Monitoring equine visceral pain with a composite pain scale score and correlation with survival after emergency gastrointestinal surgery.
Authors: van Loon Johannes P A M, Jonckheer-Sheehy Valerie S M, Back Willem, van Weeren P René, Hellebrekers Ludo J
Journal: Veterinary journal (London, England : 1997)
Summary
# Editorial Summary Following emergency gastrointestinal surgery in horses, accurate pain assessment remains challenging despite recent advances in equine pain recognition—yet high pain scores consistently correlate with poor surgical outcomes. Researchers evaluated the composite pain scale (CPS) as an objective monitoring tool in 48 post-operative colic cases, recording pain scores every 4 hours over 3 days and testing inter-observer reliability against a numerical rating scale (NRS). The CPS demonstrated substantially better consistency between different observers (r=0.87, K=0.84) compared to the NRS (r=0.68, K=0.72), and critically, horses that survived without complications had significantly lower pain scores than those requiring euthanasia or re-laparotomy (P<0.001), regardless of breed or lesion location. These findings validate the CPS as a more reliable framework for post-operative visceral pain assessment, which holds particular value in busy equine hospitals where multiple clinicians rotate through cases—standardising pain evaluation improves treatment consistency and potentially identifies deteriorating cases earlier through objective score comparison rather than subjective clinical impressions.
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Practical Takeaways
- •Use the composite pain scale for post-operative colic assessment—it's more reliable than simple rating scales and allows consistent communication about pain severity between different staff members treating the same horse
- •Monitor CPS trends over the first 3 days post-surgery; persistently high scores should trigger investigation for complications such as adhesions or incomplete resolution, as horses with complications had significantly higher pain scores
- •High pain scores correlate with poorer outcomes (euthanasia or need for re-laparotomy), making objective pain scoring essential for prognosis estimation and treatment decisions
Key Findings
- •Composite pain scale (CPS) demonstrated higher inter-observer reliability (r=0.87, K=0.84) compared to numerical rating scale (r=0.68, K=0.72) for assessing post-operative pain in horses
- •Horses that survived without complications had significantly lower CPS and NRS scores than those euthanased or requiring re-laparotomy (P<0.001)
- •CPS scoring improved objectivity of pain assessment and allows reliable comparison between different clinicians in multi-provider hospital settings
- •Breed and intestinal location (small vs large intestine) did not significantly influence pain scores