Objective Assessment of Acute Pain in Foals Using a Facial Expression-Based Pain Scale

Pain assessment is very important for monitoring welfare and quality of life in horses. To date, no studies have described pain scales for objective assessment of pain in foals. Studies in other species have shown that facial expression can be used in neonatal animals for objective assessment of acute pain. The aim of the current study was to adapt a facial expression-based pain scale for assessment of acute pain in mature horses for valid pain assessment in foals. The scale was applied to fifty-nine foals (20 patients and 39 healthy controls); animals were assessed from video recordings (30–60 s) by 3 observers, who were blinded for the condition of the animals. Patients were diagnosed with acute health problems by means of clinical examination and additional diagnostic procedures. EQUUS-FAP FOAL (Equine Utrecht University Scale for Facial Assessment of Pain in Foals) showed good inter- and intra-observer reliability (Cronbach’s alpha = 0.95 and 0.98, p < 0.001). Patients had significantly higher pain scores compared to controls (p < 0.001) and the pain scores decreased after treatment with NSAIDs (meloxicam or flunixin meglumine IV) (p < 0.05). Our results indicate that a facial expression-based pain scale could be useful for the assessment of acute pain in foals. Further studies are needed to validate this pain scale.

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Monitoring Acute Pain in Donkeys with the Equine Utrecht University Scale for Donkeys Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP)

Animals ◽

10.3390/ani10020354 ◽

2020 ◽

Vol 10 (2) ◽

pp. 354 ◽

Cited By ~ 4

Author(s):

Machteld C. van Dierendonck ◽

Faith A. Burden ◽

Karen Rickards ◽

Johannes P.A.M. van Loon

Keyword(s):

Postoperative Pain ◽

Acute Pain ◽

Pain Assessment ◽

Pain Scale ◽

Follow Up Study ◽

Observer Reliability ◽

Pain Scales ◽

Different Types ◽

Good For

Objective pain assessment in donkeys is of vital importance for improving welfare in a species that is considered stoic. This study presents the construction and testing of two pain scales, the Equine Utrecht University Scale for Donkey Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP), in donkeys with acute pain. A cohort follow-up study using 264 adult donkeys (n = 12 acute colic, n = 25 acute orthopaedic pain, n = 18 acute head-related pain, n = 24 postoperative pain, and n = 185 controls) was performed. Both pain scales showed differences between donkeys with different types of pain and their control animals (p < 0.001). The EQUUS-DONKEY-COMPASS and EQUUS-DONKEY-FAP showed high inter-observer reliability (Cronbach’s alpha = 0.97 and 0.94, respectively, both p < 0.001). Sensitivity of the EQUUS-DONKEY-COMPASS was good for colic and orthopaedic pain (83% and 88%, respectively), but poor for head-related and postoperative pain (17% and 21%, respectively). Sensitivity of the EQUUS-DONKEY-FAP was good for colic and head-related pain (75% and 78%, respectively), but moderate for orthopaedic and postoperative pain (40% and 50%, respectively). Specificity was good for all types of pain with both scales (91%–99%). Different types of acute pain in donkeys can be validly assessed by either a composite or a facial expression-based pain scale.

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Evaluation of targeted bupivacaine for reducing acute postoperative pain in cats undergoing routine ovariohysterectomy

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19826700 ◽

2019 ◽

Vol 22 (2) ◽

pp. 91-99 ◽

Cited By ~ 1

Author(s):

James Mack Fudge ◽

Bernie Page ◽

Amy Mackrell ◽

Inhyung Lee

Keyword(s):

Postoperative Pain ◽

Acute Pain ◽

Rating Scale ◽

High Volume ◽

Pain Scale ◽

Placebo Control ◽

Controlled Clinical Trial ◽

Colorado State University ◽

Pain Scores ◽

Pain Scales

Objectives This study sought to determine if bupivacaine targeted at specific, potentially painful sites could enhance postoperative analgesia in routine feline ovariohysterectomies. A secondary objective was to assess the utility of multiple acute pain scales for cats in a high-volume surgery setting. Methods Two hundred and twelve cats were included in a prospective, randomized, double-blinded, placebo-controlled clinical trial. Anesthesia included buprenorphine, ketamine, dexmedetomidine and isoflurane. A ventral midline ovariohysterectomy was performed and cats were administered bupivacaine (2 mg/kg), placebo control (0.9% saline) or sham control (observation only) intraoperatively at the ovarian suspensory ligaments and vessels, uterine body and incisional subcutaneous tissues. Two pain scales were used to assess cats postoperatively. Initially, a multidimensional composite pain scale (MCPS) and a 0–10 numeric pain rating scale (NRS) were used. Subsequently, the MCPS was replaced with a modified Colorado State University Feline Acute Pain Scale (mCSU). Pain scores for the test groups were compared using a one-way ANOVA and a Holm–Bonferroni post hoc analysis when a difference was found ( P <0.05). Results Pain for the bupivacaine group was lower than the control groups at 1 h post-recovery and discharge, attaining significance with higher body weights. The P values were 0.008 and 0.004 for 1 h post-recovery and discharge, respectively. Pain scores between evaluators for the MCPS and NRS correlated poorly with r values for 1 h post-recovery and discharge of −0.08 and 0.22, respectively. Additionally, the MCPS proved difficult to use and time consuming, especially for feral and fractious patients, and was replaced with the mCSU. Conclusions and relevance Targeted bupivacaine reduced early postoperative pain scores following routine feline ovariohysterectomies. The technique used was simple, requiring just over a minute to perform at minimal additional cost. The MCPS was not ideal for use in a high-volume spay setting.

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Objective Assessment of Chronic Pain in Horses Using the Horse Chronic Pain Scale (HCPS): A Scale-Construction Study

Animals ◽

10.3390/ani11061826 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1826

Author(s):

Johannes P. A. M. van Loon ◽

Lucia Macri

Keyword(s):

Chronic Pain ◽

Facial Expression ◽

Objective Assessment ◽

Intraclass Correlation ◽

Diagnostic Procedures ◽

Pain Scale ◽

Treatment Regimens ◽

Observer Reliability ◽

Healthy Control ◽

And Control

The objective assessment of chronic pain is of utmost importance for improving welfare and quality of life in horses. Freedom from disease and pain is one of the ‘five freedoms’ that are necessary for animal welfare. The aim of this study was to develop a pain scale for the assessment of chronic pain in horses (Horse Chronic Pain Scale; HCPS), which is based on behavioural and facial expressions. The scale was used to assess 53 horses (26 horses diagnosed with chronic painful conditions by means of clinical examination and additional diagnostic procedures (consisting of osteoarthritis, chronic laminitis, chronic back and neck problems, chronic dental disorders) and 27 healthy control animals). Animals were assessed once daily for three consecutive days by two observers that were blinded to the condition of the animals and were unaware of any analgesic treatment regimens. The HCPS consists of two parts, the Horse Chronic Pain Composite Pain Scale (HCP CPS, with behavioural parameters) and the EQUUS-FAP (Equine Utrecht University Scale for Facial Assessment of Pain). The HCP CPS had good inter-observer reliability (intraclass correlation coefficient (ICC) = 0.84, p < 0.001), while the EQUUS-FAP component (with facial expression-based parameters) had poor inter-observer reliability (ICC = 0.45, p < 0.05). The inter-observer reliability of the combined HCPS was good (ICC = 0.78, p < 0.001). The HCPS revealed significant differences between horses with chronic painful conditions and control horses on 2 out of 3 days (p < 0.05). In conclusion, we tested a composite pain scale for the assessment of chronic pain in horses based on behavioural and facial expression-based parameters. Further studies are needed to validate this pain scale before it can be used in practice.

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Acute pain in cats: Recent advances in clinical assessment

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x18808103 ◽

2018 ◽

Vol 21 (1) ◽

pp. 25-34 ◽

Cited By ~ 9

Author(s):

Paulo V Steagall ◽

Beatriz P Monteiro

Keyword(s):

Acute Pain ◽

Pain Assessment ◽

Pain Scale ◽

Treatment Standards ◽

Future Directions ◽

Recent Advances ◽

Pain Scales ◽

Species Specific ◽

Pain Recognition ◽

Development And Validation

Practical relevance: Pain assessment has gained much attention in recent years as a means of improving pain management and treatment standards. It has become an elemental part of feline practice with ultimate benefit to feline health and welfare. Currently pain assessment involves mostly the investigation of sensory-discriminative (intensity, location and duration) and affective-motivational (emotional) domains of pain. Specific behaviors associated with acute pain have been identified and constitute the basis for its assessment in cats. Recent advances: The publication of pain scales with reported validation – the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale – and species-specific studies have advanced our knowledge on the subject. Facial expressions have also been shown to be different between painful and non-painful cats, and very recently the Feline Grimace Scale has been validated as a tool for acute pain assessment. Clinical challenges: Despite recent advances, several challenges still exist. For instance, the effects of disease and sedation on pain scoring/ assessment are unknown. Also, specific painful conditions (eg, dental pain) have not been systematically investigated. The development and validation of instruments for pain assessment by cat owners is warranted, as these tools are currently lacking. Aims: This article reviews the use, advantages, disadvantages and limitations of the two validated pain scales, and presents a practical, stepwise approach to feline pain recognition and assessment using a dynamic and interactive process. The authors also offer perspectives regarding current challenges and future directions.

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Identification of Body Behaviors and Facial Expressions Associated with Induced Orthopedic Pain in Four Equine Pain Scales

Animals ◽

10.3390/ani10112155 ◽

2020 ◽

Vol 10 (11) ◽

pp. 2155

Author(s):

Katrina Ask ◽

Marie Rhodin ◽

Lena-Mari Tamminen ◽

Elin Hernlund ◽

Pia Haubro Andersen

Keyword(s):

Facial Expression ◽

Facial Expressions ◽

Pain Assessment ◽

Head Position ◽

Position Location ◽

Interactive Behavior ◽

Pain Scales ◽

Before And After ◽

Pain Detection ◽

Movement Asymmetry

Equine orthopedic pain scales are targeted towards horses with moderate to severe orthopedic pain. Improved assessment of pain behavior and pain-related facial expressions at rest may refine orthopedic pain detection for mild lameness grades. Therefore, this study explored pain-related behaviors and facial expressions and sought to identify frequently occurring combinations. Orthopedic pain was induced by intra-articular LPS in eight horses, and objective movement asymmetry analyses were performed before and after induction together with pain assessments at rest. Three observers independently assessed horses in their box stalls, using four equine pain scales simultaneously. Increase in movement asymmetry after induction was used as a proxy for pain. Behaviors and facial expressions commonly co-occurred and were strongly associated with movement asymmetry. Posture-related scale items were the strongest predictors of movement asymmetry. Display of facial expressions at rest varied between horses but, when present, were strongly associated with movement asymmetry. Reliability of facial expression items was lower than reliability of behavioral items. These findings suggest that five body behaviors (posture, head position, location in the box stall, focus, and interactive behavior) should be included in a scale for live assessment of mild orthopedic pain. We also recommend inclusion of facial expressions in pain assessment.

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A Pilot Study of a Functional Pain Assessment for Adult Patients Admitted with Sickle Cell Pain Crisis

Blood ◽

10.1182/blood-2019-124847 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4693-4693

Author(s):

Marquita Nelson ◽

Monica Peek ◽

Kenneth Cohen ◽

Danielle Bowsman ◽

Nabil Abou-Baker

Keyword(s):

Sickle Cell ◽

Acute Pain ◽

Pain Assessment ◽

Assessment Tool ◽

Adult Patients ◽

Free Response ◽

Response Options ◽

Pain Scores ◽

Functional Pain ◽

Pain Crisis

Introduction Acute vaso-occlusive pain crises are the most common complications of sickle cell disease (SCD). Pain is a subjective sensation and is often difficult to describe and for practitioners to understand. The complexity and multidimensional nature of pain requires additional evaluation beyond pain intensity. Pain assessment is also influenced by implicit and explicit biases related to race and ethnicity which can negatively influence treatment (Wandner et al J Pain 2012). In this pilot quality improvement study, we studied resident perceptions to a functional assessment tool in adult patients hospitalized with sickle cell vaso-occlusive crises. We used the Youth Acute Pain Functional Ability Questionnaire (YAPFAQ), a validated questionnaire of physical function in youth experiencing acute pain (Zempsky et al J Pain 2014) (Figure 1). Resident responses to using the YAPFAQ were measured as an initial step to implementation of functional pain assessment in hospitalized adults with SCD pain crises. Methods We piloted this study on internal medicine residents. First, residents completed the Resident Acute SCD Pain Assessment Survey regarding their current management of acute pain in SCD (Figure 2). This was done to determine their baseline demographic information, methods of pain assessment, satisfaction with the numerical pain score system, and to understand barriers in assessing acute pain. This survey included a combination of multiple choice, free response, and binary response options. The residents then trialed the YAPFAQ with a patient admitted with vaso-occlusive pain crisis then the residents completed The Post YAPFAQ Evaluation Survey in response to this assessment tool (Figure 3). This survey included a combination of multiple choice, free response, and binary response options. The goal of this survey was to assess resident satisfaction with YAPFAQ, perceived patient receptiveness to YAPFAQ, and feasibility of using this tool during daily assessments. Patients were not surveyed during this pilot study. We performed descriptive statistics to describe the survey results. Results Sixteen residents completed the Acute SCD Pain Management survey prior to using the YAPFAQ. Sixty-nine percent of residents reported dissatisfaction with using numerical pain scores. Reported barriers to assessing pain included: subjectivity of pain scores, concern for malingering, and the ceiling effect of the numeric scale. Seven residents completed the post YAPFAQ evaluation survey. A majority of residents (86%) were extremely satisfied or satisfied with using the YAPFAQ. Fifty seven percent of residents felt that patients were extremely receptive or receptive to using this tool. The majority of residents (85%) felt that the YAPFAQ improved their understanding of patients' pain. All YAPFAQs were completed with patients in 10 minutes or less. Most residents (57%) reported that the tool would be feasible for implementation on rounds. Conclusions Similar to previous studies, our residents felt that numerical pain score systems inadequately describe pain. Residents had generally positive responses to the YAPFAQ. One resident stated that the questionnaire was "structured and easy to compare day to day." Functional pain assessment allows providers to better understand how pain limits daily activities and can provide useful functional targets for safe hospital discharge. Future directions of this project include performing a larger study of patients hospitalized with vaso-occlusive pain crises to validate the YAPFAQ in adult patients, survey patients regarding experiences with the YAPFAQ, and to create tailored pain management plans based on functional pain assessments. Disclosures No relevant conflicts of interest to declare.

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T4 Impact of Opioid-Minimizing Pain Protocols after Burn Injury

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.003 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S3-S4

Author(s):

Deepanjli Donthula ◽

Christopher R Conner ◽

Van Thi Thanh Truong ◽

Charles Green ◽

Chuantao Jiang ◽

...

Keyword(s):

Acute Pain ◽

Posterior Probability ◽

Linear Models ◽

Rating Scale ◽

Burn Injury ◽

Numeric Rating Scale ◽

Pain Scale ◽

Domain Specific ◽

Lengths Of Stay ◽

Pain Scores

Abstract Introduction Traditionally, opioids have been the mainstay of treatment for background, breakthrough, procedural, and postoperative pain after burns. However, in addition to an impetus to reduce provider-driven opioid exposure, there is increasing evidence that opioids can worsen acute pain through induction of hyperalgesia. In 2019, we implemented a pill-based, opioid-minimizing pain protocol and protocolized moderate sedation for dressing changes. We hypothesized that these protocols would reduce inpatient opioid exposure without increasing acute pain scores. Methods Two groups of consecutive patients admitted to the burn service were compared: Pre (01/2018 to 07/2019) and Post (01/2020 to 06/2020) implementation of the protocols (08/2019 to 12/2019). Patient demographics, burn characteristics, and lengths of stay were abstracted from the burn registry. Opioid exposure and pain scale scores were obtained from the electronic medical record. The primary outcome was total morphine milligram equivalents (MME). Secondary outcomes included MME/day, pain domain specific MME, pain scores, and lengths of stay. Pain was estimated by creating a normalized pain score (range 0–1) from three different pain scales (Numeric Rating Scale, Behavioral Pain Scale, and Behavioral Pain Assessment Scale). Groups were compared using Wilcoxon Rank Sum and Chi Square. Treatment effect was estimated using Bayesian generalized linear models. Results There were no differences in demographics or burn characteristics between the Pre (n=495) and Post groups (n=174), including TBSA burn (Pre 4% [2, 10] versus Post 5% [2, 10], p=0.898). The Post group had significantly lower total MME (IRR 0.72, 95% CrI 0.57–0.93, posterior probability 99%), MME/day (IRR 0.76, 95% CrI 0.65–0.90, posterior probability 99%), and domain-specific total MME (Table). No difference in average normalized pain scores was seen. The Pre group were hospitalized longer than the Post group (5 days [2, 14] versus 4 days [1, 9], p=0.012). Conclusions Implementation of opioid-minimizing protocols for acute burn pain were associated with a significant reduction in inpatient opioid exposure without increased pain scores. More information is needed to understand the association with reduced hospital days.

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Comparison of Self-Reported and Behavioral Pain Assessment Tools in Critically Ill Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066618757450 ◽

2018 ◽

Vol 35 (5) ◽

pp. 453-460 ◽

Cited By ~ 6

Author(s):

Rima H. Bouajram ◽

Christian M. Sebat ◽

Dawn Love ◽

Erin L. Louie ◽

Machelle D. Wilson ◽

...

Keyword(s):

Critically Ill ◽

Pain Assessment ◽

Critically Ill Patients ◽

Strong Correlation ◽

Rating Scale ◽

Assessment Method ◽

Pain Scale ◽

Assessment Tools ◽

Pain Scales ◽

Behavioral Pain Scale

Background:Self-reported and behavioral pain assessment scales are often used interchangeably in critically ill patients due to fluctuations in mental status. The correlation between scales is not well elucidated. The purpose of this study was to describe the correlation between self-reported and behavioral pain scores in critically ill patients.Methods:Pain was assessed using behavioral and self-reported pain assessment tools. Behavioral pain tools included Critical Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS). Self-reported pain tools included Numeric Rating Scale (NRS) and Wong-Baker Faces Pain Scales. Delirium was assessed using the confusion assessment method for the intensive care unit. Patient preference regarding pain assessment method was queried. Correlation between scores was evaluated.Results:A total of 115 patients were included: 67 patients were nondelirious and 48 patients were delirious. The overall correlation between self-reported (NRS) and behavioral (CPOT) pain scales was poor (0.30, P = .018). In patients without delirium, a strong correlation was found between the 2 behavioral pain scales (0.94, P < .0001) and 2 self-reported pain scales (0.77, P < .0001). Self-reported pain scale (NRS) and behavioral pain scale (CPOT) were poorly correlated with each other (0.28, P = .021). In patients with delirium, there was a strong correlation between behavioral pain scales (0.86, P < .0001) and a moderate correlation between self-reported pain scales (0.69, P < .0001). There was no apparent correlation between self-reported (NRS) and behavioral pain scales (CPOT) in patients with delirium (0.23, P = .12). Most participants preferred self-reported pain assessment.Conclusion:Self-reported pain scales and behavioral pain scales cannot be used interchangeably. Current validated behavioral pain scales may not accurately reflect self-reported pain in critically ill patients.

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Validation of the Eleven-Point Pain Scale in the Measurement of Migraine Headache Pain

Cephalalgia ◽

10.1111/j.1468-2982.2007.01283.x ◽

2007 ◽

Vol 27 (4) ◽

pp. 336-342 ◽

Cited By ~ 28

Author(s):

WJ Kwong ◽

DS Pathak

Keyword(s):

Pain Scale ◽

Primary Objective ◽

Pain Scores ◽

Pain Scales ◽

Scale Scores ◽

Headache Pain ◽

Highly Correlated ◽

Using Data ◽

Strong Linear Relationship

The four-point pain scale (none, mild, moderate, severe) and the 11-point pain scale (0 = no pain, 10 = pain as bad as it could be) have been used in migraine studies to assess treatment efficacy. The primary objective of this study was to investigate the validity and responsiveness of the 11-point pain scale using the four-point pain scale as a benchmark. Using data from 95 migraine patients recruited from headache clinics, this study found that 11-point pain scale scores were highly correlated with four-point pain scores. The correlations between the pain scales were significantly higher than the correlations with quality of life measures such as functional ability and emotional feelings. The 11-point pain scale was 55% more sensitive than the four-point pain scale in detecting clinically important differences. The strong linear relationship between the two pain scales allowed researchers to transform four-point pain scores to 11-point pain scores using regression weights.

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The Quality of Pain Treatment in Community-Dwelling Persons with Dementia

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000441717 ◽

2015 ◽

Vol 5 (3) ◽

pp. 470-481 ◽

Cited By ~ 5

Author(s):

Jiwen Li ◽

A. Lynn Snow ◽

Nancy Wilson ◽

Melinda A. Stanley ◽

Robert O. Morgan ◽

...

Keyword(s):

Pain Assessment ◽

Medical Records ◽

Pain Treatment ◽

Pain Scale ◽

Veterans Affairs ◽

Community Dwelling ◽

Pain Scales ◽

Pain Care

Background/Aims: Despite pervasive and debilitating pain among elders, it is underassessed and undertreated; and cognitive impairment can add challenges. We assessed the quality of pain care for community-dwelling elderly patients with dementia. Methods: We phone interviewed 203 Veterans Affairs primary care outpatients with dementia and pain and reviewed medical records to score 15 quality indicators of pain assessment and management. Results: Pain assessment was documented for 98%, and a standard pain scale was used for 94%. Modified pain scales were rarely used. Though 70% self-reported pain of ‘quite bad' or worse, charts documented no pain in 64%. When pain was identified, treatment was offered to 80%; but only 59% had a follow-up assessment within 6 months. Nonpharmacological interventions were underused. Conclusion: Community-dwelling elders with dementia are underdiagnosed and undertreated for pain.

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