December 2020

In this VETgirl online veterinary continuing education blog, Amy Newfield, CVT, VTS (ECC) reviews how to pain score cats with the new Feline Grimace Scale.

Pain Scoring: Feline Grimace Scale
Amy Newfield, CVT, VTS (ECC)

Cats love to hide pain. They pretend they are fine so that everyone around them still thinks they are the fearless predator they want to be. The don’t pant and rarely vocalize. They don’t whine or cry. Instead they sit in silence and suffer in pain…or do they?

Thanks to many dedicated veterinary professionals, the Feline Grimace Scale was developed. The Feline Grimace Scale was developed by the Veterinary Teaching Hospital (CHUV – Centre hospitalier universitaire vétérinaire) of the Faculty of Veterinary Medicine, Université de Montréal. The team wanted to analyze facial expressions in cat to identify pain that was easy to interrupt by the veterinary professional.

Clients consented to the teaching hospital recording their cats before and after pain medication. Cat friendly techniques were used. Through watching countless of hours of video the team was able to identify four unique facial changes that cats performed when painful. Instead of obvious vocalizing painful cats will make changes in their:

• Ear position
• Orbital tightening
• Muzzle tension
• Whiskers position

Comfortable Cats:
In cats that were comfortable the researchers noted:
• Ears faced forward
• Eyes fully opened
• Face was round and relaxed
• Whiskers were loose and curved
• Head is above their shoulders

Mild to Moderate Pain:
• Eyes are not fully open
• Ears are pulled slightly apart
• Muzzle is tense
• Whiskers are slightly curved or straight
• Head is aligned with shoulders

Moderate to Severe Pain:
• Ears are flattened and rotated outwards
• Eyes are squinted
• Muzzle is tense
• Whiskers are straight and moving forwards
• Head is below the shoulders or tilted down

For each one of these facial features that are affected a point value is assigned. When a cat is assigned a point scale of greater than four then pain medication must be considered or the patient evaluated every 10-15 minutes to look for changes in the facial markers.

The Feline Grimace Scale is a fast and accurate tool that uses data to help the veterinary team drive decisions for better pain management in cats. Too often unless cats are vocalizing or visibly shaking the pain signs are missed. Cats are silent, but do exhibit signs of pain. Based on the score for the scale the veterinary team can make more informed clinical decision in pain management.

All veterinary professional should be aware of and comfortable with the Feline Grimace Scale. It should be hung in the treatment area where feline patients are housed as a visual reminder to look and assess feline patient’s pain.

To test your skills, download the chart and read the data go to:

Feline Grimace Score VETgirl blog

  1. This is amazing! Kind of one of those things you know when you see it, but how ingenious to come up with an objective scoring system for a cat’s facial expression. Thank you for posting this, I’m going to share it with the staff I work with.

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