Development of a Composite Pain Scale in Foals: A Pilot Study.
Authors: Lanci Aliai, Benedetti Beatrice, Freccero Francesca, Castagnetti Carolina, Mariella Jole, van Loon Johannes P A M, Padalino Barbara
Journal: Animals : an open access journal from MDPI
Summary
# Editorial Summary: Development of a Composite Pain Scale in Foals Identifying and quantifying pain in foals remains challenging for equine practitioners, as most validated assessment tools have been developed for adult horses and may not reliably capture the distinctive pain presentations of younger animals. Researchers at several European institutions developed the Foal Composite Pain Scale (FCPS)—a 20-item assessment tool incorporating facial expressions (11 items), behavioural indicators (4 items), and physical parameters (5 items)—and tested its reliability using video recordings of 35 pain-free foals and 15 foals undergoing treatment for acute pain conditions, with five blinded observers scoring each recording twice to determine consistency. The FCPS demonstrated strong inter- and intra-observer reliability (Fleiss' kappa moderate to almost perfect; intraclass correlation coefficient 0.923) and internal consistency (Cronbach's alpha 0.842), with pain scores significantly higher in the pain group than controls (p < 0.001) and decreasing meaningfully following analgesia (T1 and T2 > T3; p = 0.001), using a cut-off score of ≥7 to indicate pain presence. For equine professionals involved in foal care, this represents a promising step towards standardised pain assessment in younger animals; however, the authors acknowledge the pilot nature of this work and recommend refinement and validation on larger cohorts before routine clinical implementation. The availability of a reliable composite pain scale could substantially improve analgesic decision-making and welfare monitoring in foal management across veterinary, farriery, and rehabilitation settings.
Read the full abstract on PubMed
Practical Takeaways
- •A validated composite pain scale for foals could standardize pain assessment and improve analgesic treatment decisions in clinical practice
- •Facial expressions, behaviour, and physical indicators together provide more reliable pain detection than single parameters alone
- •Further refinement and testing is needed before the FCPS can be confidently used in routine foal pain management protocols
Key Findings
- •The Foal Composite Pain Scale (FCPS) with 20 items (11 facial, 4 behavioural, 5 physical) demonstrated excellent inter-rater reliability (ICC = 0.923) and internal consistency (Cronbach's alpha = 0.842)
- •A cut-off score of ≥7 on the FCPS indicated presence of pain with excellent discrimination between pain-free foals and those in pain (p < 0.001)
- •Pain Group scores significantly decreased from pre-treatment (T1) through post-treatment (T2) to recovery (T3), with T1 and T2 both significantly higher than T3 (p = 0.001)
- •The scale requires modification and validation on larger sample sizes before clinical implementation