Do brachycephalic cats present pain scoring challenges?
- zeropainphilosophy
- Jan 25
- 3 min read
In a recent publication, Marangoni et al set out to investigate the Feline Grimace Scale in brachycephalic cats. Specifically, then examined the inter-rater reliability, agreement and responsiveness of the FGS in this demographic.
Remember, the FGS looks at five specific 'action units' which are ear position, orbital tightening, muzzle tension, whiskers position and head position. The scale assigns a score out of 10, with 10 being most painful. This therefore raises the question about whether the FGS would accurately assess pain in these cats.
In this study the cats that were assessed were cats with ocular pain, which the authors describe as 'ocular manifestations involving pathologies that could induce acute pain (eg, ulcerative keratitis, corneal sequestration, glaucoma, eosinophilic keratitis'.
Video recordings were made of the cats, after a 10-minute acclimatisation period. Cats undisturbed and filmed for 10 minutes. Pain scoring was performed after video recording using the UNESP-Botucatu Feline Pain Scale-Short Form (UFEPS-SF) and the FGS. Video recordings and pain assessment were conducted at the following time points:
-Before surgery and the administration of premedication/analgesia (baseline)
-40–60 mins after premedication/analgesia
-2 h after the end of surgery
-Approximately 30 mins after the administration of postoperative analgesia.
Video recordings and pain scoring were performed by one trained female observer with over 10 years of experience in feline medicine and surgery.
Images were captured to show frontal facial orientation with visible AUs and overall representativeness of the video content. These were assessed by 4 vets using the FGS.
A total of 28 brachycephalics of the following breeds were included (Exotic Shorthair (n = 13), Persian (n = 5), British Shorthair (n = 5), British Longhair (n = 3), Scottish Fold (n = 1) and Devon Rex (n = 1). Ocular surgery included lamellar keratectomy (with or without grafting for corneal ulcers or corneal sequestrum) (n = 17) and enucleation (n = 8). Non-surgical cases included ulcerative keratitis (n = 3). A total of 95 images were captured, and 8 excluded from analysis.
Inter-rater reliability was poor for muzzle tension and whiskers change, good for ear position and orbital tightening, moderate for head position and good for FGS total ratio scores. On the basis of the scores from the 4 assessors, 66 (77.64%), 65 (76.47%), 64 (75.29%) and 60 (70.59%) of the images would have surpassed the threshold for rescue analgesia.
The mean FGS total ratio scores decreased after analgesia pre and postoperatively which is a reassuring finding for those of us working with these cats trying to assess their pain. This confirms the responsiveness of the FGS.
Overall, the results demonstrate that inter-rater reliability was good using ICCsingle and excellent using ICCaverage for FGS total ratio scores. This refers to individual results versus combining them with other assessors. This is useful to know for us in practice - it helps to ask someone else to pain score with you!
Part of the study looked at FGS results with and without an e collar. The recommendations of the researchers is that ideally, e-collars should be removed during pain assessment so they do not bias evaluations in these cats.
The concluding statement from the paper is 'these findings underscore both the clinical applicability and limitations of the FGS in brachycephalic cats, emphasising the importance of comprehensive real-time pain assessment and continuous monitoring for effective pain management'. Our recommendation? Use the FGS for assessing brachycephalic cats with ocular pain, and remove the e collar for assessment if you can!
References
Marangoni S, Chow D, Garbin M, St Denis K, Bosmans T, Bukhari SSUH, Vanore M, Steagall PV. Challenges using the Feline Grimace Scale in brachycephalic cats with ocular pain. J Feline Med Surg. 2026 Jan;28(1)
Comments