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.
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.
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)
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
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.
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
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.
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.
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
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.
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.
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.
- Activity / Posture
- Attention to wound
- Response to people
- Response to touch
- Facial expression
Symptoms and Scoring in Glasgow Composite Pain Scale
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
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
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.
- Score 0: Normal
- Score 1: Wide
- Score 2: Flat
- 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.
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
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.
- Visual Analogue Scale (2003), Science Direct, Measurement and Valuation of Health for Economic Evaluation
- 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.
- 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)
- 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats, Journal of Feline Medicine and Surgery (2022) 24, 4–30
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
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.