Peer-reviewed veterinary case report
Problems using the Feline Grimace Scale for eye pain in flat-faced
By Marangoni, Sabrine et al.·Published in Journal of feline medicine and surgery·2026·Department of Clinical Sciences, Canada·View original on PubMed →
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Original publication title: Challenges using the Feline Grimace Scale in brachycephalic cats with ocular pain.
- Species:
- cat
Plain-English summary
A group of 28 brachycephalic cats, averaging 6.6 years old, were evaluated for pain before and after eye surgery using the Feline Grimace Scale (FGS). The study found that while the FGS was generally effective in measuring pain, some signs of discomfort, like muzzle tension and whisker position, were not as reliable. After receiving pain relief, the cats showed a significant decrease in their pain scores, indicating that the treatment worked well. This suggests that the FGS can help assess pain in these cats, but care should be taken as some signs may be misleading.
People also search for: brachycephalic cat eye surgery pain · feline grimace scale reliability · cat pain signs after surgery
Abstract
ObjectivesThis study investigated the inter-rater reliability, agreement and responsiveness of the Feline Grimace Scale (FGS) in brachycephalic cats.MethodsA total of 28 brachycephalic cats (mean age 6.6 ± 4.4 years, mean weight 4.2 ± 1.0 kg) undergoing ocular surgery were included in a prospective, randomised, blinded study. Cats presenting fear-anxiety behaviours were not enrolled. In total, 95 images of these cats were collected from video recordings pre- and postoperatively (before/after analgesia), scored by four raters using the FGS and compared with real-time scores. Limits of agreement (LoAs) and bias were evaluated using the Bland-Altman method (good or poor agreement if bias <0.1 or >0.1, respectively). Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC; <0.50 = poor, 0.50-0.75 = moderate, 0.76-0.90 = good and >0.90 = excellent reliability). Generalised linear mixed models evaluated responsiveness (<0.05).ResultsInter-rater reliability (ICC) was poor for muzzle tension (0.47, 95% confidence interval [CI] 0.36-0.58) and whiskers change (0.34, 95% CI 0.22-0.46), good for ear (0.81, 95% CI 0.74-0.86) and eye position (0.84, 95% CI 0.79-0.88), moderate for head position (0.71, 95% CI 0.59-0.79) and good for FGS total ratio scores (0.76, 95% CI 0.68-0.82). LoAs were in the range of -0.37 to 0.22 with a bias of -0.08, suggesting that some cats could have their scores affected in comparison with real-time scores. Mean FGS total scores decreased after analgesia pre- (0.56 ± 0.10 vs 0.38 ± 0.15; = 0.005) and postoperatively (0.60 ± 0.18 vs 0.36 ± 0.15;<0.001).Conclusions and relevanceThe FGS is a responsive pain-scoring instrument in brachycephalic cats with ocular pain, with good agreement and excellent inter-rater reliability for total ratio scores. Pain may be overestimated using image assessment in some brachycephalic cats.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/41251310/