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W2076842429 abstract "The ability to experience pain is universally shared by all mammals, including companion animals, and as members of the veterinary healthcare team it is our moral and ethical duty to mitigate this suffering to the best of our ability. This begins by evaluating for pain at every patient contact. However, and despite advances in the recognition and treatment of pain, there remains a gap between its occurrence and its successful management; the inability to accurately diagnose pain and limitations in, and/or comfort with, the analgesic modalities available remain root causes. Both would benefit from the development, broad dissemination, and adoption of pain assessment and management guidelines. The World Small Animal Veterinary Association (WSAVA) is an ‘association of associations’ with 91 current members representing over 145,000 small animal veterinarians globally. As such, it is the global voice of the small animal veterinary healthcare team and has a long-standing and successful history of developing global guidelines on the recognition, diagnosis, and/or treatment of common small animal ailments having a global relevance. To date, these have included hepatic, gastrointestinal, and renal diseases; vaccine guidelines; and nutritional recommendations. Standardization efforts are one of the WSAVA's core activities, which also include animal welfare, continuing education, and the World Congress; the pain assessment and management guidelines have unique relevance to all. GPC Vision: An empowered, motivated, and globally unified veterinary profession that effectively recognizes and minimizes pain prevalence and impact. GPC Mission: To raise global awareness and provide a call to action based upon an understanding that all animals are sentient and can therefore feel pain and suffer from it. Through the identification of regionally specific resources for recognizing and treating pain, and targeted education, the Global Pain Council strives to elevate the level of confidence and competence in applying pain treatments. This document is designed to provide the user with easy-to-implement, core fundamentals on the successful recognition and treatment of pain in the day-to-day small animal clinical practice setting. While not intended to be an exhaustive treatise on the subject matter, the text does provide an extensive reference list and there is additional material on the WSAVA website (www.wsava.org) designed to provide resources for those wanting to further their knowledge of this subject matter based on the current literature. There are no geographic limitations to the occurrence of pain, nor to the ability to diagnose it. The only limiting factors are awareness, education, and a commitment to include pain assessment in every physical examination. As such, the pain assessment guidelines herein should be easily implemented regardless of practice setting and/or location. In contrast, there are real regional differences in the availability of the various classes of analgesics, specific analgesic products, and the regulatory environment that governs their use. This represents a significant hurdle to the ideal management of pain in various regions of the world, irrespective of the ability to diagnose. In the treatment section of these guidelines, these issues are taken into account by the provision of ‘tiered’ management guidelines beginning with comprehensive pain management modalities that represent the current ‘state of the art’ followed by alternative protocols that may be considered where regulatory restrictions on analgesic products prevent ideal case management. Owing to space limitations, tiered management cannot be listed for all situations, but the analgesics available can be selected from the recommended management. It should also be recognized that in some situations, whether due to a etiology or available analgesics, euthanasia may be the only moral or ethical (hence viable) treatment option available. Humane methods are presented. Sections are given on the various product and procedure modalities including pharmacology, mechanism of action, indications, contraindications, dosing, and practical clinical notes to help guide the reader in tailoring the therapeutic protocol to the needs of the individual patient. Recognize this document as providing guidelines only, with each situation unique and requiring the individual assessment and therapeutic recommendations that only a licensed veterinarian can provide. There are a number of statements that are the collective opinion of the authors, based on their cumulative experience with pain management gained within their respective fields but not yet evidenced via published data. It is the view of the group that providing this guidance is important in areas where to date there is little published work to underpin clinical pain treatment in dogs and cats. We can't always know that our patient does hurt, but we can do our best to ensure that it doesn't hurt Pain is a complex multi-dimensional experience involving sensory and affective (emotional) components. In other words, ‘pain is not just about how it feels, but how it makes you feel’, and it is those unpleasant feelings that cause the suffering we associate with pain. The official definition of pain by the International Association for the Study of Pain (IASP) is: “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage, or described in terms of such damage”.1 Pain is a uniquely individual experience in humans and animals, which makes it hard to appreciate how individuals feel. In non-verbal patients, including animals, we use behavioural signs and knowledge of likely causes of pain to guide its management. The conscious experience of pain defies precise anatomical, physiological and or pharmacological definition; furthermore, it is a subjective emotion that can be experienced even in the absence of obvious external noxious stimulation, and which can be modified by behavioural experiences including fear, memory and stress. At its simplest, pain is classified as either acute or chronic. The distinction between acute and chronic pain is not clear, although traditionally an arbitrary interval of time from onset of pain has been used – e.g. pain of more than 3 months’ duration can be considered to be chronic. Acute pain is generally associated with tissue damage or the threat of this and serves the vital purpose of rapidly altering the animal's behaviour in order to avoid or minimize damage, and to optimize the conditions in which healing can take place, stopping when healing is complete. Acute pain varies in its severity from mild-to-moderate to severe-to-excruciating. It is evoked by a specific disease or injury; it serves a biological purpose during healing and it is self-limiting. Examples of acute pain include that associated with a cut/wound, elective surgical procedures, or acute onset disease e.g. acute pancreatitis. In contrast, chronic pain persists beyond the expected course of an acute disease process, has no biological purpose and no clear end-point and in people, as well as having an effect on physical wellbeing, it can have a significant impact upon the psychology of the sufferer. Chronic pain is generally described in human medicine as pain that persists beyond the normal time of healing, or as persistent pain caused by conditions where healing has not occurred or which remit and then recur. Thus acute and chronic pain are different clinical entities, and chronic pain may be considered as a disease state. The therapeutic approaches to pain management should reflect these different profiles. The therapy of acute pain is aimed at treating the underlying cause and interrupting the nociceptive signals at a range of levels throughout the nervous system, while treatment approaches to chronic pain must rely on a multidisciplinary approach and holistic management of the patient's quality of life. Many dogs and cats suffer from long-term chronic disease and illness which are accompanied by chronic pain. During the lifetime of the animal acute exacerbations of the pain may occur (breakthrough pain), or new sources of acute pain may occur independently which may impact on the management of the underlying chronic pain state (‘acute on chronic pain’). For these animals aggressive pain management is required to restore the animal's comfort. Pain is a subjective emotion, which can be experienced even in the absence of obvious external noxious stimulation, and which can be enhanced or abolished by a wide range of behavioural experiences including fear and memory. Adaptive ‘physiological’ pain announces the presence of a potentially harmful stimulus and thus has an essential protective function. In contrast, maladaptive pain represents malfunction of neurological transmission and serves no physiological purpose, leading to chronic syndromes in which pain itself may become the primary disease. Conscious perception of pain represents the final product of a complex neurological information-processing system, resulting from the interplay of facilitatory and inhibitory pathways throughout the periphery and central nervous systems. Several distinct types of pain exist, classified as nociceptive, inflammatory and neuropathic.2 Cancer pain often displays characteristics of both inflammatory and neuropathic pain. The conscious experience of acute pain resulting from a noxious stimulus is mediated by a high-threshold nociceptive sensory system. The basic neuroanatomy of this system is reviewed elsewhere.3 Nociceptors represent the free endings of primary sensory neurons, with their cell bodies located in the dorsal root and trigeminal ganglia. The primary afferent nerve fibres which carry information from these free nerve endings to their central location consist of two main types: unmyelinated C-fibres and myelinated A-delta fibres. Following tissue trauma, changes in the properties of nociceptors occur such that large-diameter Aβ fibres, normally not associated with nociception, may also transmit ‘pain information’. Unmyelinated C-fibres are activated by intense mechanical, chemical and thermal stimuli contributing to the ‘slow burn’ sensation of pain. The Aγ fibres conduct impulses more quickly and contribute to the rapid ‘stab’ of the acute pain response and function primarily as a warning, is protective, resulting in rapid withdrawal from the stimulus. Delay of withdrawal results in C-fibre activation, the intensity of which is dependent on injury. There is also a population of so-called ‘silent’ nociceptors, which may become active during inflammation or tissue damage such as occurs in inflammatory bowel disease and cystitis, for example. Primary afferent fibres carrying sensory information from nociceptors synapse in the dorsal horn of the spinal cord. The fibres of ‘nociceptive’ responsive cells of the spinal cord project to various higher centres involved in pain transmission, both ipsilaterally and contralaterally to their site of origin. Several spinal-brainstem-spinal pathways are activated simultaneously when a noxious stimulus occurs, providing widespread positive and negative feedback loops by which information relating to noxious stimulation can be amplified or diminished (descending inhibitory pathways). The cerebral cortex is the seat of conscious experience of pain. The cerebral cortex exerts top-down control and can modulate the sensation of pain. Central pain associated with a cortical or subcortical lesion can result in severe pain, which is not associated with any detectable pathology in the body. Pain is considered to consist of three key components: a sensory-discriminatory component (temporal, spatial, thermal/mechanical), an affective component (subjective and emotional, describing associated fear, tension and autonomic responses), and an evaluative component, describing the magnitude of the quality (e.g. stabbing/ pounding; mild/severe). Undoubtedly, an animal's pain experience is similarly composed, although our tendency is to focus on pain intensity alone. The nociceptive sensory system is an inherently plastic system and when tissue injury or inflammation occurs, the sensitivity of an injured region is enhanced so that both noxious and normally innocuous stimuli are perceived as painful. The clinical hallmarks of sensitization of the nociceptive system are hyperalgesia and allodynia. Hyperalgesia is an exaggerated and prolonged response to a noxious stimulus, while allodynia is a pain response to a low-intensity, normally innocuous stimulus such as light touch to the skin or gentle pressure. Hyperalgesia and allodynia are a consequence of peripheral and central sensitization. Peripheral sensitization is the result of changes in the environment bathing nociceptor terminals as a result of tissue injury or inflammation. Chemical mediators are released by damaged cells which either directly activate nociceptors, or sensitize the nerve terminals. This results in long-lasting changes in the functional properties of peripheral nociceptors. Trauma and inflammation can also sensitize nociceptor transmission in the spinal cord to produce central sensitization. This requires a brief but intense period of nociceptor stimulation (e.g. a surgical incision, intense input following tissue trauma, or following nerve injury). As a result, the response threshold of the central neurons falls, their responses to subsequent stimulation are amplified and their receptive fields enlarge to recruit additional previously ‘sleeping’ afferent fibres into nociceptive transmission. Inflammatory pain is usually responsible for acute postoperative pain, until the wound has healed. It has a rapid onset and, in general, its intensity and duration are related directly to the severity and duration of tissue damage. The changes in the nociceptive system are generally reversible and normal sensitivity of the system should be restored as tissue heals. However, if the noxious insult was severe, or if a focus of ongoing inflammation persists, then pain will persist as is the case in dogs with chronic inflammatory diseases such as arthritis, otitis, gingivitis, dermatitis and back pain. Neuropathic pain is defined as pain caused or initiated by a primary lesion, injury or dysfunction in the peripheral nervous system or central nervous system. There follows a plethora of changes in the peripheral nervous system, spinal cord, brainstem and brain as damaged nerves fire spontaneously and develop hyper-responsivity to both inflammatory and normally innocuous stimuli.4 In humans, neuropathic pain is commonly manifested in, for example, post-amputation phantom limb pain and post-herpetic neuropathy; furthermore, it has been suggested that neuropathic pain is the major cause of long-term post surgical pain in humans.5 It is surprising, therefore, that neuropathic pain is not described in animals more commonly; however, this may be due to lack of awareness of the potential for neuropathic pain and its recognition. Prevention of neuropathic pain is frequently accomplished by appropriate selection and duration of administration of analgesic(s). Post-surgical pain: persistent pain after surgery remains a problem in humans, particularly following major surgery, with a minority of these patients experiencing severe chronic pain, often neuropathic in nature. The risk of persistent post-surgical pain in dogs and cats has not been quantified; however, it is likely to occur. Veterinarians should be aware of the potential for chronic pain to exist. Breakthrough pain (BTP) may occur with all painful conditions (e.g. arthritis). It is defined as an abrupt, short-lived, and intense pain that ‘breaks through’ the analgesia that controls pain. The analgesic protocol should be re-assessed by careful examination and observation to ensure there is no new underlying problem causing pain. Veterinarians may be unaware of the occurrence of BTP in patients with persistent pain unless specific questions are asked of the client. Chronic pain: there is no direct link between the duration or intensity of injury which transforms acute transient pain into chronic pain. However, as with neuropathic pain, appropriate management of acute pain is essential to prevent establishment of chronic pain. As noted, the pain information processing systems display plasticity, driven by peripheral and central sensitization. This plasticity can be reversible, as is commonly the case in acute inflammatory pain; or it can be long-lasting which is associated with changes expressed in the phenotype of the nociceptive cells and their expression of proteins involved in pain processing. Acute pain is the result of a traumatic, surgical, medical or infectious event that begins abruptly and should be relatively brief. This pain can usually be alleviated by the correct choice of analgesic drugs, most commonly opioids and non-steroidal anti-inflammatory drugs (NSAIDs). For successful relief of pain, one must first look for it and recognize it. It is recommended that assessment of pain is incorporated into Temperature, Pulse and Respiration (TPR) examinations, making pain the 4th vital sign we monitor. Cats that have been injured or undergone surgery should be monitored closely and pain must be treated promptly to prevent it from escalating. Treatment must be continued until the acute inflammatory response abates. The degree of trauma dictates the intensity and duration of the inflammatory response but treatment may be required for several days. Feral cats require preemptive administration of analgesics based on the severity of the proposed surgical procedure rather than based on their behaviour; in addition, interactive pain assessment is not possible in this population.6 Neuroendocrine assays measuring β-endorphin, catecholamines and cortisol concentrations in plasma have been correlated with acute pain in cats; however, these are also influenced by other factors such as anxiety, stress, fear and drugs.7 Objective measurements such as heart rate, pupil size and respiratory rate have not been consistently correlated with signs of pain in cats – therefore we depend on subjective evaluation based on behaviour.8 A multidimensional composite pain scale (UNESP-Botucatu) for assessing postoperative pain in cats has been validated and can be applied in the clinical setting as a useful tool.8a Take into consideration the type, anatomical location and duration of surgery, the environment, individual variation, age, and health status. The cat should be observed from a distance then, if possible, the caregiver should interact with the cat and palpate the painful area to fully assess the cat's pain. A good knowledge of the cat's normal behaviour is very helpful as changes in behaviour (absence of normal behaviours such as grooming and climbing into the litter box) and presence of new behaviours (a previously friendly cat becoming aggressive, hiding or trying to escape) may provide helpful clues. Some cats may not display clear overt behaviour indicative of pain, especially in the presence of human beings, other animals or in stressful situations. Cats should not be awakened to check their pain status; rest and sleep are good signs of comfort but one should ensure the cat is resting or sleeping in a normal posture (relaxed, curled up). In some cases cats will remain very still because they are afraid or it is too painful to move, and some cats feign sleep when stressed.9 Facial expressions and postures: these can be altered in cats experiencing pain: furrowed brow, orbital squeezing (squinted eyes) and a hanging head (head down) can be indicators of pain. Following abdominal surgery a hunched position and/or a tense abdomen is indicative of pain. Abnormal gait or shifting of weight and sitting or lying in abnormal positions may reflect discomfort and protection of an injured area. Comfortable cats should display normal facial expressions, postures and movement after successful analgesic therapy. Figure 1 provides examples of normal postures and facial expressions and those that may be indicative of pain. Behavioural changes associated with acute pain in cats: reduced activity, loss of appetite, quietness, hiding, hissing and growling (vocalization), excessive licking of a specific area of the body (usually involving surgical wounds), guarding behaviour, cessation of grooming, tail flicking and aggression may be observed. Cats in severe pain are usually depressed, immobile and silent. They will appear tense and distant from their environment.10 Dysphoria versus pain: thrashing, restlessness and continuous activity can be signs of severe pain in cats. However, these can also be related to dysphoria. Dysphoria is usually restricted to the early postoperative period (20–30 min) and/or associated with poor anaesthetic recoveries after inhalant anaesthesia and/or ketamine administration and/or after high doses of opioids. Hyperthermia associated with the administration of hydromorphone and some other opioids may lead to anxiety and signs of agitation in cats. Acute pain occurs commonly in dogs as a result of a trauma, surgery, medical problems, infections or inflammatory disease. The severity of pain can range from very mild to very severe. The duration of pain can be expected to be from a few hours to several days. It is generally well managed by the use of analgesic drugs. The effective management of pain relies on the ability of the veterinarian, animal health technician and veterinary nurse to recognize pain, and assess and measure it in a reliable manner. When the dog is discharged home, owners should be given guidance on signs of pain and how to treat it. Objective measurements including heart rate, arterial blood pressure and plasma cortisol and catecholamine levels have been associated with acute pain in dogs;11 however, they are unreliable as stress, fear and anaesthetic drugs affect them. Thus, evaluation of pain in dogs is primarily subjective and based on behavioural signs. Behavioural expression of pain is species-specific and is influenced by age, breed, individual temperament and the presence of additional stressors such as anxiety or fear. Debilitating disease can dramatically reduce the range of behavioural indicators of pain that the animal would normally show e.g. dogs may not vocalize and may be reluctant to move to prevent worsening pain. Therefore, when assessing a dog for pain a range of factors should be considered, including the type, anatomical location and duration of surgery, the medical problem, or extent of injury. It is helpful to know the dog's normal behaviour; however, this is not always practical and strangers, other dogs, and many analgesic and other drugs (e.g. sedatives) may inhibit the dog's normal behavioural repertoire. Where a dog is judged to be in pain, treatment should be given immediately to provide relief. Dogs should be assessed continuously to ensure that treatment has been effective, and thereafter on a 2–4 hourly basis. Pain measurement tools: these should possess the key properties of validity, reliability and sensitivity to change. Pain is an abstract construct so there is no gold standard for measurement and as the goal is to measure the affective component of pain (i.e. how it makes the dog feel), this is a real challenge. This is further compounded by the use of an observer to rate the dog's pain. Few of the scales available for use in dogs have been fully validated. Simple uni-dimensional scales, including the Numerical Rating Scale (NRS), the Visual Analogue Scale (VAS) and the Simple Descriptive Scale (SDS) (Figure 5), have been used.12, 13 These scales require the user to record a subjective score for pain intensity. When using these scales, the observer's judgment can be affected by factors such as age, gender, personal health and clinical experience, thus introducing a degree of inter-observer variability and limiting the reliability of the scale. However, when used consistently, these are effective as part of a protocol to evaluate pain as described above. Of the three types of scales described (and there are others in this category), the NRS (0 to 10) is recommended for use due to its enhanced sensitivity over the SDS and increased reliability over the VAS. Composite scales include the Glasgow Composite Measure Pain Scale and its short form (CMPS-SF),14, 15 and the French Association for Animal Anaesthesia and Analgesia pain scoring system, the 4A-Vet.15 The CMPS-SF, validated for use in measuring acute pain, is a clinical decision-making tool when used in conjunction with clinical judgement. Intervention level scores have been described (i.e. the score at which analgesia should be administered), thus it can be used to indicate the need for analgesic treatment. The instrument is available to download online.16 The 4A-Vet, which is also available online,17 is available for use in cats and dogs, although evidence for its validity and reliability have not yet been demonstrated. The Colorado State University (CSU) acute pain scale for the dog18 combines aspects of the numerical rating scale along with composite behavioural observation, and it has been shown to increase awareness of behavioural changes associated with pain. The University of Melbourne Pain Scale combines physiologic data and behavioural responses.19 Japanese Society of Study for Animal Pain (JSSAP) Canine Acute Pain Scale (written in Japanese) is a numerical rating scale combined with behavioural observation and can be downloaded from the website.20 All of the composite scales above are easy to use and include interactive components and behavioural categories. Chronic pain is of long duration, and is commonly associated with chronic diseases e.g. degenerative joint disease (DJD), stomatitis and intervertebral disk disease. It may also be present in the absence of ongoing clinical disease, persisting beyond the expected course of an acute disease process – such as neuropathic pain following onychectomy, limb or tail amputation. As cats live longer there has been an increased recognition of chronic pain associated with certain conditions, which has a negative impact on quality of life (QoL). In recent years, treatment options for some cancers in companion animals have become a viable alternative to euthanasia, and managing chronic pain and the impact of aggressive treatment protocols has become a challenging and important welfare issue. Pain recognition is the keystone of effective pain measurement and management. The behavioural changes associated with chronic pain may develop gradually and may be subtle, making them most easily detected by someone very familiar with the animal (usually the owner). Each of these should be assessed and ‘scored’ in some manner (e.g. using either a descriptive, numerical rating or visual analogue scale). Re-evaluation over time will help determine the impact of pain, and the extent of pain relief. Chronic pain is of long duration and is commonly associated with chronic diseases. It may also be present in the absence of ongoing clinical disease, persisting beyond the expected course of an acute disease process. As dogs live longer there has been an increase in the incidence of painful chronic conditions such as osteoarthritis (OA) and in recent years the treatment of cancer in companion animals has become a viable alternative to euthanasia. For many chronic conditions, chronic pain is a challenge as is the impact of aggressive treatment protocols. Treatment options for chronic pain are complex, and response to treatment is subject to much individual variation. Accordingly the veterinarian must monitor health status effectively on an ongoing basis in order to tailor treatment to the individual. Owner assessments are the mainstay of the assessment of chronic pain in dogs. Functional assessment, QoL and HRQoL tools have been developed and used.32, 33 QoL measures used in veterinary medicine vary from simple scales tied to certain descriptors of behaviours34 to broad, unconstrained assessments.35-37 Questionnaires have been developed to assess HRQoL in dogs with DJD, cardiac disease,38 cancer,39, 40 chronic pain,41, 42 spinal cord injuries43, 44 and atopic dermatitis,45 while some are less specific.46, 47 Several instruments focused mainly on functional assessment (Clinical Metrology Instruments, CMIs) have been developed for canine OA and have undergone a variable degree of validation.13, 35, 48-52 Such questionnaires typically include a semi-objective rating of disease parameters such as ‘lameness’ and ‘pain’ on either a discontinuous ordinal scale or a visual analogue scale. GUVQuest is an owner-based questionnaire developed using psychometric principles for assessing the impact of chronic pain on the HRQoL of dogs, and is validated in dogs with chronic joint disease and cancer. The Canine Brief Pain Inventory (CBPI) has been used to evaluate improvements in pain scores in dogs with OA and in dogs with osteosarcoma. The Helsinki Chronic Pain Index (HCPI) is also an owner-based questionnaire and has been used for assessing chronic pain in dogs with OA and, along with the CBPI, has been evaluated for content validity, reliability48, 51 and responsiveness.35, 51 The CMI from Texas A&M13 has been investigated for validity and reliability but not responsiveness. The Liverpool Osteoarthritis in Dogs (‘LOAD’) CMI has been validated in dogs with chronic elbow OA, and has been shown to be reliable with satisfactory responsiveness.49 Recently, its validity for both forelimb and hind limb OA was demonstratred.54 The JSSAP Canine Chronic Pain Index is an owner-based questionnaire written in Japanese and has been used for assessing chronic pain in dogs with OA. Such a complete assessment will involve input from both the veterinarian (physical and or" @default.
W2076842429 created "2016-06-24" @default.
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W2076842429 date "2014-05-20" @default.
W2076842429 modified "2023-10-01" @default.
W2076842429 title "Guidelines for Recognition, Assessment and Treatment of Pain" @default.
W2076842429 cites W1550740201 @default.
W2076842429 cites W1558874724 @default.
W2076842429 cites W1582633699 @default.
W2076842429 cites W1606439636 @default.
W2076842429 cites W1697061755 @default.
W2076842429 cites W1735709815 @default.
W2076842429 cites W1800259478 @default.
W2076842429 cites W1900231133 @default.
W2076842429 cites W1908210847 @default.
W2076842429 cites W1922941678 @default.
W2076842429 cites W1964980514 @default.
W2076842429 cites W1965621046 @default.
W2076842429 cites W1966704176 @default.
W2076842429 cites W1967897673 @default.
W2076842429 cites W1968507153 @default.
W2076842429 cites W1968508035 @default.
W2076842429 cites W1969501102 @default.
W2076842429 cites W1969516655 @default.
W2076842429 cites W1974109971 @default.
W2076842429 cites W1974198316 @default.
W2076842429 cites W1974465921 @default.
W2076842429 cites W1976278484 @default.
W2076842429 cites W1980088747 @default.
W2076842429 cites W1980162693 @default.
W2076842429 cites W1980307139 @default.
W2076842429 cites W1983475367 @default.
W2076842429 cites W1984832858 @default.
W2076842429 cites W1984851051 @default.
W2076842429 cites W1986456314 @default.
W2076842429 cites W1988710182 @default.
W2076842429 cites W1992147388 @default.
W2076842429 cites W1992193149 @default.
W2076842429 cites W1992900074 @default.
W2076842429 cites W1994600407 @default.
W2076842429 cites W1996583516 @default.
W2076842429 cites W1997971171 @default.
W2076842429 cites W1998454663 @default.
W2076842429 cites W1998502272 @default.
W2076842429 cites W2000788663 @default.
W2076842429 cites W2001722529 @default.
W2076842429 cites W2002242922 @default.
W2076842429 cites W2002246573 @default.
W2076842429 cites W2002855917 @default.
W2076842429 cites W2006863089 @default.
W2076842429 cites W2007532055 @default.
W2076842429 cites W2007687040 @default.
W2076842429 cites W2010277538 @default.
W2076842429 cites W2010488693 @default.
W2076842429 cites W2010544365 @default.
W2076842429 cites W2012180729 @default.
W2076842429 cites W2014466088 @default.
W2076842429 cites W2015275612 @default.
W2076842429 cites W2015572891 @default.
W2076842429 cites W2017256180 @default.
W2076842429 cites W2017785434 @default.
W2076842429 cites W2018754594 @default.
W2076842429 cites W2020127826 @default.
W2076842429 cites W2020764350 @default.
W2076842429 cites W2024962838 @default.
W2076842429 cites W2026703924 @default.
W2076842429 cites W2027321325 @default.
W2076842429 cites W2028197152 @default.
W2076842429 cites W2030959945 @default.
W2076842429 cites W2031226699 @default.
W2076842429 cites W2032719298 @default.
W2076842429 cites W2032788861 @default.
W2076842429 cites W2034946412 @default.
W2076842429 cites W2035792676 @default.
W2076842429 cites W2037924530 @default.
W2076842429 cites W2039184914 @default.
W2076842429 cites W2040032687 @default.
W2076842429 cites W2040037808 @default.
W2076842429 cites W2040539969 @default.
W2076842429 cites W2041420488 @default.
W2076842429 cites W2043755202 @default.
W2076842429 cites W2044108785 @default.
W2076842429 cites W2045259604 @default.
W2076842429 cites W2051391374 @default.
W2076842429 cites W2051599946 @default.
W2076842429 cites W2052232949 @default.
W2076842429 cites W2052655619 @default.
W2076842429 cites W2052840755 @default.
W2076842429 cites W2053710854 @default.
W2076842429 cites W2054272463 @default.
W2076842429 cites W2054387906 @default.