (buprenorphine 0.02 mg/kg IM) to painful kittens. Screenshots of facial images were collected from the video recordings for FGS scoring. Four observers blinded to treatment groups and time points scored 111 randomized images twice with a 5-week interval using the FGS. Five action units (AUs) were scored (ear position, orbital tightening, muzzle tension, whiskers position and head position; 0–2 each). Construct validity, responsiveness, and inter- and intra-rater reliability were evaluated using linear models with Benjamini–Hochberg correction, Wilcoxon signed-rank test and single intraclass correlation coefficients (ICCsingle), respectively (P <0.05). Results: FGS total ratio scores were higher at 1 and 2 h after ovariohysterectomy (median [interquartile range, IQR]: 0.30 [0.20–0.40] and 0.30 [0.20–0.40], respectively) than at baseline (median [IQR]: 0.10 [0.00–0.30]) (P <0.001). FGS total ratio scores were lower after the administration of rescue analgesia (median [IQR] before and after rescue analgesia) 0.40 [0.20–0.50] and 0.20 [0.10–0.38], respectively (P <0.001). Inter-rater ICCsingle was 0.68 for the FGS total ratio scores and 0.35–0.70 for all AUs considered individually. Intra-rater ICCsingle was 0.77–0.91 for the FGS total ratio scores and 0.55–1.00 for all AUs considered individually. Conclusions and relevance: The FGS is a valid and responsive acute pain-scoring instrument with moderate inter-rater reliability and good to excellent intra-rater reliability in kittens. [ABSTRACT FROM AUTHOR]

Simple Summary: A pain assessment is essential to provide appropriate pain relief. The Feline Grimace Scale© (FGS) is a facial expression-based acute pain scale used in feline medicine; increased FGS scores could indicate acute pain in cats requiring analgesia. However, it is unknown if some sedatives and/or anesthetics can bias pain assessment using the FGS. This study aimed to investigate the effects of sedation with dexmedetomidine-butorphanol followed by anesthesia with propofol-isoflurane on the FGS scores of healthy cats. The cats were video-recorded before and up to 24 h after sedation and general anesthesia. Images collected from the videos were randomized and scored independently by four raters who were masked to the treatments. Dexmedetomidine and butorphanol significantly increased the FGS scores at 20 min after administration. General anesthesia with propofol and isoflurane significantly increased the FGS scores at 0.5 h post-anesthesia, but not after. There were no other statistically significant findings. In conclusion, sedation with dexmedetomidine and butorphanol and general anesthesia with propofol and isoflurane increase FGS scores and may bias clinical pain assessment. Although the effects were short-lived, they should be taken into account during acute pain assessment. This study aimed to evaluate the effects of sedation and anesthesia on Feline Grimace Scale© (FGS) scores. Twelve healthy cats were included in a prospective, blinded and randomized, cross-over study with a 14 day wash-out. Saline or dexmedetomidine-butorphanol (Dex-But) was administered intramuscularly before an anesthetic induction with propofol and maintenance with isoflurane. Saline or atipamezole (Dex-But) was administered at the end of the general anesthesia. Video-filming/image capturing was performed before and up to 24 h post-anesthesia. A total of 125 images were evaluated by four raters blinded to the treatment groups using the FGS (ear position/orbital tightening/muzzle tension/whiskers change/head position; action units (AU); scores 0–2 for each AU). The effects of the sedation/anesthesia were analyzed (p < 0.05). The total FGS and each AU scores were significantly higher with Dex-But than with saline 20 min post-sedation. In the saline group, the total FGS, orbital tightening, and whiskers and head position scores were significantly higher than baseline at 0.5 h post-anesthesia. In the Dex-But group, the total FGS and each AU scores were significantly higher after sedation, whereas the orbital tightening scores were significantly higher at 0.5 h post-anesthesia when compared with the baseline. None of the other comparisons between or within the groups was significantly different. The sedation with dexmedetomidine-butorphanol and anesthesia with propofol-isoflurane changed the FGS scores on a short-term basis; consequently, they may bias acute pain assessment. [ABSTRACT FROM AUTHOR]

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Practical relevance: Pain assessment has gained much attention in recent years as a means of improving pain management and treatment standards. It has become an elemental part of feline practice with ultimate benefit to feline health and welfare. Currently pain assessment involves mostly the investigation of sensory-discriminative (intensity, location and duration) and affective-motivational (emotional) domains of pain. Specific behaviors associated with acute pain have been identified and constitute the basis for its assessment in cats. Recent advances: The publication of pain scales with reported validation – the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale – and species-specific studies have advanced our knowledge on the subject. Facial expressions have also been shown to be different between painful and non-painful cats, and very recently the Feline Grimace Scale has been validated as a tool for acute pain assessment. Clinical challenges: Despite recent advances, several challenges still exist. For instance, the effects of disease and sedation on pain scoring/ assessment are unknown. Also, specific painful conditions (eg, dental pain) have not been systematically investigated. The development and validation of instruments for pain assessment by cat owners is warranted, as these tools are currently lacking. Aims: This article reviews the use, advantages, disadvantages and limitations of the two validated pain scales, and presents a practical, stepwise approach to feline pain recognition and assessment using a dynamic and interactive process. The authors also offer perspectives regarding current challenges and future directions. [ABSTRACT FROM AUTHOR]