Part 1: History / Introduction
Part 6: Pain in the Avian Species
Part 8: Quality-of-Life Issues (Please scroll down)
Part 8: Quality-of-Life Issues
Acute pain causes tissue damage and alters behavior in order to avoid further damage. Healing takes place, and the pain ceases when healing is complete. Chronic pain, on the other hand, continues long after the acute disease process ends and has a significant impact on the psychology of the sufferer. Human chronic pain causes fear, anger, anxiety, depression, and fatigue; these in turn exacerbate the pain. Because of this, chronic pain impacts the patient’s social, psychological, and physical well being, thereby affecting their quality of life.
Like pain, QOL is subjective to the individual. HRQL is concerned with the aspects of QOL that change as a result of illness or medical intervention. Previously there has been little concern for QOL or HRQL in animals; therefore, no guidelines or measurements of HRQL have been developed. It is now considered important to go beyond the concept of “welfare” for animals. The goal of welfare is to make the animal feel “not too badly.” It exists to make sure the animals (usually farm animals) receive the minimum of care, rather than attempting to make them feel good or very good.
The Importance of Measuring Chronic Pain, Quality of Life (QOL), and Health-related Quality of Life (HRQL)
Veterinarians are seeing an increase in chronic pain among their patients due to the upsurge in the geriatric population of dogs and cats, and more recently, of birds. Birds live far longer than mammalian pets, so their chronic pain will also become longer-lasting; they are seeing a rise in such painful and chronic conditions as arthritis and cancer. No field of animal medicine has undergone more change than oncology.
A reliable method of determining pain and Health-related Quality of Life (HRQL) has been lacking up to now, and veterinarians and clients have struggled with ethical considerations of treatment options and euthanasia. When is aggressive cancer treatment too much for the animal to handle? And when does palliative care become necessary? When should the animal be allowed to die?
To deal with these issues, veterinarians have adopted and adjusted human QOL and HRQL standards in order to shift the focus from animal welfare to achieving the best possible quality of life. Although pain is a subjective experience, most scientists agree that animals suffer pain just as humans do. Chronic pain as the same negative effects in animals as it does in humans; in fact, recent evidence and studies have proven it.
Currently, veterinarians are managing chronic osteoarthritis pain in mammalian pets by using a combination of therapies along with lifestyle changes and dietary management. Many of these options are adapted for you by avian veterinarians as well.
To assess the effectiveness of these therapies, clinicians and clients need a reliable means of measuring pain and HRQL. From this they can plan the changes in treatments and, if necessary, consider euthanasia. This is particularly true in oncology and palliative care. These treatments can have both positive and negative effects on the anima, so both clinician and client will need to discuss the advisability of such treatments in order to avoid the moral distress suffered by those involved.
Not only the pain itself, but the emotional and unpleasant feelings associated with it will cause suffering in the animal. Knowing that, practitioners and clients must consider the HRQL of the animal—a significant challenge.
Pain Recognition in Birds
So many of us have difficulty recognizing when our pets are in pain or are uncomfortable, fearful, upset or depressed. Birds are very good at hiding their illnesses, many times until it is too late to help them. How do we determine if our pets are in discomfort or pain Birds give us signals that something is not right with them, but we have to be very observant. Birds are prey animals and they know it; they realize that if they show any signs of weakness (and pain and illness are weaknesses) they will not live long. The following guidelines will assist you in better understanding your bird's level of comfort and/or pain and help you determine if your bird is indeed suffering and should see your avian veterinarian.
Pain Assessment in Birds
Domain: Regularly ... Sometimes ... Rarely
- Is your bird’s energy level normal?
- Is your bird capable of completing normal, everyday tasks (playing, foraging, etc.)
- Is your bird eating normal amounts of food?
- Does your bird eat the normal variety of foods offered?
- Does your bird greet you with alertness and vocalization?
- Does your bird walk easily?
- Does your bird fly easily?
- Does your bird stumble due to poor vision?
- Does your bird fly into windows or furniture?
- Does your bird hear normally?
- Does your bird recognize his name and turn his head when you speak to him?
- Is your bird breathing normally, without tail-bobbing?
- Does your bird become out-of-breath after light exertion?
- Does your bird let you touch the painful area?
- Does your bird sleep comfortably on a perch?
- Does your bird sleep on a platform or cage floor?
- Does your bird alternate its sleeping positions?
- Does your bird sit for long periods with its feathers fluffed and head under the wing?
- Does your bird react adversely to any medications?
- Is your bird presently on any medications?
- Is your bird behaving normally?
- Does your bird play with toys?
- Does your bird enjoy foraging opportunities?
- Does your bird engage in normal self-grooming/preening behavior?
- Does your bird engage in social grooming of other birds?
- Does your bird preen normally after a bath?
- Does your bird appear chilled and remain still after a bath instead of preening normally?
- Is your bird easy to awaken?
- Is your bird ever unusually anxious or nervous?
- Does your bird cry out unexpectedly?
- Does your bird exhibit guarding behavior by changing body positions in order to protect a painful area?
- Does your bird withdraw to a corner or other solitary place and sit still?
- Does your bird engage in feather-destructive behavior?
- Does your bird engage in painful grooming behavior or self-mutilation at a specific site?
- Does your bird engage in painful grooming behavior or self-mutilation generally?
- Does your bird experience long periods of decreased activity?
- Is your bird increasingly aggressive toward other birds of the same species?
- Is your bird increasingly aggressive toward you?
- Is your bird tolerant of other pets in the house?
- Is your bird's plumage in good condition?
- Are there any unusual lumps or growths on your bird?
- Are your bird's eyes clear and bright?
- When you lift the eyelid, is it red?
- Are the nares clear and free of debris?
- Is there any discharge from the nares?
- Is your bird’s vent red, inflamed or swollen?
- Is there any tissue coming out of the vent?
- Does his preen gland appear normal?
- Is your bird happy to see you when you get home?
- Does your bird interact normally with you?
- Does your bird interact normally with other people?
- Do you think your bird is happy?
What is your bird’s pain assessment?
The Bird Is In No Pain 0_____________________________________10 The Bird Is In Great Pain
Paul-Murphy J. Pain Management for the Pet Bird. In: Handbook of Veterinary Pain Management, Ed. Gaynor J and Muir W III. Second Edition, Mosby Inc., 2009. p. 467
(Additional questions provided by J Miesle)