p.1

SCORING PAIN IN ANIMALS: SCALES/VIDEOS
Mary Ellen Goldberg LVT, CVT, SRA, CCRVN, CVPP, VTS-lab animal medicine (research anesthesia), VTS-physical rehabilitation
Vetscope 2019

p.2

ASSESSING PAIN
-Neonates and geriatric animals may not express their pain as plainly as other animals
-Each scale has its advantages and its limitations
-Choose one system to be used by the entire veterinary team

p.3

PAIN SIGNS
Physiologic Signs
-increased heart rate
-Increased blood pressure
-Increased respiratory rate
-Vocalization
Behavioral Changes
-general restlessness
-decreased appetite
-not sleeping
-resenting handling
-not assuming a normal position may be even more significant

p.4

SPECIES SPECIFIC SIGNS OF PAIN
-Species
-Vocalizing
-Posture
-Locomotion
-Temperament

p.5

DOG
-Whimpers, howls, growls
-Cowers, Crouches; Recumbent
-Reluctant to move; awkward, shuffles
-Varies from chronic to acute; can be subdued or vicious; quiet or restless
What indicates this dog is in pain?

p.6

CAT
-Generally silent; may growl or hiss
-Stiff, hunched in sternal recumbency; limbs tucked under body
-Reluctant to move limb, carry limb
-Reclusive

p.7

NON-HUMAN PRIMATE
-Screams, grunts, moans
-Head forward, arms across body; huddled crouching
-Favors area in pain
-Docile to aggressive

p.8

RODENTS
-Squeaks, squeals
-Dormouse posture; rounded back; head tilted; back rigid
-Ataxia; running in circles
-Docile or aggressive depending on severity of pain, eats neonates

p.9

GUINEA PIG
-Urgent repetitive squeals
-Hunched
-Drags hind legs
-Docile, quiet, terrified, agitated

p.10

RABBIT
-Piercing squeal on acute pain
-Hunched; faces back of cage
-Inactive; drags hind legs
-Apprehensive, dull, sometimes aggressive depending on severity of pain; eats neonates

p.11

HORSES
•Grunting, nicker
•Rigid; head lowered
•Reluctant to move; walk in circles ""up & down"" movement
•Restless, depressed

p.12

COWS, CALVES, GOATS
-Grunting; grinding teeth
-Rigid; head lowered; back humped
-Limp; reluctant to move the painful area
-Dull, depressed; act violent when handled

p.13

SHEEP
-Grunting; teeth grinding
-Rigid; head down
-Limp; reluctant to move the painful area
-Disinterested in surroundings; dull, depressed

p.14

PIGS
-From excessive squealing to no sound at all
-All four feet close together under body
-Unwilling to move; unable to stand
-From passive to aggressive depending on severity of pain

p.15

CHICKENS
-Gasping
-Stand on one foot, hunched huddled
-None
-Lethargic, allows handling

p.16

BIRD
-Chirping
-Huddled, hunched
-From excessive movement to tonic immobility depending on severity of pain
-Inactive; drooping, miserable appearance

p.17

REPTILE
-Hiss; grunting
-Hunched; hiding; color change
-Immobility unless forced
-Anorexia; aggressive; lethargic; avoidance

p.18

AMPHIBIAN
-None
-Hunched; hiding; color change
-Immobility unless forced
-Anorexia; aggressive; lethargic; avoidance

p.19

FISH
-None
-Clamped fins; pale color; hiding; anorexia
-None unless forced; if a schooling fish; will separate itself from others
-First sign to occur is anorexia; lethargic; stressed easily

p.20

INVERTEBRATES
-None
-Withdrawn
-No movement
-Color change, not eating

p.21

Pain scales should be used in conjunction with a thorough physical exam and history to assess every patient
Recognize that all pain scales have limitations
Individual patient behavior may dictate prompt pain relief, regardless of the pain score
Caregivers should strive for low pain scores in a comfortable appearing patient ARE THEIR LIMITATIONS TO PAIN SCALES?

p.22

VISUAL ANALOG SCALES (VAS
-VAS – a line with no markings is used, numbers are at each end 0 being no pain and 100 being worst.

p.23

NUMERICAL RATING SCALE
-NRS – a number line with individual numerical markings (1- 10) which are chosen as the score.

p.24

SIMPLE DESCRIPTIVE SCALE
-SDS – numbers used to assign to descriptions that categorize different levels of pain intensity

p.25

MULTIDIMENSIONAL PAIN SCALE
-A pain scale should ideally be multidimensional, in that several aspects of pain intensity & pain related disability are included and question especially the dynamic aspects. The Glasgow CPS is thought to be Multidimensional.” (Karas, 2011)
There is a validated Glasgow Pain Scale for Cats

p.26

GRIMACE SCALES/PAIN FACES/FACIAL EXPRESSIONS/FACIAL ACTION CODING UNITS Can we look at an animal and know they are in pain?

p.27

BASED ‘ACTION UNITS’ OF THE FACIAL ACTION CODING SYSTEM

p.28

MOUSE GRIMACE SCALE
Langford DJ et al. (2010) Coding facial expressions of pain in the laboratory mouse. Nature Methods June 7(6) pg 448.

p.29

THE RAT GRIMACE SCALE
Sotocinal SG et. al. (2011) The Rat Grimace Scale: A partially automated method for quantifying pain in the laboratory rat via facial expressions. Molecular Pain 7:55

p.30

THE RABBIT GRIMACE SCALE
Keating SCJ, Thomas AA, Flecknell PA, Leach MC (2012) Evaluation of EMLA Cream for Preventing Pain during Tattooing of Rabbits: Changes in Physiological, Behavioural and Facial Expression Responses. PLoS ONE 7(9): e44437.

p.31

THE FERRET GRIMACE SCALE
Reijgwart ML, Schoemaker NJ, Pascuzzo R, Leach MC, Stodel M, de Nies L, et al. (2017) The composition and initial evaluation of a grimace scale in ferrets after surgical implantation of a telemetry probe. PLoS ONE 12(11): e0187986.

p.32

THE EQUINE GRIMACE SCALE
Dalla Costa E, Minero M, Lebelt D, Stucke D, Canali E, et al. (2014) Development of the Horse Grimace Scale (HGS) as a Pain Assessment Tool in Horses Undergoing Routine Castration. PLoS ONE 9(3): e92281.

p.33

THE COW GRIMACE SCALE
Gleerupa KB, Andersenb PH, Munksgaardc L, Forkmanaa B. (2015) Pain evaluation in dairy cattle. Applied Animal Behaviour Science, 171: 25-32

p.34

THE SHEEP GRIMACE SCALE
McLennan KM, Rebelo CJB, Corke MJ et al. (2016) Development of a facial expression scale using footrot and mastitis as models of pain in sheep. Applied Animal Behaviour Science, 176, 19-26

p.35

DAIRY GOAT PAIN
Muri K and Valle PS. (2012) Human-animal relationships in the Norwegian dairy goat industry: assessment of pain and provision of veterinary treatment (Part II). Animal Welfare, 21: 547-558

p.36

THE PIG GRIMACE SCALE
Giminiani PD, Brierley VLMH, Scollo A, Gottardo F, Malcolm EM, Edwards SA, Leach MC. (2016) The Assessment of Facial Expressions in Piglets Undergoing Tail Docking and Castration: Toward the Development of the Piglet Grimace Scale. Front. Vet. Sci., 14 November 2016

p.37

THE CAT GRIMACE SCALE
Holden E, Calvo G, Collins M, Bell A, Reid J, Scott EM, Nolan AM. (2014) Evaluation of facial expression in acute pain in cats, Journal of Small Animal Practice 55, 615–621

p.38

DOG FACIAL ACTION UNITS
Waller B, Caeiro C, Peirce K, Burrows AM, Kaminski J. (2013) DogFACS: The Dog Facial Action Coding System Manual, Paedomorphic facial expressions give dogs a selective advantage. PloS One, 8(12), e82686.

p.39

FACIAL ACTION UNITS ORANGUTAN
Waller, B. M., Caeiro, C. C., & Davila-Ross, M. (2015). Orangutans modify facial displays depending on recipient attention. Peer J, 3, e827.

p.40

FACIAL ACTION UNITS FOR GIBBONS
Waller, B.M., Kuchenbuch, P., Lembeck, M., Burrows, A.M. & Liebal, K. (2012). GibbonFACS: A muscle based coding system for the hylobatids. International Journal of Primatology, 33(4), 809-821

p.41

MACAQUE FACIAL ACTION UNITS
Parr, L.A., Waller, B.M., Burrows, A.M., Gothard, K.M. & Vick, S.J. (2010). MaqFACS: A muscle-based facial movement coding system for the macaque monkey. American Journal of Physical Anthropology, 143, 625-630

p.42

FACIAL ACTION UNITS CHIMPANZEE
Vick, S.J., Waller, B.M., Parr, L.A., Smith Pasaqualini, M.C. & Bard, K.A. (2007). A cross- species comparison of facial morphology and movement in humans and chimpanzees using the facial action coding system (FACS). Journal of Nonverbal Behaviour, 31, 1-20.

p.43

GRIMACE SCALE VS. FACIAL ACTION UNITS
Grimace Scales/Pain Faces are specific to painful behaviors and detecting certain expressions that any mammal can develop when in a pain states (acute, chronic or neuropathic).
Since the coding is based on individual muscle movements and not on the perception of a composed facial expression, it avoids any emotional context biases.

p.44

POST OP DOES THE DOG REALLY SHAKE?

p.45

IS ANALGESIA GOOD OR BAD?

p.46

WHAT SCORE WOULD YOU GIVE THIS KITTY?

p.47

WAS IT PAIN OR DYSPHORIA?

p.48

SPAY NEUTER CLINIC

p.49

SCORE THIS PAIN

p.50

SCORE THIS PAIN

p.51

SCORE THIS PAIN

p.52

Thank you