SP Greaney, a cat owner for over 20 years, has given homes to stray cats and
kittens. She has been around all types of cats.
This article explains the many types of pain scales used to assess acute pain
in cats and helps you learn how to use them yourself.
Max Baskakov, CC BY SA, via Unsplash.com
What Is an Acute Pain Scale?
There are a number of acute pain scales that can be used to access if your cat
is in pain as well as analyzing the severity of pain that it might be
experiencing. A pain scale is a tool that a veterinarian uses to help them
recognize if an animal is in pain. Some of these pain scales were not
developed for cats, but they are used to assess pain in them as well as other
types of animals.
Some of these scales are one-dimensional and are used to assess if the cat has
pain. The new pain scale models look at different features on the cat’s face
and analyze the cat’s behavior and its actions to assess the level of pain.
These newer models also assess the behavior of the cat prior to its assessment
and post its assessment. They also rely on more interaction as well as
observation of the cat during the period of assessment.
One-Dimensional
These types of scales are used to assess the level of pain that the cat is
experiencing at the present time. None of these scales have been validated.
They require the veterinary personnel to use their knowledge and experiences
to assist in their assessment.
- Numerical Rating Scale
- Descriptive Scale
- Visual Analogue Scale (VAS)
- Dynamic Interactive Visual Analogue Scale (DIVAS)
Multi-Dimensional
These new scales rely on more interaction as well as observation and palpation
of the cat’s wound to come to a diagnosis when assessing a cat to determine
the severity of pain that it is in.
- The UNESP-Botucatu Multidimensional Composite Pain Scale
- Glasgow Composite Measure Pain Scale – Feline
Both of these scales are validated according to American Animal Hospital
Association and are able to be used in practices.
Additional Acute Pain Scale
- Feline Acute Pain Scale (FAPS)
Training Scale Used for Acute Pain
- Colorado State University Canine Acute Pain Scale
The Numerical rating scale assigns numbers to identify the level of pain the
cat is experiencing.
1. The Numerical Rating Scale
The numerical rating scale works by using numbers to assess the levels of pain
the cat is in. Some of these scales might have a threshold that assigns
numbers into groups to determine the severity of the pain. These scales could
be designed with a pain rating scale from between 1 to 5 or 1 to 10. This is a
very basic pain scale which is simple and easy to use.
For instance, if the cat was assessed and its pain levels fell within the pain
level between of 0-5 range instead of the 6-10 range, then it could mean that
the cat is experiencing mild pain. If the pain level fell within the 6-10
range then the level of pain that the cat is experiencing is very strong and
could be severe. In this instance, the cat would need to be administered some
form of painkillers.
It will be the veterinary personnel who will assess the cat to determine if
they are in pain.
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Diagram of a simple descriptive scale used for feline pain management.
2. Descriptive Scale
This is another scale that is used to assess pain levels in cats and other
animals. It will help guide the veterinary personnel in determining how much
pain the cat is in at that moment in time. If the pain is mild, then it will
fall into category zero. But if the pain is severe, it will be assessed as
five.
However, this scale does not take into account the cat’s behavior or its
actions at any point during the assessment. Sometimes pain can start off mild
but as time progresses, it can become very severe. When using this pain scale
any slight changes in the cat’s behavior could be missed as pain symptoms can
increase or decrease over a period of hours.
Using a number to assess a pain level is very simple and easy and it does help
to some degree. However, it does not take account of any other actions of the
cat over a period of time.
Pain Scale Measurement
- 0 means no pain
- 1 means the level of pain is medium
- 2 means the level of pain is moderate
- 3 means the level of pain is very severe
Visual Analogue Scale can be numerical or non-numeric. It is a straight line
that can be numbered from 1 -5 or 1-10 and with the higher number determining
the intensity of the cat’s pain.
3. Visual Analogue Scale (VAS)
The visual analogue scale was initially used to identify pain in humans and
over a period of time, it was adapted to help in assessing the pain in
animals. This scale is used to assess acute and chronic pain in felines .
In this pain scale the veterinary personnel observe the cat to identify the
intensity of the pain.
However, it has been reported that observation alone will only help the user
to identify if the cat is in pain. It won’t help in determining the cause or
the severity of the pain. However, if the person using the visual analogue
scale has experience and knowledge on how to accurately use the scale, then
most often their assessment can be accurate. It is only a problem when it is
used incorrectly by an inexperienced individual where error can occur.
The visual analogue scale is also a scale that is simple enough for any cat
owner to understand and it can easily help them to identify if their cat is
currently in some form of pain which will prompt them to bring it to the
veterinarian.
The Dynamic Interactive Visual Analogue Scale uses observation along with a
physical assessment when assessing a cat for pain.
4. Dynamic Interactive Visual Analogue Scale (DIVAS)
This scale is similar to the visual analogue scale but it differs in the sense
that it analysis actions prior to the cat’s assessment and after it has been
assessed.
On this scale, the veterinary personnel first observe the cat’s behavior, and
then they approach it to assess it. The area of pain/wound is palpitated to
investigate the reason for the pain and this type of physical exam will help
them to determine what might be causing the cat’s pain. Finally, the
veterinary personnel will attempt to get the cat to walk to complete the final
part of the examination.
This scale is considered better than the VAS pain scale because it does not
rely on observation alone but also an examination which will greatly improve
the user’s ability to identify the cause of the cat’s pain.
The UNESP-Botucatu Multidimensional Composite Pain Scale questionaire.
Multidimensional Scale One: The UNESP-Botucatu Multidimensional Composite
Pain Scale for Cats
The UNESP-Botucatu multidimensional composite pain scale is validated and it
is used to assess postoperative pain in cats. It originated in Brazil and has
been translated into different languages like French, Italian, English and
Spanish.
The pain scale is used to assess the pain in cats undergoing
ovariohysterectomy i.e. spaying, but research is ongoing to see if it could
also be used to assess pain in instances where there is trauma, surgical
procedures or medical issues.
It relies on assessing the intensity of the pain along with how unpleasant or
affected the animal is impacted by the pain. There are three different areas
that encompass different variables that are used to assess the pain in the
animal.
1. Pain Expression
- Reaction to palpation of the surgical wound, flank and abdomen
- Vocalization – level of meowing or growling
- Other behavior like the swishing of its tail and the squinting of its eyes
2. Psychomotor Change
- Change in its posture
- Its level of comfort
- Its overall attitude
- Its level of activity
3. Physiological Variables
- Does it have an appetite?
- Does it have high or low blood pressure?
Scoring the Pain
The scale works by assessing the level of pain
- No pain: 0
- Mild pain: 1 to 8
- Moderate pain: 9 to 21
- Severe pain: 22 to 30
Result
Sometimes the blood pressure of the cat is not included in calculating the
overall score. This would then mean that when the cat was assessed, they
scored out of 27. If the score comes to 6 out of 27, then pain medication is
administered.
If the blood pressure of the cat was assessed and contributed to the overall
pain score, then when the total score comes to 7 out of 30, pain medication
would be administered.
Multidimensional Scale Two: Glasgow Composite Measure Pain Scale – Feline
Another scale that is used by veterinarians is the Glasgow Composite Measure
Pain Scale – Feline. This scale was developed by the University of Glasgow in
2008 and is a scale that has been acknowledged as a reliable tool that
evaluates the behavior of cats in pain. This scale can also be used to assess
other kinds of acute pain associated with medical, surgical or trauma. It is
also easier to use compared to the UNESP-Botucatu Multidimensional Composite
Pain Scale
This scale is used by veterinary personnel to assess the level of pain that
the cat is in. This assessment tool is similar to a questionnaire that lists
behavioral and physical symptoms that will help guide the observer to
determine how much pain the cat is in.
Some categories can have 4 symptoms while others could have 5 or 6. Each
reaction is then given a score and once the assessment is completed the score
is calculated.
Each symptom will be rated a score from 0 to 4 depending on how many
behavioral or physical symptoms are outlined under each question.
This scale requires the cat to be observed and assessed over a number of
hours. Following this assessment, they can then correlate this information to
assess the behavior of the cat when it is in pain against its behavior after
it has been administered pain medication.
Result
If the overall score from all the categories is more than 20 then pain
medication should be administered. If the score totals 20 then the pain level
is not as easy to assess.
If the issue with the cat is non-ambulatory which means the cat cannot walk
without assistance, then in this instance the cat would be treated as if the
result was 5 out of 20.
Glasgow Composite Measure Pain Scale – Feline is a tool used to assess the
pain level a cat is feeling.
How the Glasgow Composite Measure Pain Scale – Feline Works
This scale can look at six to seven different behavioral categories and the
cat is assessed according to how it reacts in each category. This scale also
identifies a level, where at a certain score additional pain medication needs
to be administered to the cat.
There could be a number of reactions listed under each heading and each
reaction is given a score from 0 to 5 depending on the number listed under
that category.
- Vocalization
- Activity / Posture
- Attention to wound
- Response to people
- Response to touch
- Demeanor
- Facial expression
Symptoms and Scoring in Glasgow Composite Pain Scale
Vocalization
When a cat is healthy it will meow and purr. However, cats who are sick or in
pain may start growling at their owner or crying in pain if the area that is
painful is touched.
- Score 0: Silent / purring / meowing
- Score 1: Crying / growling / groaning
Activity / Posture
The way that a cat sits or stands can be a big indicator in determining if
your cat is in pain. If a cat crouches or tries to sink into the floor it can
be a sign that they don’t want to be touched or approached.
- Score 0: Relaxed
- Score 1: Licking lips
- Score 2: Restless / scared
- Score 3: Tense—head down or ears flat
- Score 4: Rigid
Attention to Wound
If a cat has a wound it will often lick around that area. But if they behave
as if nothing is wrong or they take no notice of that wound, then it might not
be as serious as you suspect.
- Score 0: Ignoring the wound
- Score 1: Attention to wound
Response to people
Every cat can behave differently when in pain. If your cat is conscience
enough to recognizes you, then often your presence can be a comfort to them.
However, some cats that are in pain or those that are frightened can start
hissing, growling and spiting even at their owner because of their pain.
- Score 0: Do nothing
- Score 1: Swish tail / flatten ears
- Score 2: Cry / hiss
- Score 3: Growl
- Score 4: Bite / attack
Response to Touch
Some cats can be very placid and be extremely calm about been examined.
However, if a cat is experiencing a high level of pain, two things can happen.
It can become either aggressive or fearful and be very hesitant around people.
Or the opposite can occur and the cat might simple shut down and become very
unresponsive and withdrawn.
- Score 0: Fine with being stroked
- Score 1: Unresponsive
- Score 2: Aggressive
Demeanor
A fearful cat will behave differently to a happy cat. A quiet cat won’t engage
with you where a happy cat will. Even from just viewing your cat from a
distance, you can gauge how it feels. A happy cat that is not in too much pain
will be alert and looking around. A fearful cat will be withdrawn and hiding
in the back of its cat carrier or cage.
- Score 0: Happy
- Score 1: Quiet
- Score 2: Fearful
- Score 3: Dull
- Score 4: Grumpy
Facial Expression
In this pain scale, the position of the cat’s ears and the muzzle is an
important part of the assessment. If a cat is in pain then it will lower its
ears and its muzzle. A cat that is experiencing mild pain might not lower its
ears or its muzzle and so their pain could be identified then as extremely
mild.
Ears
- Score 0: Normal
- Score 1: Wide
- Score 2: Flat
Muzzle
- Score 0: Normal
- Score 1: Wide
- Score 2: Flattened
Additional Acute Pain Scale: Feline Grimace Scale (FGS)
This is a scale that was invented to help veterinary professionals develop a
better understanding of how to access what type of pain the cat is
experiencing.
The scale along with observation as well as interaction with the cat can help
the veterinarian determine how much pain the cat is in.
This scale was developed by professors of veterinary anaesthesia and analgesia
at The University of Montreal.
The Feline Grimace Scale is an additional tool that veterinary personnel use
to help them gauge how much pain a cat is in.
How Does the Feline Grimace Scale Work?
The veterinary personnel analyses the cat’s facial features to determine how
much pain the cat is in. It looks at these areas.
- ear position
- orbital tightening
- muzzle tension
- whiskers position
- head position
Each feature is then rated and given a score between 0 and 2.
- 0 means that there is no pain
- 1 means the pain is moderate
- 2 means that pain is present
Result
A drug for pain is then administered if the overall score of these five
features comes in at 4 out of 10.
How the Feline Grimace Scale Accesses Pain in Cats
Scale Level – 0
- In this score, your cat should be relaxed and engaging and their face should look relaxed.
- You might notice that your cat is also very alert and has its face and ears facing forward so that it can listen and see everything that is happening around it.
- Their whiskers should also be relaxed and stretched out as normal.
- Your cat will basically be acting like a nosey inquisitive cat that wants to know where it is and what you are doing.
Scale Level 1
- In this score, your cat’s eyes might be partially squinted.
- Their head will be slightly droopy and it will be level with their shoulders.
- You might notice a large space between the cat’s ears that is as wide as three or four of your fingers close together. Now if your cat has a big head, then this part of the assessment won’t apply.
- But again as in 0, their ears will still be slightly facing forward close to their eyes.
- Their whiskers might be slightly curved down towards their feet.
Scale Level – 2
- In this score, your cat will be full-on squinting and will be unable to fully keep its eyes focused.
- Its head will drop down towards its chest.
- Its ears will be facing out to the left and right sides.
- Its whiskers will most likely be facing down towards the floor.
Training Scale: The Colorado State University Canine Acute Pain Scale
The Colorado State University (CSU) acute pain scale is not validated but is
used in veterinarian colleges as a tool to help teach students how to
recognize pain in animals.
It has been shown to be a useful tool that helps new veterinary students
understand and recognize the signs and changes in an animal’s behavior because
of pain. It uses aspects of the numerical rating scale with composite
behavioral observation to identify pain in animals.
It’s also a very easy scale to use, and it gives the students a better
understanding of how to apply what they are learning in their college into a
clinical setting with a live animal.
However, another scale that they have designed especially for cats, The
Colorado State University Feline Acute Pain Scale was identified as not been a
valid pain scale tool that could be used in clinical settings to help students
identify pain specifically in felines.
An experiment was carried out to determine its validity and unfortunately, it
was found to not meet the guidelines required to be used in general practices.
Choosing a Pain Scale
Each pain scale is slightly different in how it works. The newer ones are more
in-depth and assess every aspect of the cat’s face, its body language, its
outward behavior and its appearance during and after examination while others
rely more on a physical exam as well as continued observation to determine the
pain level.
Each pain scale does a good job of assisting in identifying the level of pain
it is that the cat is experiencing. It’s also important that one scale is used
when assessing the level of pain. Using different types of pain scales at one
time can give an inaccurate reading.
It is also important that the scale is reliable and that everybody who uses it
gets the same results when assessing the cat for pain. It also needs to be
able to recognize that giving any pain medication will result in a change in
pain levels.
Cat owners can use the scales as a base to determine if there is something
wrong with their cat but it is only qualified and experienced veterinarian
personal who will know how to accurately use them.
Every veterinarian practice will have chosen a pain scale that they feel is
the best one for their practice. They will also have more knowledge and
experience in assessing cats and determining the type and level of pain that
they are in.
Sources
- Visual Analogue Scale (2003), Science Direct, Measurement and Valuation of Health for Economic Evaluation
- Pain: a review of three commonly used pain rating scales,(2005), Amelia Williamson MSc, RGN, PGCE Barbara Hoggart MBBS, FRCA, Wiley Online Library
- Review of different methods used for clinical recognition and assessment of pain in dogs and cats **** (2019), International Journal of Veterinary Science and Medicine
- Assessment Of Acute Pain In Cats | Today’s Veterinary Practice
- Quantifying animal pain, Research Excellance Framework 2014, Impact Case Studies.
- Acute Pain in Cats, Recent Advances in Clinical Assessment (2019), Journal of Feline Medicine and Surgery
- Canine & Feline Pain Scales (2018), MedVet Medical & Cancer Centers for Pets
- Feline Acute Pain Series Assessment of Acute Pain in Cats (2014), Today’s Veterinary Practice
- UNESP-Botucatu Multidimensional Composite Pain Scale for Assessing Postoperative Pain in Cats
- Update on Clinical Acute Pain Assessment in Cats, Todays Veterinary Practice
- Acute pain assessment scale for cats (2020)
- Acute pain in cats: Recent Advancement in clinical assessment (2019), Journal of Feline Medicine
This article is accurate and true to the best of the author’s knowledge. It
is not meant to substitute for diagnosis, prognosis, treatment, prescription,
or formal and individualized advice from a veterinary medical professional.
Animals exhibiting signs and symptoms of distress should be seen by a
veterinarian immediately.
© 2021 Sp Greaney
Comments
Sp Greaney (author) from Ireland on May 07, 2021:
@Amara, thank you. I’m glad you found it useful.
Amara from Pakistan on May 07, 2021:
What a comprehensive article about cat problems.. Impressive..
Sp Greaney (author) from Ireland on May 07, 2021:
@Pamela Oglesby, so sorry to hear about that. Cats are notoriously good at
hiding signs of any illnesses or pain.
I was surprised to, to see the number of pain scales developed. I would love
to know which one is used the most in practices. I do think veterinarians
should use a scale specifically designed for cats instead of a general one
that was developed for all animals, especially when asessing their pain.
Pamela Oglesby from Sunny Florida on May 06, 2021:
This is an excellent article, Sp. I had no idea there were so many pain scales
for cats. I lost a cat a little over a year ago, and I have felt guilty about
not taking him to the vet to have him put down a few days before he passed
away. I wasn’t sure he was in pain, although I knew he was dying.