Pain Physiology and Assessment

in Small Animals

Emma Archer RVN Dip AVN Surgical VTS Anesthesia

Anaesthesia Technician
Animal Health Trust

Why is pain assessment important?

There are many answers to this question…

 The most obvious answer to this question is because our patients are unable to
talk, so it is up to us to read and interpret their body language.

 This is not always an easy task, and requires knowledge of different species,
breeds, and ideally of the individual patient themselves. Sometimes they may be
trying to tell us they are in pain, and we need to interpret the signs they are giving
and their body language. Equally, they may be trying to hide their suffering from
us – something some species have evolved over thousands of years to do.

 Another reason is that it is part of our duty of care, and part of our responsibility
as nurses. We owe it to our patients to look after them as a whole, not just a
series of body parts and systems – this is where the holistic approach comes into
its own and is what makes someone a good nurse.

 Treating pain makes patients more co-operative and less aggressive and
facilitates procedures such as intravenous (IV) catheter placement and
radiography.

 Identifying and treating pain is important because…

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  Pain contributes to stress, which can cause immunosuppression, fluid retention,
increased risk of gastroduodenal ulceration and delayed wound healing. These
lead to longer hospital stays, unhappy patients and higher costs. A patient in pain
is less likely to eat, leading to anorexia, negative energy balance and catabolism,
ileus in rabbits and electrolyte imbalances.

 Reduced mobility due to pain increases the risk of decubital ulcers,

thromboembolism, lung atelactasis and pneumonia.

 Acute pain that is left untreated can develop into chronic pain, which is much
more difficult to manage.

 The pain pathway is flexible or ‘plastic’ and is able to change. Repeated

activation of the nociceptive pathway results in sensitisation, causing an
increased sensitivity to noxious stimuli (hyperalgesia), and stimuli that were
previously non-painful to become painful (allodynia). Therefore it is obviously
best avoided in the first place.

 Pain will cause behaviour changes that are likely to make the patient more difficult
to nurse. These behaviours may become associated with the clinic and cause
problems on future visits. A patient that experiences a pain-free hospital stay is
likely to be much more manageable, and occasionally even relish their visits to
see the veterinary staff who gave them so much fuss and TLC!

 Pain is NEVER beneficial to the patient.

Physiology of Pain
Understanding the pain pathway, and the changes that occur in response to repeated
painful stimuli is important to manage pain effectively in our patients.

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Nociception refers to the detection of a noxious (unpleasant) or painful stimulus,
whereas ‘pain’ implies an actual perception and emotional response to pain, after input
to the brain from the spinal cord and periphery.

Pain pathway
There are several parts to the pain pathway; nociception which is the detection of a
painful stimulus. This is made up of 3 parts; transduction, transmission and
modulation), and perception. The pain pathway starts in the body tissues, where
nociceptors, (which are nerve endings located throughout the skin, muscles, blood
vessels, periosteum, viscera and the peritoneum), detect and respond to noxious
chemical, mechanical or thermal stimuli. Transduction is the conversion of this noxious
stimulus into a nerve impulse by nocieptors. There is a threshold which must be
exceeded for the impulse to be activated, preventing it from being activated by non-
painful stimulus. Transmission is the carriage of impulses along the nerve fibres to the
central nervous system (CNS). Animals have an intrinsic analgesic system, this inhibits
some of the afferent pain signals and the perception of pain (modulation). Perception
occurs in the brain and is the conscious and emotional experience of pain produced by
nociceptor information and many other body inputs.

Sensitisation
Because the pain pathway has plasticity (ie, is flexible) rather than being rigid, once the
pain pathway has been stimulated it can change the way it responds to further painful
stimuli.

Peripheral sensitisation
After a tissue is damaged by a noxious stimuli, inflammation occurs. The damaged
tissue releases many different chemicals and inflammatory mediators, such as
prostaglandins and histamine. This ‘inflammatory soup’ stimulates more nociceptors in
the area, widening the painful area, but it also lowers the nociceptor threshold. This
results in the pain pathway responding more violently to a noxious stimulus, so a
previously non-painful stimulus becomes painful as it is now reaches the new lower
nociceptor threshold (allodynia), and a painful stimulus provokes a greater and more
prolonged pain (hyperalgesia).

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Central Sensitisation
A bombardment of painful impulses causes changes in the dorsal horn neurones in the
spinal cord. This causes the neurones to become hyperexcitable and exaggerate further
pain impulses. The neurones start to process non-painful inputs as pain signals.
Central sensitisation also results in secondary peripheral hyperalgesia where further
nociceptors are recruited in undamaged tissue causing a more intense and more
prolonged pain response. The result is a larger area that feels pain and a massive
intensification of pain, which is very difficult to control. Activation of the N-methyl-D-
aspartate (NMDA) receptor in the spinal cord, is an important event in central
sensitization. The NMDA receptor contributes to the transmission of noxious input from
the periphery to the CNS following repeated input of noxious stimuli. It is not activated
initially, but after repeated noxious stimulus activation occurs and there is a sudden
increase in the amount of noxious input to the spinal cord and on to the brain where it is
perceived as pain.

Assessing pain in small animals

Assessing whether or not an animal is in pain sounds like it should be quite a simple
subject but it is actually very complex.

Most species of animals have evolved over thousands of years to hide the fact that they
are suffering. A rabbit in the wild will soon be picked off by a hungry fox if it is squealing,
or obviously lame. Cats are incredibly good at masking pain and it is well known that
when they are hurt, e.g. after a road traffic accident (RTA) many cats with horrible
injuries manage to take themselves off somewhere to find solitude and lick their wounds.
Loyal dogs that wag their tails to greet their owners just hours after major surgery may
be doing so because this is how they behave, not because they are pain free.

Because of these differences in behaviour compared to how us humans would act, many
myths have developed over the years. The three most perpetuated are:

1. “Animals don’t feel pain like we do”

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This is not true, they have the same neurological pathways as us, and they can also
remember previous painful incidents. It is only their behaviours for expressing pain that
are different to ours.

2. “Animals can cope so much better with pain than us”

Something to remember here is “an animal tolerating pain is not the same as an animal
free of pain”. Stoic breeds such as Labradors have the same nerve pathways as the
more sensitive breeds such as Greyhounds, but they express their behaviours very
differently. Of course there will be some animals that have a greater tolerance of pain
than others, just as the same is true for people, but it doesn’t mean they should cope
without analgesia.

Also, severe acute pain, such as after falling from a balcony, may not be felt at the
moment of injury, but will definitely kick in within a matter of hours once the adrenaline
wears off.

3. “If they are too comfortable they will move around too much and further hurt
themselves”

This is just an excuse for poor veterinary care! Pain should never be used to restrain an
animal when we have bandages, crates or kennels and sedatives. Pain actually delays
healing, and in fact an animal in pain is more likely to chew at the wound and self-
traumatise than a comfortable patient.

Another argument against this viewpoint is that analgesics are unlikely to completely
block the pain sensation anyway. They make the patient more comfortable but if they
get up and bound around on their broken leg, even after morphine it’s probably going to
hurt. In fact only local anaesthetics are truly analgesic, the rest would maybe be better
described as hypoalgesic.

Fortunately the number of people believing these myths is decreasing and pain
management is now a very popular topic for continuing professional development. The
number of available analgesic drugs has also increased.

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The veterinary nurse is likely to be the first to notice the hospitalised animal in pain, we
are at the forefront and it is up to us to understand the topic, notice the signs, inform the
veterinary surgeon, and if necessary badger them to prescribe analgesics.

Being in the practice environment changes the way animals behave and this may mask
signs of pain. Try and get a good history and if possible observe the patient before an
elective surgery so that it is easier to spot signs of pain.

The most common signs of pain that seem to be shared by most species are decreased
appetite and decreased activity. Activity in this sense does not just mean
walking/running, but applies to general daily behaviours such as grooming and playing
etc.

In addition to the above, there are typical behaviours that may be associated with
different levels of pain:

1. Escape behaviour +/- vocalisation – Acute pain/injury

2. Protective, guarded, can’t seem to settle in one position – General/post op
pain or discomfort.
3. Depression, lethargy, body condition loss – Chronic pain.

Of course any change in behaviour can be associated with disease too, but if pain is
suspected it is worth remembering these signs.

The smaller animal are probably the most under-diagnosed and under-treated for pain.
Decreased normal activities and loss of appetite remain the most prominent signs. They
may also become immobile and possibly squeak or squeal when handled.

With rabbits and guinea pigs anorexia can lead to gut stasis so must be addressed as a
priority. Other signs of a rabbit in pain include teeth grinding, hunching, lack of interest
in their environment/owner, paying lots of attention to one area (licking, scratching),
possibly aggression and closing their eyes.

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Rats may lie low to the floor, arch their backs or twitch while resting. You may notice an
increase in porphyrin secretion around the eyes and nose, which could be due to
increased stress and/or decreased grooming. Exotics are a very specialist area and
may be best referred!

The best way to approach whether or not you think any species may be in pain is to use
the ‘Principle of Analogy’. This is basically if you think a procedure or situation would
cause a human pain then it will cause an animal pain too. There will be some
procedures we just cannot relate to (e.g. tail docking) so you must also take a scientific
approach and consider which types of tissue have been traumatised, how bad the
wound is, and if there has been any nerve damage.

A person’s own experiences of pain will always affect this approach to a certain extent,
as well as how much natural empathy they have. Also some things are more obviously
painful, e.g. a squealing puppy with a corneal foreign body compared to a stoic old
Labrador with arthritic hips. Young animals tend to show pain more readily too.

Everyone (hopefully) would give analgesics to a victim of an RTA, stick injury or burn,
but what about the less obvious conditions? Otitis externa, glaucoma, corneal ulcers,
renal disease, and meningitis– these are all likely to be very painful and need both the
disease and the pain treated together, but the pain is often overlooked.

Pain will also inhibit sleep, so next time you recover a patient that seems to wake up
unexpectedly fast, immediately stands up, is probably panting and maybe looking tired
but refusing to lie down, it is probably in pain. Do a pain check and also take into
account they may need the toilet, or maybe the bedding is unsuitable. So if pain inhibits
sleep it follows that if an animal is sleeping soundly (not just resting or catnapping) don’t
wake them up to do a pain check.

It has been shown in humans that there is also a strong psychological element to pain,
and that negative emotions such as fear, isolation, separation anxiety, rage and
frustration travel along similar pathways to the brain as pain does. It is reasonable to
assume the same in animals. Anything that adds to a patient’s discomfort such as being
hungry or thirsty, feeling sick, unsuitable bedding and excessive environmental noise will

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all have the same detrimental effect as pain. This is again where empathy and a holistic
nursing approach are needed.

Good hospital record keeping is essential for both carrying out the pain assessment, and
assessing the effect of any analgesia given. This should be done throughout the
animals stay, and also at the post-op checks. Many people place far too much
significance on vocalisation when in fact this is rarely demonstrated until the pain is
already severe. Also they may not realise that dogs may wag their tails, and a cat may
purr despite being in pain.

Common signs of pain

Cats Dogs Rabbits

Hunched in sternal
recumbency
Unusual aggression
Reduced or absent appetite Seeking more contact than
Reluctance to move
Failure to use litter tray
Squinting eyes
Flattened ears
Failure to groom
Over grooming or chewing
painful area
Withdrawal from contact
Vocalisation
Reduce appetite/anorexia
Unusual aggression
usual
Low head carriage
Over grooming/ self trauma
Inability to settle
Lack of good quality sleep
Guarding of painful area
Tense abdomen
Lameness
vocalisation
Reduced appetite
Hunched position
Immobility
Teeth grinding
squinting
Rapid respiratory rate
Over grooming/chewing
painful area
Unusual aggression
Vocalisation

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Chronic Pain
Chronic pain remains overlooked and under-treated in many animals. It is also very
difficult to manage once established. As a profession we are still getting to grips with
chronic pain in animals, and we need to work with the public and educate owners as we
learn ourselves.

Cats probably come off worse at the moment. One study (Hardie et al 2002) showed that 90%
of cats over the age of 12 years have Degenerative Joint Disease (DJD). It is often
joked that this is difficult to spot in cats, as one of the main signs is becoming less active
– hard to notice in an animal that spends 16-20 hours out of 24 asleep! But you may
notice that they pull themselves up on the sofa rather than jump up, and maybe they are
not sleeping on the top of the wardrobe like they used to. Perhaps they don’t seek your
company as much and are not as ‘chatty’ as they once were. If a client mentions an
apparent behaviour problem in that their cat passes faeces near the litter tray but not
quite in it, then consider osteoarthritis. The poor cat either cannot quite climb into the
litter tray, or just manages to make it into the tray but cannot physically squat so it pops
out over the side!

Chronic renal and dental pain can also go a long time undetected, observe for cats
pawing at the mouth or under-grooming. Conversely over-grooming, such as a dog
developing a lick granuloma on their carpus from constantly licking, may be a sign of
pain in that area.

Chronic pain, which is pain that lasts longer than expected for a particular disease or
after an injury has healed (or as a rough guide lasts for over 3 months) can actually
shorten an animal’s life, and the longer it goes on the harder it will be to control, so it’s
important to start analgesics sooner rather than later. Also consider complementary
methods of pain relief such as physiotherapy, acupuncture, hydrotherapy and heat.

Pain scoring
Pain scoring systems are useful not only to detect the presence of pain, but also to help
select the appropriate type, dose, frequency and adequacy of analgesia, and the timings
for additional requirements. Pain scores standardize pain assessments and reduces
inter-observer variability as well as providing a written record of pain assessment. There

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are many different pain scoring systems that can be used, or adapted for use in your
practice depending on your requirements. It is important to remember when pain
scoring that each animal is different and reacts differently to pain. The ideal pain scoring
system should not only be able to detect the presence of pain, but also the magnitude
(intense, throbbing, etc) and type of pain (neuropathic, visceral etc) as well as how it
makes that animal feel (scared, depressed etc). It should be reliable, sensitive, easy to
use and interpret, multidimensional (preferably looking at undisturbed behaviour,
behaviour on interaction and physiological parameters) and ideally, validated. Pain
scoring is very difficult in animals and the perfect pain score system does not yet exist,
although there is lots of ongoing work in human and veterinary fields to establish an
ideal scoring system. Animal pain scoring systems are adapted from human pain
management and are mainly for management of acute pain. Regardless of the type of
scoring system used, assessment should occur regularly and be performed by a person
experienced in understanding signs of pain. Where possible consecutive scores should
be performed by the same person, to minimize observer variation, it is also useful to
have observed the dogs normal temperament and behavior prior to the painful stimulus.

Simple descriptive scale (SDS)

An SDS is the most basic type of pain scoring system, which looks at the patients’
behaviour. There are normally 3-5 grades of pain defined by a short description. It is
very simple, and therefore user friendly, but not very good at detecting small changes or
differences in pain, and it is very subjective.

Example of an SDS
0 No pain
1 Happy, but slight flinch on wound palpation
2 Happy, but tense & flinches on stroking around wound

3 Hunched, looks uncomfortable, but can touch wound

4 Painful, hunched, depressed, vocalising, unable to stroke

or touch near wound

Visual Analogue Scale (VAS)

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Consisits of a line 100 mm in length, with ‘no pain at all’ on one end, and the other end
corresponding with ‘the worst possible pain’. The observer marks a point on the line that
corresponds to the pain intensity for that patient. It is more sensitive than the SDS,
although still very subjective. It is used widely in both human pain management and
veterinary studies, although it does require an experienced observer to give a reliable
score. .
No pain at Worst possible
all pain

Dynamic & Interactive Visual Analogue Scale

This a modified VAS, where the observer marks a point on the 100mm line, and the
distance from the start of the line in mm is the pain score. It normally incorporates
undisturbed behaviour, with behaviour on interaction and wound palpation, so is more
sensitive than the basic VAS. This is important as a dog lying asleep in their kennel may
not demonstrate signs of pain, but after interaction and manipulation it may become
clear that pain is present.

Numerical Rating Scale (NRS)

This is similar to VAS but the observer chooses a number on a scale
Worst possible
pain

No pain
at 0all 1 2 3 4 5 6 7 8 9 10

Glasgow Composite Pain Score

Is a multidimensional pain scoring system, taking into account both undisturbed
behaviour and behaviour on interaction. It is a more complex version of an NRS. It tries
to take into account emotional effects and intensity of pain. It is made up of a number of

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separate assessments of different aspects of behaviour that can be associated with
pain. Each category has 4-6 descriptions, and each score is added up to give an overall
score. It is currently the only validated pain score in dogs (none are validated in cats), so
it is perhaps the scoring system of choice for acute main management, although it is
quite time consuming and knowledge of pain is required. It also does not take into
account physiological parameters. It was, and still is, being developed at Glasgow vet
school, and can be downloaded from the Glasgow university website, where they
recommend giving analgesia if a pain score is > 6/24.
www.gla.ac.uk/faculties/vet/smallanimalhospital/ourservices/painmanagementandacupu
ncture/

University of Melbourne Pain Scale

This is a variable rating scale taking into account both undisturbed behaviour, and
behaviour on interaction, as well as physiological parameters, such as pulse rate,
respiratory rate, pupil size, salivation and body temperature. Initial work implies that it is
effective, and it looks like it will be validated for use in dogs soon, although it is quite
time consuming and complex and knowledge of pain assessment is required.

Physiological parameters are often not included in pain scores because interpretation
can be affected by other factors including, the patient’s cardiovascular status (ie
hypovolaemia), fear and sedatives.

To summarise, most patients in your practice will have had some sort of injury or surgery
resulting in pain. Regular and effective assessment of pain, then treatment, is vital for a
successful outcome in critical patients.

Reference
Hardie EM, Roe SC, Martin FR. Radiographic evidence of degenerative joint disease in
geriatric cats: 100 cats (1994-1997). J Am Vet Med Assoc 2002; 220(5): 628-632

Further Reading
Pain Management in Small Animals- A Manual for Veterinary Nurses and Technicians.
Grant D (2006) Butterworth Heinemann;

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Pain Management for the Small Animal Practicioner (2000). Tranquilli WJ, Grimm KA,
Lamont LA. Part of the Teton New Media ‘Made Easy’ Series.

Anaesthesia for Veterinary Nurses. Welsh E. (2003) 1st Edition Oxford: Blackwell
Science

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 PAIN EVALUATION CHART – DOGS

Patient name _____________________________________________________

Case number _____________________________________________________
Analgesics _____________________________________________________
Date(s) _____________________________________________________

Please tick the answer that you feel is appropriate to the dog you are assessing. If more than one
answer is appropriate, tick all that apply.

From outside the kennel, look at the dog’s behaviour and answer the following questions.

1. Look at the dog’s posture, does it seem…

Rigid
Hunched or Tense
Neither of these

2. Does the dog seem to be…

Restless
Settled

3. If the dog is vocalising, is it…

Screaming
Groaning
Crying or whimpering
Not vocalising/none of
these

4. Look at the dog’s chart, has it…

Not eaten anything
Picked at it’s food
Eaten well

5. If the dog is paying/trying to pay attention to it’s wound (even if it has a collar on),
is it…
Chewing
Licking, looking or
rubbing
Ignoring the wound

6. Does the dog seem to be…

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Aggressive
Depressed
Disinterested
Nervous, anxious or
fearful
Quiet or indifferent
Happy and content
Happy and bouncy

*READ LAMINATED SHEET – INSTRUCTION A (Ophthalmology patients only)

7. Assess the following conditions and give a score for each…

Blepharospasm
Blinks (no. in 30
seconds)
Lacrimation
Conjunctival hyperaemia

TIME
INITIALS

* READ LAMINATED SHEET – INSTRUCTION B

8. Does the dog seem to be…
Aggressive
Depressed
Disinterested
Nervous, anxious or
fearful
Quiet or indifferent
Happy and content
Happy and bouncy

*READ LAMINATED SHEET – INSTRUCTION C

9. During this procedure did the dog seem to be…
Stiff
Slow/reluctant to rise or
sit

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Lame
None of these
Assessment not carried
out

*READ LAMINATED SHEET – INSTRUCTION D

10. When touched did the dog…
Snap
Growl or guard the area
Cry
Flinch/become tense
Look round sharply
None of these

11. In your opinion, would you classify the dog as…

Painful
Uncomfortable
Comfortable

Taking everything you’ve assessed into account, and using the guide below, allocate a
number between 1-10 for how painful you consider the dog to be, and tick if pain relief
was given.
It is also worth reading the NCP to see how the dog has been in itself.
Any additional comments you would like to make can be written on the patient’s kennel
chart.
▲ 1 2 3 4 5 6 7 8 9 10
▲

No pain Low pain Painful Very painful

Extreme pain

PAIN SCORE
PAIN RELIEF
GIVEN?

TIME
INITIALS

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ADDITONAL
COMMENTS/NOTES

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 PAIN EVALUATION CHART – CATS

Patient name _____________________________________________________

Case number _____________________________________________________
Analgesics _____________________________________________________
Date _____________________________________________________

Please tick the answer that you feel is appropriate to the dog you are assessing. If
more than one answer is appropriate, tick all that apply.

From outside the cat’s pod, look at the cat’s behaviour and answer the following questions.

2. Look at the cat’s posture, does it seem…

Crouched or rigid
Hunched or Tense
Neither of these

2. Does the cat seem to be…

Restless
Settled

3. Is the cat…
Sitting in the litter tray
Meowing abnormally
None of these

12. Look at the cat’s chart, has it…

Not eaten anything
Picked at it’s food
Eaten well

13. If the cat is paying/trying to pay attention to it’s wound (even if it has a collar on), is
it…
Chewing
Licking, looking or
rubbing
Ignoring the wound

14. Does the cat seem to be…

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Aggressive/hissing/spitti
ng
Depressed
Disinterested
Nervous, anxious or
fearful
Quiet or indifferent
Contented
Happy and affectionate

*READ LAMINATED SHEET – INSTRUCTION A (Ophthalmology patients only)

7. Assess the following conditions and give a score for each…

Blepharospasm
Blinks (no. in 30
seconds)
Lacrimation
Conjunctival hyperaemia

TIME
INITIALS

* READ LAMINATED SHEET – INSTRUCTION B

8. Does the cat seem to be…
Aggressive/hissing/spitti
ng
Depressed
Disinterested
Nervous, anxious or
fearful
Quiet or indifferent
Contented
Happy and affectionate

*READ LAMINATED SHEET – INSTRUCTION C

9. During this procedure did the cat seem to be…
Stiff
Slow/reluctant to rise or
sit

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Lame
None of these
Assessment not carried
out

*READ LAMINATED SHEET – INSTRUCTION D

10. When touched did the cat…
Become defensive
Hiss
Growl or guard the
wound
Flinch/become tense
Look round sharply
None of these

11. In your opinion, would you classify the cat as…

Painful
Uncomfortable
Comfortable

Taking everything you’ve assessed into account, and using the guide below, allocate a
number between 1-10 for how painful you consider the cat to be, and tick if pain relief
was given.
It is also worth reading the NCP to see how the cat has been in itself.
Any additional comments you would like to make can be written on the patient’s kennel
chart.

▲ 1 2 3 4 5 6 7 8 9 10

No pain Low pain Painful Very painful

Extreme pain

PAIN SCORE
PAIN RELIEF
GIVEN?

TIME
INITIALS

20
ADDITONAL
COMMENTS/NOTES

AHT Pain scoring instructions

DOGS

INSTRUCTION A.

Observing the animal, use the following scoring system to assess the level of discomfort

(0 = none, 1 = mild, 2 = moderate, 3 = severe)

Blepharospasm Score 0, 1, 2, 3
Blinks Count the number in 30 seconds
Lacrimation Score 0, 1, 2, 3
Conjunctival hyperaemia Score 0, 1, 2, 3

INSTRUCTION B.

Now approach the kennel door and call the dog’s name. Then, if the patient’s condition allows,
open the door and encourage the dog to come to you. From the dog’s reaction to you try and
assess their character.

INSTRUCTION C.

Now look at the dog’s response to stimuli. If a mobility assessment is possible, open the kennel
and put a lead on the dog. If the dog is sitting down, encourage it to stand and then come out of
the kennel. Walk slowly up and down the area outside the kennel. If the dog was standing up in
the kennel and has undergone a procedure that may be painful in the perianal area, ask the dog to
sit down.

INSTRUCTION D.
Assess the dog’s response to touch. If the dog has a wound, apply gentle pressure using two
fingers in an area approximately 2 inches around it. If the position of the wound is impossible to
touch, then apply the pressure to the closest point to the wound. If there is no wound, apply the
same pressure to the stifle and surrounding area.

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 1 2 3 4 5 6 7 8 9 10

No pain Low pain Painful Very painful Extreme pain

22
AHT Pain scoring instructions

CATS

INSTRUCTION A.

Observing the animal, use the following scoring system to assess the level of
discomfort

(0 = none, 1 = mild, 2 = moderate, 3 = severe)

Blepharospasm Score 0, 1, 2, 3
Blinks Count the number in 30 seconds
Lacrimation Score 0, 1, 2, 3
Conjunctival hyperaemia Score 0, 1, 2, 3

INSTRUCTION B.

Now approach the pod door and call the cat’s name. Then, if the patient’s condition allows, open
the door and encourage the cat to come to you. From the cat’s reaction to you try and assess their
character.

INSTRUCTION C.

Now look at the cat’s response to stimuli. If a mobility assessment is possible, open the pod and
lift the cat out onto the floor or table. If the cat is lying down, encourage it to stand and then come
out of the pod. If the cat was standing up in the kennel and has undergone a procedure that may
be painful in the perianal area, observe if the cat is able to sit down.

INSTRUCTION D.

Assess the cat’s response to touch. If the cat has a wound, apply gentle pressure using two fingers
in an area approximately 2 inches around it. If the position of the wound is impossible to touch,
then apply the pressure to the closest point to the wound. If there is no wound, apply the same
pressure to the stifle and surrounding area.

1 2 3 4 5 6 7 8 9 10

No pain Low pain Painful Very painful Extreme pain

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