Abstract
BackgroundQuantification of pain plays a vital role in the diagnosis and management of pain in animals. In order to refine and validate an acute pain scale for horses a prospective, randomized, blinded study was conducted. Twenty-four client owned adult horses were recruited and allocated to one of four following groups: anaesthesia only (GA); pre-emptive analgesia and anaesthesia (GAA,); anaesthesia, castration and postoperative analgesia (GC); or pre-emptive analgesia, anaesthesia and castration (GCA). One investigator, unaware of the treatment group, assessed all horses at time-points before and after intervention and completed the pain scale. Videos were also obtained at these time-points and were evaluated by a further four blinded evaluators who also completed the scale. The data were used to investigate the relevance, specificity, criterion validity and inter- and intra-observer reliability of each item on the pain scale, and to evaluate construct validity and responsiveness of the scale.ResultsConstruct validity was demonstrated by the observed differences in scores between the groups, four hours after anaesthetic recovery and before administration of systemic analgesia in the GC group. Inter- and intra-observer reliability for the items was only satisfactory. Subsequently the pain scale was refined, based on results for relevance, specificity and total item correlation.ConclusionsScale refinement and exclusion of items that did not meet predefined requirements generated a selection of relevant pain behaviours in horses. After further validation for reliability, these may be used to evaluate pain under clinical and experimental conditions.
Highlights
Quantification of pain plays a vital role in the diagnosis and management of pain in animals
The groups: anaesthesia only (GA) group included four geldings and two mares; the Group pre-emptive analgesia and anaesthesia (GAA) group included three geldings and three mares (369 ± 68 kg and 10 ± 5 years old); the Group anaesthesia (GC) group comprised of six male horses (319 ± 48 kg and 4 ± 2 years old) and Group pre-emptive analgesia (GCA) included six male horses (302 ± 27 kg and 4 ± 2 years old)
Four horses had missing data points; one horse (GA) at T4 and moment six hours after anaesthetic recovery (T6) and one horse (GCA) at moment 24 hours after anaesthetic recovery (T24) due to abdominal discomfort, which recovered after clinical treatment, one horse (GAA) at T24, due to technical problems with the camera and one horse (GC) at T24, due to postoperative haemorrhage
Summary
Quantification of pain plays a vital role in the diagnosis and management of pain in animals. In order to refine and validate an acute pain scale for horses a prospective, randomized, blinded study was conducted. Unaware of the treatment group, assessed all horses at time-points before and after intervention and completed the pain scale. Recognition of pain-related behaviours in animals is difficult due to inter-species and individual variation [1], yet it is universally acknowledged that improvements in pain assessment may facilitate diagnosis and analgesic treatment in horses. There are established psychometric methods for developing and refining structured questionnaires of abstract constructs such as acute pain in humans. This approach can be adopted for similar purposes in animals. Thereafter the scale must be scrutinized for both content and face validity and the scale must undergo reliability testing [6]
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