For a long time, cats received fewer analgesics compared to dogs. This profile has recently changed with the creation of specific scales to assess pain in this species. The pioneering and most referenced scale to date is the Unesp-Botucatu Multidimensional Scale for the assessment of postoperative pain in cats (UFEPS – Unesp-Botucatu feline pain scale), validated in Portuguese, English, French, Spanish and Italian.
This instrument, pioneering in the world scientific literature, presents a numerical criterion indicative of the need for analgesic intervention, that is, a value that represents a cut-off point from which the use of analgesics is recommended. This is a very important guide to apply the scale in clinical and experimental practice.
To make the assessment more practical and faster, we developed and validated the short version of the UFEPS (UFEPS-SF – UFEPS Short Form). The items appetite and blood pressure were removed and others were combined, which facilitates its use in clinical situations. The UFEPS-SF has been validated in eight languages (Portuguese, English, French, Spanish, Italian, German, Chinese, and Japanese).
Read the topics below to learn about and use the scale.
Unesp-Botucatu Multidimensional Scale to assess pain in cats (UFEPS)
The Unesp-Botucatu Multidimensional Scale to assess pain in cats (UFEPS) presents 10 characteristics divided into 3 dimensions or subscales:
1) Psychomotor alteration (posture, comfort, activity, attitude, miscellaneous behaviors)
2) Protection of the painful area (reaction to palpation of the affected area, reaction to palpation of the abdomen/flank)
3) Physiological variables (blood pressure, appetite)
Each characteristic is scored from 0 (normal state) to 3 (greatest possible pain).
Assessment guidelines:
The multidimensional structure of the scale allows the separate use of two of the three dimensions (subscales), which have an independent analgesic cut-off point. For example, when the animal does not allow the evaluation (“protection of the painful area” or “physiological variables”) or due to technical difficulties (“physiological variables”), these subscales (dimensions) may not be evaluated and evaluation may be based only in subscale “psychomotor change”, including or not subscale “pain expression”.
For each item or characteristic, choose only one item (score) referring to the highest score representing the animal’s behavior.
Initially observe the cat’s behavior without opening the cage. Observe whether it is resting or active; interested or uninterested in its surroundings; quiet or vocal. Check for the presence of specific behaviors (see “miscellaneous behaviors” above).
Open the cage and observe whether the cat quickly moves out or hesitates to leave the cage. Approach the cat and evaluate its reaction: friendly, aggressive, frightened, indifferent, or vocal. Touch the cat and interact with it, check whether it is receptive (if it likes to be stroked and/or is interested in playing). If the cat hesitates to leave the cage, encourage it to move through stimuli (call it by name and stroke it) and handling (change its body position and/or take it out of the cage).
Observe the cat when outside the cage, if it moves spontaneously, in a reserved manner, or is reluctant to move. Offer it palatable food and observe its response (*to evaluate appetite during the immediate postoperative period, initially offer a small quantity of palatable food immediately after recovery from anesthesia. At this moment most cats eat normally independent of the presence or absence of pain. Wait a short while, offer food again, and observe the cat’s reaction).
Finally, place the cat in lateral or sternal recumbency and measure its arterial blood pressure. Evaluate the cat’s reaction when the abdomen/flank is first touched (slide your fingers over the area) and in sequence gently pressed (apply direct pressure over the area). Wait for a time, and carry out the same procedure to assess the cat`s reaction to palpation of the affected area.
UFEPS – Unesp-Botucatu Feline Pain Scale
SUBESCALE 1: PSYCOMOTOR CHANGE (0 – 12) – cut-off score for indication of rescue analgesia > 3
1. Posture
Score
Videos
The cat is in a natural posture with relaxed muscles (it moves normally)
0
The cat is in a natural posture but is tense (it moves little or is reluctant to move)
1
The cat is sitting or in sternal recumbency with its back arched and head down; or the cat is in dorso-lateral recumbency with its pelvic limbs extended or contracted
2
The cat frequently alters its body position in an attempt to find a comfortable posture
3
2. Comfort
Score
Videos
The cat is comfortable, awake or asleep, and interacts when stimulated (it interacts with the observer and/or is interested in its surroundings)
0
The cat is quiet and slightly receptive when stimulated (it interacts little with the observer and/or is not very interested in its surroundings)
1
The cat is quiet and “dissociated from the environment” (even when stimulated it does not interact with the observer and/or has no interest in its surroundings). The cat may be facing the back of the cage
2
The cat is uncomfortable, restless (frequently changes its body position), and slightly receptive when stimulated or “dissociated from the environment”. The cat may be facing the back of the cage
3
3. Activity
Score
Videos
The cat moves normally (it immediately moves when the cage is opened; outside the cage it moves spontaneously when stimulated or handled)
0
The cat moves more than normal (inside the cage it moves continuously from side to side)
1
The cat is quieter than normal (it may hesitate to leave the cage and if removed from the cage tends to return, outside the cage it moves a little after stimulation or handling)
2
The cat is reluctant to move (it may hesitate to leave the cage and if removed from the cage tends to return, outside the cage it does not move even when stimulated or handled)
3
4. Attitude: Observe and mark the presence of the mental states listed below
Videos
A – Satisfied: The cat is alert and interested in its surroundings (explores its surroundings), friendly and interactive with the observer (plays and/or responds to stimuli). The cat may initially interact with the observer through games to distract it from the pain. Carefully observe to distinguish between distraction and satisfaction games
B – Uninterested: The cat does not interact with the observer (not interested by toys or plays a little; does not respond to calls or strokes from the observer). In cats which don’t like to play, evaluate interaction with the observer by its response to calls and strokes
C – Indifferent: The cat is not interested in its surroundings (it is not curious; it does not explore its surroundings). The cat can initially be afraid to explore its surroundings. The observer needs to handle the cat and encourage it to move itself (take it out of the cage and/or change its body position)
D – Anxious: The cat is frightened (it tries to hide or escape) or nervous (demonstrating impatience and growling, howling, or hissing) when stroked and/or handled
E – Aggressive: The cat is aggressive (tries to bite or scratch when stroked or handled)
Score
Presence of the mental state A
0
Presence of one of the mental states B, C, D, or E
1
Presence of two of the mental states B, C, D, or E
2
Presence of three or all of the mental states B, C, D, or E
3
SUBESCALE 2: PAIN EXPRESSION (0 – 12) – cut-off score for indication of recue analgesia > 2
1. Miscellaneous behaviors: Observe and mark the presence of the behaviors listed below.
Videos
A – The cat is laying down and quiet, but moving its tail
B – The cat contracts and extends its pelvic limbs and/or contracts its abdominal muscles (flank)
C – The cats eyes are partially closed (eyes half closed)
D – The cat licks and/or bites the affected area
Score
All above behaviors are absent
0
Presence of one of the above behaviors
1
Presence of two of the above behaviors
2
Presence of three or all of the above behaviors
3
2. Vocalization
Score
Videos
The cat is quiet, purring when stimulated, or miaows interacting with the observer, but does not growl, groan, or hiss
0
The cat purrs spontaneously (without being stimulated or handled by the observer)
1
The cat growls, howls, or hisses when handled by the observer (when its body position is changed by the observer)
2
The cat growls, howls, hisses spontaneously (without being stimulated or handled by the observer)
3
3. Reaction to palpation of the abdomen/flank
Score
Videos
The cat does not react when the abdomen/flank is touched or pressed; or no change from pre-surgical response (if basal evaluation was made). The abdomen/ flank is not tense
0
The cat does not react when the abdomen/ flank is touched, but does react when it is pressed. The abdomen/flank is tense
1
The cat reacts when the abdomen/ flank is touched and when pressed. The abdomen/flank is tense
2
The cat reacts when the observer approaches the abdomen/ flank. It may vocalize and/or try to bite.
3
4. Reaction to palpation of the affected area
Score
Videos
The cat does not react when the affected area is touched or pressed; or no change from pre-surgical response (if basal evaluation was made)
0
The cat does not react when the affected area is touched, but does react when it is pressed. It may vocalize and/or try to bite
1
The cat reacts when the affected area is touched and when pressed. It may vocalize and/or try to bite
2
The cat reacts when the observer approaches the affected area. It may vocalize and/or try to bite
3
SUBESCALE 3: PHYSIOLOGICAL VARIABLE (0 – 6) – cut-off score for indication of recue analgesia is not available
1. Arterial blood pressure
Score
0% to 15% above pre-surgery value
0
16% to 29% above pre-surgery value
1
30% to 45% above pre-surgery value
2
> 45% above pre-surgery value
3
2. Appetite
Score
Videos
The cat is eating normally
0
The cat is eating more than normal
1
The cat is eating less than normal
2
The cat is not interested in food
3
Total
30
After watching the videos corresponding to all sub-items of each item on the scale, watch the test videos, and analyze and score the behaviors. Then check the responses for each video. You are able to use the scale when your scores are up to 20% higher or lower than the template scores in at least three tests.
Decision to perform analgesia*
Maximum score
Analgesic intervention score
(cut-off point)
Full scale
30
≥ 8
Subscale 1 – psychomotor alteration
12
≥ 4
Subscale 2 – expression of pain
12
≥ 3
Subscales 1 + 2
≥ 7
* Regardless of the score, it is up to the veterinarian to decide whether or not to use analgesics, according to clinical evaluation.
After reading and training the previous items, click below to assess pain in your animal.
Short Form of the Unesp-Botucatu Multidimensional Feline Pain Assessment Scale (UFEPS-SF)
UFEPS-SF -Short Form of the Unesp-Botucatu Feline Pain Scale (UFEPS-SF)
PSYCHOMOTOR CHANGES
Score
Videos
1. Evaluate the cat’s posture in the cage for 2 minutes
Natural, relaxed and/or moves normally
0
Natural but tense, does not move or moves little or is reluctant to move
1
Hunched position and/or dorso-lateral recumbency
2
Frequently changes position or restless
3
2. Please tick where applicable
Videos
The cat contracts and extends its pelvic limbs and/or contracts its abdominal muscles (flank)
The cat’s eyes are partially closed (do not consider this item if present until 1h after the end of anesthesia)
The cat licks and/or bites the affected area
The cat moves its tail strongly
Score
All above behaviors are absent
0
Presence of one of the above behaviors
1
Presence of two of the above behaviors
2
Presence of three or all of the above behaviors
3
Score
Videos
3. Evaluation of comfort, activity and attitude after the cage is open and how attentive the cat is to the observer and/or surroundings
Comfortable and attentive
0
Quiet and slightly attentive
1
Quiet and not attentive. The cat may face the back of the cage
2
Uncomfortable, restless and slightly attentive or not attentive. The cat may face the back of the cage
3
PROTECTION OF THE AFFECTED AREA
Score
Videos
1. Evaluation of the cat’s reaction when touching, followed by pressuring around the painful site
Does not react
0
Does not react when the painful site is touched, but does react when it is gently pressed
1
Reacts when the painful site is touched and when pressed
2
Does not allow touch or palpation
3
After watching the videos corresponding to all sub-items of each item on the scale, watch the test videos, and analyze and score the behaviors. Then check the responses for each video. You are able to use the scale when your scores are up to 20% higher or lower than the template scores in at least three tests.
Decision to perform analgesia*
Score
Analgesic intervention score
(cut-off point)
UFEPS-SF
0 to 12
≥ 4
UFEPS-SF: items 1 + 2 + 3 (excluding item 4 – reaction to touch)**
0 to 9
≥ 3
UFEPS-SF diagnostic uncertainty zone: scores between 3 and 5
Numerical scale
1 to 10
≥ 4
Simple descriptive scale
1 to 4
≥ 3
Visual analogue scale
0 – 100 mm
≥ 31 mm
* Regardless of the score, it is up to the veterinarian to decide whether or not to use analgesics, according to clinical evaluation.
** When it is not possible to palpate the painful area.
After reading and training the previous items, click below to assess pain in your animal.