Clinical validation of the short and long UNESP-Botucatu scales for feline pain assessment

Abstract

Background The UNESP-Botucatu multidimensional feline pain assessment scale (UFEPS) is a valid and reliable instrument for acute pain assessment in cats. However, its limitations are that responsiveness was not tested using a negative control group, it was validated only for ovariohysterectomy, and it can be time-consuming. We aimed to evaluate the construct and criterion validity, reliability, sensitivity, and specificity of the UFEPS and its novel short form (SF) in various clinical or painful surgical conditions. Methods Ten client-owned healthy controls (CG) and 40 client-owned cats requiring pain management for clinical or surgical care (20 clinical and 20 surgery group (12 orthopedic and eight soft tissue surgeries) were recruited. Three evaluators assessed pain, in real-time, in clinical cases before and 20 min after rescue analgesia and in surgical cases before and up to 6.5 hours postoperatively, by using the visual analog, numerical ratio, and a simple descriptive scale, in this order, followed by the UFEPS-SF, UFEPS and Glasgow multidimensional feline pain (Glasgow CMPS-Feline) in random order. For the surgical group, rescue analgesia (methadone 0.2 mg/kg IM or IV and/or dipyrone 12.5 mg/kg IV) was performed when the UFEPS-SF score was ≥4 or exceptionally according to clinical judgement. If a third interventional analgesia was required, methadone (0.1–0.2 mg/kg IM) and ketamine (1 mg/kg IM) were administered. For the clinical group, all cats received rescue analgesia (methadone 0.1–0.2 mg/kg IM or IV or nalbuphine 0.5 mg/kg IM or IV), according to the clinician in charge, regardless of pain scores. Construct (1—comparison of scores in cats undergoing pain vs pain-free control cats by unpaired Wilcoxon-test and 2—responsiveness to analgesia by paired Wilcoxon test) and concurrent criterion validity (Spearman correlation of the total score among scales), inter-rater reliability, specificity and sensitivity were calculated for each scale (α = 0.05). Results Reliability ranged between moderate and good for the UFEPS and UFEPS-SF (confidence intervals of intraclass coefficients = 0.73–0.86 and 0.63–0.82 respectively). The Spearman correlation between UFEPS and UFEPS-SF was 0.85, and their correlation with Glasgow CMPS-Feline was strong (0.79 and 0.78 respectively), confirming criterion validity. All scales showed construct validity or responsiveness (higher scores of cats with clinical and postoperative pain vs healthy controls, and the reduction in scores after rescue analgesia). The sensitivity and specificity of the UFEPS, UFEPS-SF and Glasgow CMPS-Feline were moderate (sensitivity 83.25, 78.60% and 74.28%; specificity 72.00, 84.67 and 70.00%, respectively). Conclusions Both UFEPS and UFEPS–SF showed appropriate concurrent validity, responsiveness, reliability, sensitivity, and specificity for feline acute pain assessment in cats with various clinical and orthopedic and soft tissue surgical conditions.

Multilingual validation of the short form of the Unesp-Botucatu Feline Pain Scale (UFEPS-SF)

“…The prototype Unesp-Botucatu Feline Pain Scale (UFEPS) was refined in 2011 ( Brondani, Luna & Padovani, 2011 ) and the full scale validated in 2013 ( Brondani et al, 2013b ). Afterward, the development of other feline specific pain assessment tools ( Calvo et al, 2014 ; Reid et al, 2017 ; Evangelista et al, 2019 ; Belli et al, 2021 ) improved recognition of pain-related behavior and veterinary health care attitudes towards the provision of analgesia ( Simon et al, 2017 ; Steagall & Monteiro, 2019 ;).…”

“…Unidimensional (visual analogue, simple descriptive and numerical) scales are more straightforward when compared to composite scales. However, they are subjective, have limited reproducibility ( Holton et al, 1998 ; Martinez-Martin, 2010 ; Belli et al, 2021 ), and may have ambiguous meaning ( Martinez-Martin, 2010 ) since they do not encompass the multiple dimensions of pain ( Robertson, 2018 ). On the other hand, composite and multidimensional scales have better consistency and accuracy than unidimensional ones because they evaluate different dimensions of pain ( Martinez-Martin, 2010 ).…”

Current Advances in Assessment of Dog’s Emotions, Facial Expressions, and Their Use for Clinical Recognition of Pain

“…In this scale, psychomotor and facial aspects are considered a means of manifestation of pain through changes in facial expression. These include assessing the distance between the ears and the facial muscles’ tension as distinctive features of pain recognition with a sensitivity of 74.6% and specificity of 84.6% [ 152 , 153 ]. This has been used to evaluate postoperative analgesia in procedures such as tibial plateau leveling osteotomies [ 151 ] or to determine the perioperative efficacy of opioid drugs such as tramadol during canine sterilization [ 154 ].…”

2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats

“…[3][4][5][6] Moreover, there are now three scales with reported validity for acute feline pain assessment that take into consideration facial expressions and the cat's unique behaviour. [7][8][9][10] All three provide clinical guidance on the need for analgesia when a cut-off value is reached. However, rescue interventions may be administered even when the cut-off is not reached if the veterinarian feels that the cat could be in pain.…”