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«Porcine pain face – identifying visible characteristics of pain in pigs Lina Göransson Uppsala 2016 Degree project 30 credits within the ...»

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Faculty of Veterinary Medicine and

Animal Science

Department of Clinical Sciences

Porcine pain face

– identifying visible characteristics of pain in pigs

Lina Göransson

Uppsala 2016

Degree project 30 credits within the Veterinary Medicine Programme

ISSN 1652-8697

Examensarbete 2016:37

Porcine pain face – identifying visible characteristics of pain in pigs

Pain face hos gris – identifiering av möjliga markörer för smärta

Lina Göransson

Magdalena Jacobson, Swedish University of Agricultural

Supervisor:

Sciences, Department of Clinical Sciences Pia Haubro Andersen, Swedish University of Agricultural

Assistant Supervisor:

Sciences, Department of Clinical Sciences Annette Backhans, Swedish University of Agricultural

Examiner:

Sciences, Department of Clinical Sciences Credits: 30 hec Level: Second cycle, A2E Course title: Degree project in Veterinary Medicine Course code: EX0736 Programme/education: Veterinary Medicine programme Place of publication: Uppsala Year of publication: 2016 Cover picture: Illustration by Lina Göransson Title of series: Examensarbete Number of part of series: 2016:37 ISSN:1652-8697 Online publication: http://stud.epsilon.slu.se Keywords: pain, porcine, pig, pain assessment, pain face, facial expressions, Capsaicin Sveriges lantbruksuniversitet Swedish University of Agricultural Sciences Faculty of Veterinary Medicine and Animal Science Department of Clinical Sciences

TABLE OF CONTENTS

SUMMARY

SAMMANFATTNING

INTRODUCTION

OBJECTIVE

LITERATURE REVIEW

PAIN SENSATION IN ANIMALS

PAIN EVALUATION AND ASSESSMENT IN PIGS

FACIAL EXPRESSIONS OF PAIN

Pain face in humans

Pain face in animals

FACIAL ANATOMY OF THE PIG

CAPSAICIN AS A NOXIOUS STIMULUS

MATERIAL AND METHODS

ANIMALS AND FACILITIES

THE STUDY DESIGN

NOXIOUS STIMULUS

VIDEO RECORDINGS

PATHOANATOMICAL INVESTIGATION

DATA PROCESSING

Facial expressions of pain

Blinded evaluation

Other behaviours

STATISTICAL ANALYSIS

RESULTS

ANIMALS

Pathoanatomical investigation

FACIAL EXPRESSIONS OF PAIN

BLINDED EVALUATION

OTHER BEHAVIOURS

DISCUSSION

FACIAL EXPRESSIONS OF PAIN

OTHER BEHAVIOURS

CAPSAICIN AS A NOXIOUS STIMULUS

CONCLUSION

ACKNOWLEDGEMENTS

REFERENCES

SUMMARY The sensation of pain is an important evolutionary adaptation, vital for the survival of an organism. Not only does it enable identification and subsequent avoidance of potentially harmful threats, it also allows for special tending of the affected and possibly injured area.

However, the suppression of pain may also constitute an essential evolutionary adaptation, especially in prey animals, which tend not to show such vulnerability for as long as they can possible disguise it. In pigs, pain may thus be difficult to identify due to the stoic nature of this species. However, alleviation of pain requires it to be acknowledged. Numerous methods have been evaluated as possible means of pain assessment in pigs, but the development of a precise and reliable, objective and efficient pain assessment tool is however yet to await.

In humans, facial behavioural changes associated with pain is considered to be a reliable and consistent method for pain evaluation, and a good alternative when patients cannot convey their pain through spoken words. The concept of pain face has recently been further studied in e.g. non-human primates, horses, rodents and rabbits, and the method seems to be valuable also in these individuals unable to verbally communicate. However, to our knowledge, a pain face has not yet been developed in pigs.

Through video recordings of six pigs, following the application of topical Capsaicin crème inducing a transient burning pain sensation, facial expressions of pain were evaluated in accordance with a previously developed protocol for pain face in horses. The pigs served as their own control, and were filmed without any noxious stimulus, prior to noxious challenge.

Topical Capsaicin was thereafter applied, during separate trials, to an area on the left respectively the right shoulder. All trials were performed twice, with and without an observer in the room. The films were evaluated by two external assessors, and a drawing of a porcine pain face was produced based on these findings. Subsequently, a blinded evaluation was performed based on a number of still images from each film, to assess the presence or absence of these pain face features. Furthermore, an ethogram was constructed regarding certain gross pain behaviours observed.

The evaluation of various gross pain behaviours revealed no significant behavioural changes as a consequence of topical administration of the Capsaicin, and gross behaviours indicative of discomfort or pain were infrequently and only occasionally observed. The facial expressions of the porcine pain face seem to comprise an angled appearance of the eyes (P = 0.004), lowered ears held back or in an asymmetrical manner, wrinkling of the snout and possibly also tension of certain muscles around the mouth and cheeks. Furthermore, ears held in an upright position, turned forward in an attentive manner, were less frequent during pain induction (P = 0.02) than during the control trials.





The facial expressional changes observed in the pigs during noxious challenge may have been rather subtle. Moreover, various concentrations of Capsaicin need to be evaluated in relation to the age and weight of the pigs under investigation. The findings of this study does however indicate that also in pigs, a pain face can be identified – and that it may constitute a possible future method for the assessment of porcine pain.

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SAMMANFATTNING

Förmågan att kunna känna och uppleva smärta utgör en livsviktig evolutionär anpassning.

Smärta gör oss uppmärksamma på tänkbara faror, samtidigt som förnimmelsen leder till omvårdnad av en eventuellt skadad kroppsdel. Att kunna dölja tecken på smärta utgör dock likaså en livsnödvändig evolutionär anpassning framför allt hos bytesdjur, som normalt maskerar alla tecken på sådan sårbarhet in i det längsta. Smärtbedömning hos gris är således oftast mycket svårt, med tanke på artens stoiska karaktär. Ett flertal metoder för att kunna identifiera och bedöma smärta hos gris har studerats, men utvecklingen av en tillförlitlig, objektiv och effektiv metod för smärtbedömning hos gris återstår dock fortfarande.

Specifika smärtrelaterade förändringar i ansiktsuttryck anses vara en tillförlitlig metod för smärtbedömning inom humanmedicin, till exempel då patientens förmåga att genom ord uttrycka smärta är begränsad. Smärtrelaterade ansiktsuttryck, även kallat pain-face, har likaså studerats inom veterinärmedicin, till exempel hos andra primater, häst, gnagare och kanin.

Också hos dessa individer, oförmögna att kommunicera verbalt, förefaller smärtrelaterade förändringar i ansiktsuttryck att vara en tillförlitlig och användbar metod för bedömning av smärta. Ett pain face har dock ännu inte, såvitt vi vet, utvecklats hos gris.

Efter topikal applicering av Capsaicinsalva, vilken inducerar en övergående brännande smärtförnimmelse, filmades sex stycken grisar vars ansiktsuttryck analyserades med avseende på smärtrelaterade förändringar. Protokollet baserades på en motsvarande, nyligen genomförd studie av pain-face hos häst. Samtliga grisar fungerade som sin egen kontroll, och filmades initialt utan någon stimulus, och därefter i samband med smärtinduktion. Capsaicin applicerades på ett område på vänster respektive höger sidas bogblad, vid separata tillfällen.

Grisarna filmades först med och sedan utan en observatör i rummet. Filmerna analyserades av två externa bedömare, varpå ett pain-face utformades baserat på deras fynd. Därefter gjordes en blindad bedömning av ett antal stillbilder, med avseende på förekomst eller frånvaro av dessa ansiktsuttryck. Dessutom bedömdes ett antal andra potentiellt smärtrelaterade beteenden med hjälp av ett etogram.

Fynden i denna studie tyder på att grisens pain face inkluderar ett spetsigt eller vinklat utseende av området just ovanför ögonen (P = 0,004), sänkta och asymmetriska eller bakåt lagda öron, ett ökat antal rynkor på trynet, samt möjligen även kontraktion av viss muskulatur kring mun och längs huvudets laterala sidor. Smärtinduktionen resulterade dessutom i en signifikant minskning av den tid som grisarna höll öronen uppåt och framåt (P = 0,02).

Förekomsten av övriga smärtrelaterade beteenden uppvisade inga signifikanta skillnader före och efter appliceringen av Capsaicin. Tecken på obehag i samband med applikationen av Capsaicin sågs endast hos enstaka grisar och blott ett fåtal gånger.

De förändringar i ansiktsuttryck hos gris som observerats i samband med smärtinduktion må vara subtila. Vidare krävs utökade studier för att utvärdera en optimal koncentration av Capsaicin i relation till vikt och ålder hos grisarna. Resultaten av denna studie tyder dock på att ett pain face kan identifieras och kanske i framtiden utgöra en alternativ metod för smärtbedömning även hos gris.

3 4

INTRODUCTION

Alike the evolutionary adaptation for survival that the sensation of pain constitutes, the expression of pain – as well as the ability to detect it in others – may be considered equally important (Prkachin, 2009; Williams, 2002). The communication of pain between individuals does not only serve to warn the receiver about potential threats in the surroundings, but may also enable the observer to aid with escape, healing and recovery from the pain (Williams, 2002). The recognition of pain may become problematic, especially when the signs are subtle or well concealed (Bateson, 1991; Weary et al., 2006). Due to survival instincts, prey animals in particular tend not to show such vulnerability for as long as they can possibly disguise it (Williams, 2002; Weary et al., 2006). To perceive pain in these animals, defined and appropriate measures for pain assessment are necessary.

Today, most people would agree upon that the sensation of pain is not exclusively experienced by humans, but by other animal species as well (Bateson, 1991; Weary et al., 2006). Yet in pigs, routine husbandry procedures such as castration and tail docking, known to induce pain, are commonly performed – but the use of apt analgesia is often not sufficient for adequate pain relief (Hay et al., 2003; Kluivers-Poodt et al., 2013; Lonardi et al., 2015;

Prunier et al., 2005; Sutherland et al., 2011). Many pigs suffer from problems such as shoulder ulcers (Dahl-Pedersen et al., 2013; Larsen et al., 2015) and tail biting lesions (D’Eath et al., 2015). Pigs are furthermore commonly used as an experimental animal model for human biomedical research (Simon and Maibach, 2000), which all constitutes additional situations in which the need for proper recognition and alleviation of pain becomes essential.

Human facial expressions have been thoroughly studied (Ekman and Friesen, 1978) and have been applied in clinical medicine to evaluate pain in individuals with limited capacity to verbally communicate with their surroundings (Kunz et al., 2007; Lints-Martindale et al., 2007). In clinical veterinary medicine, the concept of pain face is however rather new (Gleerup et al., 2015; Holden et al., 2014; Keating et al., 2012; Miller et al., 2015).

Previously, within the walls of research labs, facial expressions in for example rats (Sotocinal et al., 2011), mice (Leach et al., 2012) and chimpanzees (Vick et al., 2007) have been considered as a novel tool for pain assessment. In horses (Gleerup et al., 2015), cows (Gleerup et al., 2014) and cats (Holden et al., 2014), studies of facial behavioural changes as a method of clinical pain assessment are quite recent – and the concept of pain face is successively breaking new grounds as an important complementary approach to evaluate pain.

A number of different means to detect and evaluate pain in pigs currently exist, comprising various physiological, physical and behavioural parameters (Hay et al., 2003; Kluivers-Poodt et al., 2013; Lonardi et al., 2015; Marx et al., 2003; Prunier et al., 2005). Problems arise however as these signs might often be predominantly associated with acute or substantial pain (Hay et al., 2003), and may in addition vary depending on the cause and location of the pain (Leach et al., 2012). Many farmers as well as veterinarians agree upon that recognising pain in pigs can be difficult (Ison and Rutherford, 2014; Wilson et al., 2014). As a complement to current pain assessment tools, a method enabling and facilitating the identification of more

–  –  –

Objective The identification of such facial behavioural changes would not only facilitate the assessment of pain in pigs. It would hopefully also emphasize the need for improved pain identification and management in this species.

The purpose of this study was to investigate whether pigs experiencing pain display certain characteristic facial expressions, known in several other mammals as pain face. The aim was to identify and describe these facial expressions as an additional method of pain evaluation in pigs. Furthermore, gross pain behaviour was also analysed.

LITERATURE REVIEW

Pain sensation in animals It is universally acknowledged that the sensation of pain constitutes an evolutionary adaptation central to the survival of an organism, as it enables detection and subsequent behavioural changes and avoidance of noxious stimuli and potentially harmful insults (Williams, 2002). All mammals possess all the neuroanatomical and neuropharmacological requirements enabling them to feel pain (Mathews et al., 2014). The complex mechanisms that the physiology of pain comprises are however not included in the scope of this literature review, but rather the concept of the perception and assessment of it.



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