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Veterinary practice7 min readUpdated on August 17, 2026

Recognising and scoring pain in practice: scales, ward workflow and records

Scoring pain with validated scales makes it a parameter like temperature and heart rate. Here is how to choose them, embed them in the ward and record them.

Audience
Veterinarians
Species
Dog, Cat
Scope
Valid everywhere, European Union, Italy

For years pain in veterinary medicine was judged by eye, with subjective assessments that varied from one clinician to another and from shift to shift. The result was undertreated animals, slower recoveries and families who sensed their pet's suffering better than the staff did. The turning point was to make pain a measurable parameter, the so called fourth or fifth vital sign, assessed with validated scales and recorded on the chart alongside temperature, heart rate and respiratory rate. This changes the practice at a deep level: it makes analgesic therapy a decision based on a score rather than an impression, lets different people's assessments be compared, and creates a record that documents the plan's effectiveness. This page is written for the clinical team: it explains why to measure, which tools to choose for dogs and cats, and how to fit pain assessment into the ward workflow without weighing it down.

Why measure instead of estimate

Subjective estimation of pain is unreliable by definition. Repeated studies show that different clinicians assign very different pain levels to the same animal, and that feline pain in particular is systematically underestimated. A validated scale reduces this variability, because it anchors the judgement to observable, shared behaviours.

  • Consistency between staff: a score from the same scale is comparable between whoever assessed in the morning and whoever assesses in the evening.
  • Clear intervention threshold: the scale defines the value beyond which analgesia should be reviewed, removing the individual's hesitation.
  • Defensible documentation: a recorded score shows that pain was sought and managed, a mark of quality and professional protection.
  • Faster recovery: controlled pain reduces stress, encourages eating and mobilisation and shortens the length of stay.
  • Client trust: showing that pain is measured and treated strengthens the perception of care and the relationship with the family.

Which scales to use for dogs and cats

Not all scales are equivalent, and the choice depends on the species and the context. Validated behavioural scales observe the animal and its spontaneous behaviour, without relying solely on the reaction to handling. It pays to adopt a few and use them uniformly across the whole practice.

Pain assessment tools by context
ContextSuitable toolWhat it observes
Acute pain in dogsComposite behavioural scale for dogsPosture, vocalisation, attention to the wound, response to touch, mobility
Acute pain in catsComposite behavioural scale for catsPosture, activity, response to palpation of the area, attitude
Feline facial expressionFeline facial expression scaleEars, muzzle, eyes, whiskers, head position
Chronic pain and osteoarthritisOwner completed questionnairesDaily activity, mobility, mood, changes over time

In cats, assessing facial expression is especially useful because it captures subtle signals the animal does not express through vocalisation. In chronic pain, by contrast, the best vantage point is the family, who sees the animal in its own environment and over time: owner completed questionnaires give information a consultation cannot capture. The practical rule is to choose the tool by the clinical question, not to use a single one for everything.

Embedding assessment in the ward workflow

A scale is useful only if it is used regularly. The risk is that pain assessment stays a theoretical intention overwhelmed by the ward's pace. To prevent that, it should be built into the workflow as a scheduled step, with defined responsibilities and timing.

  1. Set one scale per species

    Choose and adopt across the practice one scale for dogs and one for cats, so everyone assesses by the same measure and scores are comparable between shifts and staff.

  2. Decide when to assess

    Fix precise moments: on admission, after surgery at regular intervals, before and after each analgesic dose and before discharge. Regularity matters more than frequency.

  3. Assign responsibility

    Make clear who assesses and records, usually the nursing staff, and how they flag a threshold breach to the clinician in charge of the case.

  4. Link the score to an action

    Define in advance what happens above threshold: review of the analgesic plan, a call to the clinician, a fresh measurement after a set interval.

  5. Record next to the vitals

    Note the score, the scale used, the time and the assessor in the same section as the vital parameters, so the pain trend reads over time like a curve.

  6. Reassess and document the effect

    After every analgesic intervention measure again within a defined interval and note the response, to show effectiveness or the need to adjust the plan.

Common mistakes and how to avoid them

Adopting a scale is not enough: how it is used is what counts. A few recurring mistakes drain the assessment of meaning and should be recognised so they can be corrected.

  1. Assessing only the reaction to handling, ignoring posture and spontaneous behaviour that often say more.
  2. Underestimating feline pain, since the cat tends to hide suffering by staying still and silent, behaviour easily mistaken for calm.
  3. Switching scale between staff, making scores incomparable and negating the trend over time.
  4. Measuring without linking the score to an action, so the assessment stays a number no one uses to decide.
  5. Failing to reassess after therapy, losing the most important information, namely whether the analgesic plan is working.
  6. Neglecting chronic pain because it is less visible in consultation, when it is precisely the owner who can document it over time.

The common thread of these mistakes is treating measurement as a formality rather than a decision tool. When the pain score genuinely drives therapeutic choices, the practice gains in quality of care, in recovery times and in the relationship with families, who clearly perceive a systematic attention to their animal's wellbeing.

Frequently asked questions

How often should pain be reassessed after surgery?
There is no single interval, because it depends on the procedure, the analgesics used and the animal's condition. The practical principle is to reassess at regular intervals and always before and after each dose, so the response to therapy is documented. In the more demanding cases intervals are closer in the first hours, then widen as pain settles below the intervention threshold defined by the scale.
Why is feline pain harder to recognise?
The cat tends to hide suffering by staying still, silent and withdrawn, behaviour easily mistaken for calm. The signs are subtle and pass mainly through facial expression, a hunched posture and reduced activity and grooming. That is why feline scales that include observing the face are especially useful and reduce the well documented risk of undertreating pain in this species.
Does a pain scale slow the ward down?
If well integrated, no. An assessment with a validated scale takes a few minutes and, once part of the routine, is done alongside recording the other vital parameters. The time spent is amply recovered: controlled pain reduces complications, encourages eating and mobilisation and shortens the stay. The real cost is not the measurement but untreated pain that prolongs recovery and undermines client trust.
How do I involve the owner in assessing chronic pain?
In chronic pain the owner is the best observer, because they see the animal in its environment and over time. Providing a validated questionnaire to complete at home, focused on mobility, daily activity and mood, captures changes a single consultation does not show. Comparing questionnaires weeks apart makes the trend visible and turns vague impressions into data useful for adjusting therapy.

What to do next

Turn pain into a measurable parameter: adopt a validated scale for dogs and one for cats, use them uniformly across the practice and record the score on the chart next to the vitals. Fix when to assess, who does it and what happens above threshold, and always reassess after each analgesic to document the effect. Pay particular attention to the cat, which hides pain, and to chronic pain, where the owner is the key observer. A measurement linked to an action improves recovery, quality of care and the trust of families.

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Recognising and scoring pain in practice: scales, ward workflow and records · Animiyo