Evidence-Based Tiered Framework for Feline Pain Management: A Systematic Review

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This systematic review developed an evidence-based framework for feline pain management.The systematic search of Scopus, ScienceDirect, and PubMed from 1980 to october 2023 found 42 eligible studies that explored pharmacological and nonpharmacological approaches to feline pain management.The outcome measures included analgesic efficacy, rescue analgesia, and adverse effects.Rescue analgesia was a key endpoint in multimodal therapies and was mostly used in severe pain models.Multimodal therapies were mainly employed in complex cases/procedures with severe pain potentials, resulting in higher rescue rate (16.6%) compared to monotherapy in routine procedures/ neuter (5.29%).Pre-emptive analgesics were always associated with the best outcomes.The UNESP-Botucatu multidimensional scale was one of the most frequently used and validated pain assessment tools.The adverse effects were usually easy to manage, with the most frequent being opioid-related dysphoria and NSAID-related gastrointestinal effects.Following these results, we propose a tiered framework: a base of NSAIDs and local anaesthetics (Tier E1), supplemented with opioids for severe pain (Tier E2) and adjunctive stress-reducers (Tier E3).This is a pre-emptive, structured and severity-specific method necessary to ameliorate the cycle of treating pain insufficiently, thereby improving the welfare of cats, as well as staff safety and strengthening the veterinary practice.

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