Pain is considered the fifth vital sign in humans. Continued painful experience is detrimental to overall healing and general well-being, resulting in longer hospital stays and increased potential for complications. Today it is becoming more widely acknowledged that the same is true for animals, and the issues of animal pain and how to recognize it are covered from A to Z in this article. Nonspecific clues to painful conditions in cats and dogs, pain pointers, a suggested 0-to-10 descriptive pain-assessment scale, a table of behavioral characteristics associated with pain, and a table for pain associated with various surgical procedures help to guide the observer. Key considerations for the clinician are discussed in depth, and pain scoring systems used in human medicine such as verbal rating scales, simple descriptive scales, numerical rating scales, and visual analog scales are outlined and compared/contrasted for use in animals. Common misconceptions regarding analgesia are clarified. It is suggested that to avoid withholding pain treatment inappropriately, a simple way to improve pain-assessment skills in animals is to observe the response to analgesic therapy in situations where pain may be difficult to recognize. A discussion of behavior associated with anesthetic recovery that can confound diagnosis of pain and recommendations for improving pain management will help improve confidence in assessing and treating pain in most circumstances. Ten short "spot check" case histories provide an opportunity for practitioners and staff to test their pain-assessment skills.

COMMENTARY: New Standards for Pain Management, recently mandated by AAHA for their hospitals, raises the bar for recognizing and treating pain in animals. One of the first standards requires that all animals be assessed for pain, which is tricky and can be difficult. This article does a wonderful job of sorting out procedures and commonly associated pain, as well as signs in animals that indicate-or do not indicate-pain.

Animal pain: Figuring out what is going on. Mathews KA, Dyson D. In: Managing Pain in Cats, Dogs, Small Mammals, and Birds. Wilmington, DE: The Gloyd Group Inc, 2003, pp 7-27.