# Postoperative Pain Scoring and Analgesic Adjustment


## Key Takeaways

- Utilize validated composite pain scales (e.g., University of Melbourne Pain Scale for dogs, UNESP-Botucatu or Feline Grimace Scale for cats) for consistent, objective assessment of postoperative pain, integrating behavioral, postural, and interactive responses.
- Implement serial pain scoring at regular intervals (e.g., every 2-4 hours for the first 24 hours), with frequency adjusted based on procedure invasiveness, and interpret rising or static scores as indicators of inadequate analgesia, not measurement error.
- Administer analgesics preemptively (preoperatively) to block nociceptive input, reducing central sensitization and improving early postoperative pain control compared to postoperative administration alone.
- Employ a multimodal analgesic approach by combining drug classes with different mechanisms of action (e.g., NSAIDs with opioids or local anesthetics) to manage diverse pain pathways and address breakthrough pain effectively.
- Reassess pain scores 30-60 minutes post-intervention to document analgesic efficacy and promptly investigate non-response, considering differential diagnoses such as dysphoria, hypothermia, or surgical complications.
- Meticulously document all pain scores, analgesic interventions, and patient responses in the medical record to enable trend analysis, support clinical decision-making, and facilitate effective communication between veterinary team members.

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Postoperative pain assessment in dogs and cats is a clinical skill that directly determines analgesic adequacy, patient comfort, and recovery quality. This article reviews validated pain scoring tools for canine and feline patients and provides a structured framework for adjusting analgesic plans based on serial scores. It serves practicing veterinarians who need a procedural approach to pain monitoring in the postoperative period, from the first assessment after extubation through the days following discharge. The scope covers scoring instrument selection, interpretation, and analgesic titration. Intraoperative anesthesia management is excluded.

The clinical question at the center of this article is practical: when a score rises or fails to fall, what does the clinician do next? Answering that question requires familiarity with the psychometric properties of available scales, an understanding of how analgesic timing and drug class affect scores, and a decision framework that converts observations into interventions. The evidence base for veterinary pain scoring has grown substantially, yet surveys of veterinary personnel continue to show variability in how pain is assessed and whether formal scoring systems are used at all. In one survey of veterinary paraprofessionals in New Zealand, 93% of respondents reported that surgery warrants analgesic therapy, but the use of formal pain scoring systems in practice was inconsistent, reflecting a gap between recognition of pain and systematic measurement.

## At a Glance

| Parameter | Clinical Decision Point |
|---|---|
| Scoring tool selection | Use a validated composite scale (for example, the University of Melbourne Pain Scale) or a dynamic interactive visual analog scale (DIVAS) appropriate to the species and procedure |
| Assessment frequency | Score at extubation, then at regular intervals (for example, every 2 to 4 hours) during the first 24 hours, with frequency adjusted to procedure invasiveness |
| Score trend interpretation | A rising score or a score that fails to decline over consecutive assessments indicates inadequate analgesia, not measurement error |
| Rescue analgesia threshold | Defined by the specific scale's published intervention cutoffs, do not extrapolate thresholds across different instruments |
| Analgesic timing | Preoperative administration of nonsteroidal anti-inflammatory drugs provides superior early postoperative analgesia compared with postoperative administration |
| Multimodal approach | Combine drug classes with different mechanisms to reduce reliance on any single agent and to manage breakthrough pain |
| Reassessment interval after intervention | Re-score within 30 to 60 minutes after rescue analgesia to document response |
| Documentation | Record scores in the medical record to enable trend analysis and to support clinical decisions |

## Physiology of Postoperative Pain and Its Measurement

Surgical trauma generates pain through multiple mechanisms: incisional nociception, inflammatory mediator release, visceral distension or traction, and neuroplastic changes in the dorsal horn. These mechanisms operate on different time courses. Incisional pain peaks early, inflammatory pain evolves over hours, and central sensitization can amplify both. A single analgesic agent rarely covers all mechanisms, which is why multimodal protocols are standard. The practical consequence for scoring is that a patient may show adequate scores at one time point and inadequate scores later, as drug effects wane or as inflammatory pain escalates.

Pain scoring instruments attempt to convert behavioral and physiological observations into a numeric value. Two broad categories exist. Unidimensional scales, such as simple descriptive scales or visual analog scales, capture pain intensity alone. Composite scales, such as the University of Melbourne Pain Scale, integrate multiple domains including behavior, posture, vocalization, wound response, and interactive responses. Composite scales are generally preferred for postoperative assessment because they capture the multifaceted nature of pain and are less susceptible to observer bias than a single global judgment.

The dynamic interactive visual analog scale (DIVAS) deserves specific mention because it appears repeatedly in the postoperative analgesia literature. DIVAS involves the observer scoring pain on a 100 mm line before and after interaction with the patient, such as gentle palpation of the surgical site or encouragement to move. The interaction component is critical: it reveals pain that is masked when the patient is undisturbed. Studies comparing analgesic protocols in dogs undergoing ovariohysterectomy have used DIVAS alongside composite scales to detect differences between treatment groups, demonstrating that the instrument is sensitive enough to distinguish between drug regimens.

## Validated Scoring Instruments for Dogs and Cats

The University of Melbourne Pain Scale (UMPS) is one of the most widely cited composite scales for dogs. It assigns points across six categories: behavioral changes, response to palpation, activity, posture, vocalization, and wound appearance. Each category contains descriptors with weighted scores, and the total ranges from 0 to a maximum that varies by version. The scale has been used as a primary outcome measure in clinical trials comparing analgesic protocols, including studies of paracetamol versus meloxicam and carprofen in bitches after ovariohysterectomy. In that study, all three drugs produced gradual reductions in UMPS scores over 48 hours, confirming the scale's ability to track the expected postoperative pain trajectory.

For cats, validated scales include the UNESP-Botucatu Composite Pain Scale and the Feline Grimace Scale. The UNESP-Botucatu scale incorporates interactive assessment and has published intervention thresholds. The Feline Grimace Scale relies on facial expression changes, specifically ear position, orbital tightening, muzzle tension, whisker position, and nose appearance. Grimace scales have the advantage of requiring minimal handling, which is valuable in cats that become distressed with restraint. However, grimace scales capture a narrower aspect of the pain experience than composite scales, and they should not be used as the sole assessment method in patients with significant surgical pain.

A critical principle applies to all instruments: a score is only meaningful if the observer applies the instrument consistently and if the instrument has been validated for the species and context in which it is used. Using a canine scale on a cat, or applying a scale designed for acute pain to a chronic pain patient, produces numbers that do not correspond to the patient's actual pain experience. The choice of instrument should be documented in the medical record, and all personnel involved in postoperative monitoring should be trained in its use.

## Analgesic Timing and Its Effect on Scores

The timing of analgesic administration relative to surgery has a measurable effect on postoperative pain scores. In a prospective, randomized, double-blind trial of dogs undergoing ovariohysterectomy, carprofen administered preoperatively produced lower pain scores than carprofen administered postoperatively, with the difference significant at 2 hours after extubation. The same study found that plasma carprofen concentrations were not related to the degree of analgesia achieved, indicating that the timing of drug administration matters for reasons beyond simple pharmacokinetics. Preemptive analgesia, by blocking nociceptive input before it reaches the central nervous system, reduces central sensitization and lowers the analgesic requirement in the early postoperative period.

This finding has direct implications for scoring. A patient that received preemptive analgesia will typically show lower initial scores than a patient that received the same drug after surgery. Clinicians interpreting scores must therefore account for the analgesic protocol in place. A score of 5 on a composite scale in a patient that received no preemptive analgesia may warrant intervention, while the same score in a patient with preemptive multimodal coverage may reflect a different clinical situation. The score is a snapshot of the patient's current state, but its interpretation requires knowledge of the analgesic context.

## Framework for Analgesic Adjustment

Analgesic adjustment follows a logical sequence that begins with a score and ends with a documented response. The first step is to confirm that the score reflects pain instead of another cause of distress. Hypoxemia, hypothermia, nausea, urinary obstruction, and anxiety can all produce behaviors that inflate pain scores. A patient that is dysphoric from an anesthetic recovery can appear painful when the underlying issue is neuroexcitation. The clinician should perform a focused examination, including assessment of vital parameters, surgical site inspection, and bladder palpation, before attributing a high score to pain alone.

Once pain is confirmed, the adjustment strategy depends on the current analgesic plan. If the patient is receiving a single agent, the first step is to add a drug from a different class instead of increasing the dose of the existing drug. This multimodal approach targets different pain mechanisms and reduces the risk of dose-dependent adverse effects. If the patient is already on a multimodal protocol, the next step is to increase the dose of one component within its published range, or to add a short-acting rescue agent for breakthrough pain. Current formulary and label references must be consulted for specific doses and intervals, as these vary by drug, species, and region.

The response to any analgesic adjustment must be documented with a repeat score within 30 to 60 minutes. A score that does not improve after rescue analgesia should prompt reconsideration of the pain diagnosis, evaluation for surgical complications such as seroma or infection, and consultation with a specialist if the patient remains refractory. Persistent high scores despite escalating analgesia are a red flag that warrants investigation beyond simple analgesic adjustment.

## Selecting a Scoring Tool for Clinical Use

The choice of pain scoring instrument depends on the clinical setting, the time available, and the patient's condition. Unidimensional scales such as the Dynamic Interactive Visual Analog Scale (DIVAS) and the University of Melbourne Pain Scale (UMPS) remain the most practical tools for serial postoperative assessment in dogs. Both instruments have been used to track analgesic efficacy after ovariohysterectomy, with gradual score reduction observed over 48 hours postoperatively in dogs receiving NSAID-based protocols [Hernández-Avalos et al., 2020](https://pubmed.ncbi.nlm.nih.gov/32059002/). The DIVAS requires the assessor to mark a continuous line between anchor descriptors, which gives it sensitivity but introduces inter-observer variability. The UMPS uses categorical scoring across multiple domains, which improves consistency between observers at the cost of ceiling effects in severely painful patients.

For cats, no single instrument has achieved universal acceptance. Feline-specific behavioral scales that incorporate posture, facial expression, and interaction with the observer are preferred over scales validated in dogs, because feline pain behavior differs markedly. Grimace scales, which score orbital tightening, ear position, and whisker changes, are useful in cats that are too withdrawn to interact. These scales require minimal handling and can be applied through an observation window, which reduces stress-induced masking of pain behavior.

| Instrument | Species | Format | Strengths | Limitations | Best Use |
|---|---|---|---|---|---|
| DIVAS | Dog, cat | Continuous line, observer marked | Sensitive to small changes, rapid | Inter-observer variability, requires trained assessor | Serial assessment in hospitalized patients |
| UMPS | Dog | Categorical, multi-domain | Consistent between observers, includes physiological items | Ceiling effect in severe pain, less sensitive in cats | Routine postoperative monitoring in dogs |
| Feline grimace scale | Cat | Categorical, facial action units | No handling required, low stress | Limited to facial expression, may miss body pain | Cats that are withdrawn or fractious |
| Composite behavioral scales | Dog, cat | Categorical, multi-domain | Broad coverage of pain behavior | Time consuming, requires training | Research settings, complex cases |

The practical rule is to select one primary instrument per patient and use it consistently across the postoperative period. Changing instruments mid-course invalidates trend interpretation. The same observer should perform serial scoring where staffing permits, because inter-observer variation can exceed the treatment effect being measured.

## The Scoring Sequence and Timing

Pain scoring should follow a fixed sequence at each time point. Begin with undisturbed observation from outside the cage for 60 to 90 seconds. Record posture, activity, vocalisation, and interaction with the environment. Then enter the cage and assess response to gentle handling, wound palpation, and ambulation. Finally, record physiological variables such as heart rate, respiratory rate, and body temperature, but interpret these cautiously because they are influenced by drugs, stress, and concurrent disease.

Timing of assessments should align with analgesic dosing intervals. Score immediately before each analgesic dose to capture the trough effect, then 30 to 60 minutes after dosing to document peak effect. This pattern reveals whether the current interval is appropriate or whether the drug is wearing off prematurely. In the study by Lascelles et al., dogs receiving preoperative carprofen showed significantly lower pain scores at 2 hours post-extubation compared with dogs receiving postoperative carprofen, demonstrating that early score differences reflect both drug timing and surgical trauma [Lascelles et al., 1998](https://pubmed.ncbi.nlm.nih.gov/9845221/). Serial scoring at fixed intervals, instead of ad hoc assessment, is required to detect these patterns.

## Interpreting Scores and Adjusting the Analgesic Plan

Analgesic adjustment follows a stepwise logic based on the trend, not a single reading. A single elevated score may reflect handling stress or a transient movement. Two consecutive elevated scores at the expected trough time indicate inadequate duration of action. A rising trend across three assessments indicates inadequate intensity of analgesia regardless of the absolute values.

The adjustment framework proceeds as follows:

1. Confirm the score is valid. Reassess after 15 minutes if the patient was recently handled or disturbed.
2. Check the timing. If the elevation occurs at the end of the dosing interval, shorten the interval or add a rescue drug instead of increasing the dose of the current drug.
3. Check for non-pain causes of elevated scores. Dysphoria from opioids, urinary retention, and hypothermia can mimic pain behavior. Differentiating these requires careful observation and, where necessary, a low-dose sedative trial.
4. Escalate in a stepwise manner. Add a drug from a different class instead of doubling the dose of the current agent. For example, add a local anesthetic technique or an N-methyl-D-aspartate antagonist to an NSAID-based protocol.
5. Document the change, the rationale, and the response to the change. This creates a record that supports subsequent decisions and identifies patients who are difficult to manage.

The threshold for intervention depends on the instrument used. For the UMPS, a score above the validated intervention threshold, or a score that fails to decrease after rescue analgesia, warrants escalation. For the DIVAS, the trend matters more than the absolute value because the scale is continuous and observer dependent. The survey of veterinary paraprofessionals in New Zealand found that 93% of respondents believed surgery warrants analgesic therapy, yet formal pain scoring systems were not consistently used in practice [Kongara et al., 2016](https://pubmed.ncbi.nlm.nih.gov/26503457/). This gap between belief and systematic assessment is the primary barrier to rational analgesic adjustment.

## Rescue Analgesia Protocols

Rescue analgesia should be prescribed at the time of surgery, not decided when the patient appears painful. A standing order for rescue medication, with a specified trigger score, reduces the delay between recognition of pain and treatment. The rescue drug should be from a different class than the baseline analgesic to achieve multimodal coverage. Opioids are the most common rescue agents for dogs and cats receiving NSAID-based baseline protocols. For patients already receiving opioids, rescue options include local anesthetic blocks, ketamine infusions, or adjunctive agents.

The response to rescue analgesia should be assessed within 30 to 60 minutes. Failure to respond to an appropriate rescue dose has three possible explanations: the pain is neuropathic or visceral instead of somatic, the dose is inadequate for the individual patient, or the score reflects a non-pain cause. Each explanation requires a different response. Neuropathic pain may require gabapentinoids. Inadequate dosing requires careful dose escalation with monitoring for adverse effects. Non-pain causes require diagnostic investigation instead of further analgesia.

## Documentation and Communication

Pain scores are clinical data and should be recorded in the medical record with the same rigour as temperature and heart rate. Record the instrument used, the score, the time, the observer, and any analgesic administered. This documentation serves three purposes: it tracks the patient's trajectory, it justifies analgesic decisions to colleagues and owners, and it identifies patients with persistent pain who may need investigation beyond simple dose adjustment.

Communication between shifts is a common failure point. A patient scored as comfortable by the daytime nurse may appear painful to the evening clinician if different instruments or thresholds are used. Standardizing the instrument, the scoring times, and the intervention threshold across the hospital reduces this variability. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) and the [American College of Veterinary Surgeons](https://www.acvs.org/small-animal/) both provide species-specific guidance on postoperative assessment and analgesic planning that can serve as the basis for hospital protocols. Where a practice lacks a standardized approach, adopting a single validated instrument and training all staff in its use is the highest-yield improvement.

## Species and Context Modifications

Cats require longer observation periods and more conservative handling than dogs. A cat that is immobile and silent may be in severe pain, whereas a dog with the same posture is more likely to be resting comfortably. Feline scales that rely on facial expression are particularly useful because they do not require the cat to move. Analgesic adjustment in cats must also account for the reduced margin of safety with some drug classes, particularly NSAIDs, and the greater risk of opioid dysphoria.

The clinical context changes the acceptable threshold for intervention. A patient recovering from thoracic surgery has greater respiratory reserve requirements than a patient after routine ovariohysterectomy, and pain that splints the chest wall may require more aggressive analgesia despite moderate scores. Conversely, a patient with hemorrhagic shock may not tolerate the vasodilatory effects of some analgesics, and the clinician must balance pain control against hemodynamic stability. The [World Organization for Animal Health terrestrial standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) emphasize that animal welfare assessment must be integrated into clinical decision making, which in practice means that analgesic adjustment is a clinical judgment informed by, but not limited to, the pain score.

## Recognized Complications and Early Detection

The most common failure mode in postoperative pain management is not a single dramatic event but the gradual erosion of analgesic efficacy. Scores that rise across consecutive assessments, particularly after an initial downward trend, indicate either waning drug effect or a new surgical complication such as seroma formation, wound infection, or tissue ischemia. A rising score should trigger a focused physical examination before additional analgesic is administered, because masking a surgical problem with more drug delays definitive treatment.

Hypothermia complicates pain scoring in the immediate postoperative period. Shivering produces muscle tension and behavioral signs that mimic pain, while profound hypothermia depresses activity and vocalisation, producing falsely low scores. Rectal temperature should be recorded at every scoring interval until normothermia is sustained for at least two hours. Similarly, residual anesthetic or sedative drug effect can suppress interactive behaviors for several hours after extubation, and a low score in a still-sedated patient does not confirm adequate analgesia.

Dysphoria is the most frequently misread postoperative state. Opioid administration, particularly with pure mu agonists, can produce agitation, panting, vocalisation, and restlessness that closely resemble severe pain. The discriminating feature is the response to interaction: a dysphoric patient often becomes more agitated with handling, whereas a painful patient may brace, guard, or withdraw. When the distinction remains unclear, a small test dose of a sedative can be diagnostic, but this decision requires clinical judgment and should be documented.

Urinary retention and abdominal distension produce pain scores that do not respond to additional analgesic. Palpate the bladder at each scoring interval in patients that have not urinated. Gastric dilation, pancreatitis, and peritonitis can all elevate scores after abdominal surgery, and the scoring system alone cannot differentiate these from incisional pain. The score is a screening tool, not a diagnosis.

## Common Errors and Corrective Action

Less experienced clinicians tend to score the procedure instead of the patient. A dog that has undergone a fracture repair is assumed to be in severe pain, and a cat that has had an ovariohysterectomy is assumed to be comfortable. This anchoring bias persists despite survey evidence that veterinary paraprofessionals rank fracture repair and diaphragmatic hernia repair as highly painful procedures, which may influence their expectations before they examine the patient [Kongara et al., attitudes and perceptions of veterinary paraprofessionals in New Zealand](https://pubmed.ncbi.nlm.nih.gov/26503457/). The corrective action is to complete the scoring instrument in full, in the order written, before forming a judgment about the need for rescue analgesia.

A second common error is scoring from the doorway. Interactive components of the validated scales require handling, palpation, and observation of response to stimulation. A patient that appears quiet from a distance may resent palpation intensely. Conversely, a patient that vocalises when approached may be reacting to the observer instead of to pain. Every scoring interval should include the full interactive assessment.

A third error is treating the number instead of the patient. Thresholds for rescue analgesia are published for each instrument, but these thresholds were derived from populations, not individuals. A patient with a score below the threshold but with tachycardia, tachypnoea, and a tense abdomen still warrants investigation. The score informs the decision, it does not replace it.

## Troubleshooting Guide

| Observation | Likely cause | Discriminating check |
|---|---|---|
| Rising score 6 to 12 hours postoperatively | Waning analgesic effect | Compare score trajectory against drug duration, examine surgical site |
| High score with normal vital parameters | Dysphoria or anxiety | Assess response to gentle handling, consider sedative trial |
| Low score in a shivering patient | Hypothermia | Measure rectal temperature, rewarm before rescoring |
| Score unresponsive to rescue analgesia | Surgical complication | Full wound examination, abdominal palpation, imaging if indicated |
| High score in a cat that hides | Fear or pain | Observe from a distance first, then interactive scoring, assess posture in cage |

## Limitations of the Evidence

The evidence base for postoperative pain scoring in dogs and cats rests on a modest number of validation studies, and several instruments have been validated in single centers with specific surgical models. The University of Melbourne Pain Scale and the Dynamic Interactive Visual Analog Scale were developed largely for canine ovariohysterectomy and similar soft tissue procedures, and their performance after orthopedic surgery or thoracotomy is less well characterized [Hernández-Avalos et al., clinical evaluation of postoperative analgesia comparing paracetamol, meloxicam, and carprofen in dogs undergoing ovariohysterectomy](https://pubmed.ncbi.nlm.nih.gov/32059002/). Extrapolation to other procedures, to cats, and to patients with pre-existing behavioral abnormalities requires caution.

Expert opinion still differs on the value of composite scales versus simpler instruments. Composite scales capture more information but take longer to complete, and compliance falls when scoring is burdensome. Some authorities advocate a two-step approach: a quick observational screen followed by a full interactive assessment only when the screen suggests pain. This approach has face validity but has not been formally validated.

The relationship between analgesic timing and long-term outcomes remains incompletely defined. Preoperative administration of carprofen produced lower early postoperative pain scores than postoperative administration in dogs undergoing ovariohysterectomy, but plasma drug concentrations did not correlate with the degree of analgesia [Lascelles et al., efficacy and kinetics of carprofen administered preoperatively or postoperatively in dogs](https://pubmed.ncbi.nlm.nih.gov/9845221/). Whether this early difference translates into reduced chronic pain or faster return to function is not established.

## Referral and Escalation

Most postoperative pain can be managed in general practice, but certain circumstances warrant escalation. Persistent high scores despite two rescue interventions, scores that continue to rise over three consecutive assessments, or any score accompanied by deteriorating cardiovascular or respiratory parameters justify consultation with a specialist anesthetist or surgeon. Laboratory involvement is indicated when the differential diagnosis includes pancreatitis, peritonitis, or sepsis, because the scoring system cannot distinguish these from incisional pain.

Referral is appropriate when the pain appears to be neuropathic in origin, when the patient has a known contraindication to all available analgesic classes, or when the clinician suspects that the surgical procedure itself has produced a complication requiring revision. In these situations, continuing to adjust the analgesic plan without addressing the underlying cause delays definitive care.

Regulatory reporting obligations vary by jurisdiction. Where controlled substance use is involved, diversion or loss must be reported according to local requirements. The [AVMA practice resources](https://www.avma.org/resources-tools) provide guidance on professional obligations, and the [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) address welfare expectations that may apply in an international context. Clinicians should be familiar with the requirements of their own regulatory body.

## Frequently Asked Questions

### How Should I Proceed When Only Unvalidated or Informal Pain Scoring Is Feasible in a Busy Practice?

When time or staffing constraints preclude formal validated scoring, use a structured approximation that preserves the core elements of the validated tools. Assign a numeric value to each of three domains: behavior, wound response, and physiologic parameters. Document the score in the record with a note that a abbreviated assessment was used. The [attitudes and perceptions of veterinary paraprofessionals in New Zealand](https://pubmed.ncbi.nlm.nih.gov/26503457/) survey found that most respondents believed surgery warrants analgesia, yet formal scoring systems were inconsistently applied. Consistency matters more than instrument choice. Train all team members to use the same abbreviated method and review inter-observer agreement periodically. A documented, repeatable approximation outperforms undocumented clinical impression.

### What Is the Minimum Equipment Needed to Perform Validated Postoperative Pain Scoring?

Validated composite scales require no specialised equipment. The Dynamic Interactive Visual Analog Scale and University of Melbourne Pain Scale rely on observation, gentle palpation, and interaction with the patient. Mechanical nociceptive threshold testing, as used in [the carprofen timing study by Lascelles and colleagues](https://pubmed.ncbi.nlm.nih.gov/9845221/), adds quantitative data but is not required for clinical decision-making. A quiet examination area, consistent lighting, and a stopwatch for timed observation periods are sufficient. Avoid scoring in noisy wards where behavioral signs are suppressed or exaggerated. If a patient cannot be safely handled for interactive assessment, score from remote observation and document the limitation. The absence of advanced equipment should not delay analgesic intervention when clinical signs indicate pain.

### How Do I Adjust My Approach When the Patient Is a Cat instead of a Dog?

Cats display postoperative pain with subtler behavioral changes than dogs. They may become immobile, hide, or show reduced grooming instead of vocalising. Use a feline-specific composite scale instead of adapting a canine instrument. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) notes that cats require species-appropriate assessment because physiologic parameters are less reliable indicators in this species. Observe the cat undisturbed first, then interact gently. Palpation of the wound may elicit a more reliable response than facial expression alone. Cats frequently resume normal posture and grooming once analgesia is adequate, so use return of these behaviors as a positive indicator. Do not extrapolate analgesic requirements from canine protocols without adjusting for feline metabolism and contraindications.

### How Should I Document Pain Scores to Support Later Analgesic Decisions?

Record the instrument name, the numeric score, the time relative to surgery, and the assessor's identity for every assessment. Note which components of the scale contributed most to the total score, for example vocalisation versus wound palpation response. Document the analgesic drugs administered, their routes, and the time of administration. When a score triggers a change in the analgesic plan, record the rationale and the expected time to reassessment. This documentation supports continuity across shifts and provides a basis for evaluating whether the adjustment was effective. The [ACVS animal health resources](https://www.acvs.org/small-animal/) emphasize that postoperative monitoring should be systematic and recorded. If using an abbreviated method, state that explicitly in the record so later reviewers understand the limitations of the data.

### What Should I Do When Pain Scores Remain High Despite Maximal Doses of the Current Analgesic Class?

First, verify that the scoring is accurate and that the patient is not distressed from a non-pain cause such as dysphoria, hypothermia, or urinary retention. Reassess after addressing these factors. If pain is confirmed, consider multimodal therapy instead of increasing a single drug class. Add a different analgesic class with a complementary mechanism, provided no contraindications exist. Consult a current formulary for dosing and washout intervals, as [the comparison of paracetamol, meloxicam, and carprofen](https://pubmed.ncbi.nlm.nih.gov/32059002/) demonstrates that different NSAIDs provide comparable but not identical analgesia after ovariohysterectomy. Escalate to locoregional techniques if available. If scores remain high after two rescue interventions, reassess for surgical complications such as seroma, infection, or nerve entrapment before assuming inadequate analgesia.

### How Do I Explain a High Pain Score and the Need for Additional Analgesia to a Client?

Use concrete terms that describe what you observed instead of abstract scores. State that the patient is showing specific signs such as guarding the wound, refusing to move, or reacting to gentle touch, and that these indicate pain is not adequately controlled. Explain that the current medication is working partially but that additional, different medication is needed to address the remaining pain. Avoid alarming language about "suffering" while being honest about the assessment. The [AVMA practice resources](https://www.avma.org/resources-tools) provide guidance on communicating clinical recommendations to clients. Offer a clear plan: what drug will be added, how it will be given, when the patient will be reassessed, and what signs the client should watch for at home. This approach frames the adjustment as routine clinical care instead of a complication.

## Related Clinical & Scientific Guides

* [Perioperative Antibiotic Prophylaxis: Timing and Selection](/knowledge/veterinary-medicine/veterinary-surgery/perioperative-antibiotic-prophylaxis-timing-selection)
* [Surgical Approaches to the Femur and Stifle](/knowledge/veterinary-medicine/veterinary-surgery/surgical-approaches-femur-stifle)
* [Fracture Healing Assessment: Radiographic and Clinical Evaluation](/knowledge/veterinary-medicine/veterinary-surgery/fracture-healing-assessment-radiographic-clinical)


## References and Further Reading

- [Attitudes and perceptions of veterinary paraprofessionals in New Zealand to postoperative pain in dogs and cats.](https://pubmed.ncbi.nlm.nih.gov/26503457/). 2016.
- [Pain management in pigs undergoing experimental surgery, a literature review (2012-4).](https://pubmed.ncbi.nlm.nih.gov/26433866/). 2016.
- [Clinical evaluation of postoperative analgesia, cardiorespiratory parameters and changes in liver and renal function tests of paracetamol compared to meloxicam and carprofen in dogs undergoing ovariohysterectomy.](https://pubmed.ncbi.nlm.nih.gov/32059002/). 2020.
- [Development and validation of a mouse model to investigate post surgical pain after laparotomy.](https://pubmed.ncbi.nlm.nih.gov/39021615/). 2024.
- [Effect of Postoperative Analgesic Exposure to the Cannabinoid Receptor Agonist WIN55 on Osteogenic Differentiation and Spinal Fusion in Rats.](https://pubmed.ncbi.nlm.nih.gov/33759484/). 2021.
- [Efficacy and kinetics of carprofen, administered preoperatively or postoperatively, for the prevention of pain in dogs undergoing ovariohysterectomy.](https://pubmed.ncbi.nlm.nih.gov/9845221/). 1998.
- [American College of Veterinary Surgeons Animal Health Resources](https://www.acvs.org/small-animal/). American College of Veterinary Surgeons.
- [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual.
- [American Veterinary Medical Association Practice Resources](https://www.avma.org/resources-tools). American Veterinary Medical Association.

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> This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.