FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Veterinary journal (London, England : 1997)2015; 206(3); 356-364; doi: 10.1016/j.tvjl.2015.08.023

Monitoring acute equine visceral pain with the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP): A scale-construction study.

Abstract: Although recognition of equine pain has been studied extensively over the past decades there is still need for improvement in objective identification of pain in horses with acute colic. This study describes scale construction and clinical applicability of the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) in horses with acute colic. A cohort follow-up study was performed using 50 adult horses (n = 25 with acute colic, n = 25 controls). Composite pain scores were assessed by direct observations, Visual Analog Scale (VAS) scores were assessed from video clips. Colic patients were assessed at arrival, and on the first and second mornings after arrival. Both the EQUUS-COMPASS and EQUUS-FAP scores showed high inter-observer reliability (ICC = 0.98 for EQUUS-COMPASS, ICC = 0.93 for EQUUS-FAP, P <0.001), while a moderate inter-observer reliability for the VAS scores was found (ICC = 0.63, P <0.001). The cut-off value for differentiation between healthy and colic horses for the EQUUS-COMPASS was 5, and for differentiation between conservatively treated and surgically treated or euthanased patients it was 11. For the EQUUS-FAP, cut-off values were 4 and 6, respectively. Internal sensitivity and specificity were good for both EQUUS-COMPASS (sensitivity 95.8%, specificity 84.0%) and EQUUS-FAP (sensitivity 87.5%, specificity 88.0%). The use of the EQUUS-COMPASS and EQUUS-FAP enabled repeated and objective scoring of pain in horses with acute colic. A follow-up study with new patients and control animals will be performed to further validate the constructed scales that are described in this study.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Get Full Text
Publication Date: 2015-08-28 PubMed ID: 26526526DOI: 10.1016/j.tvjl.2015.08.023Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Evaluation Study
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study presents the development and application of two new pain assessment scales—Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP)—for better identification of pain in horses suffering from acute colic.

Study Design and Procedure

  • The researchers conducted a cohort follow-up study with 50 adult horses, half of whom were experiencing acute colic and the other half served as healthy controls.
  • The EQUUS-COMPASS and EQUUS-FAP pain assessment scales were created and applied to assess and track the pain levels of the horses with acute colic.
  • The assessments took place upon the horses’ arrival at the study site, and then subsequently on the first and second mornings following arrival.
  • A Visual Analog Scale (VAS) was used as a parallel method for pain assessment, with scores derived from video clip evaluations.

Results and Findings

  • Both the newly-developed EQUUS-COMPASS and EQUUS-FAP scales demonstrated strong inter-observer reliability—with reliability scores of 0.98 and 0.93 respectively—indicating consistent interpretation of the assessment results among different observers.
  • The Visual Analog Scale showed a moderate reliability score of 0.63.
  • The study identified a cut-off (threshold) value that could distinguish between healthy and colic horses. For the EQUUS-COMPASS scale, this cut-off was 5, while for the EQUUS-FAP scale, it was 4. These scales were also able to distinguish between horses treated conservatively and those that required surgery or euthanasia— with cut-off values of 11 and 6 respectively.

Sensitivity and Specificity of the Pain Assessment Scales

  • Both scales demonstrated strong internal sensitivity and specificity. The EQUUS-COMPASS showed 95.8% sensitivity (ability to correctly identify horses with pain) and 84.0% specificity (ability to correctly identify horses without pain). The EQUUS-FAP showed 87.5% sensitivity and 88.0% specificity.

Conclusions and Future Directions

  • These findings suggest that the EQUUS-COMPASS and EQUUS-FAP scales might be effective tools for repeated and objective pain assessment in horses with acute colic.
  • The research team plans to conduct follow-up studies with a new set of patient and control animals to further validate the performance and utility of these tools.

Cite This Article

APA
van Loon JP, Van Dierendonck MC. (2015). Monitoring acute equine visceral pain with the Equine Utrecht University Scale for Composite Pain Assessment (EQUUS-COMPASS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP): A scale-construction study. Vet J, 206(3), 356-364. https://doi.org/10.1016/j.tvjl.2015.08.023

Publication

Veterinary journal (London, England : 1997)
ISSN: 1532-2971
NlmUniqueID: 9706281
Country: England
Language: English
Volume: 206
Issue: 3
Pages: 356-364

Researcher Affiliations

van Loon, Johannes P A M
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, NL-3584 CM Utrecht, The Netherlands. Electronic address: j.p.a.m.vanloon@uu.nl.
Van Dierendonck, Machteld C
  • Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, NL-3584 CM Utrecht, The Netherlands; Veterinary Faculty Ghent University, Salisburylaan 133, 9820 Merelbeke, Ghent, Belgium; Equus Research and Therapy, Tolnegenweg 39, 3776PT Stroe, The Netherlands.

MeSH Terms

  • Acute Disease
  • Age Factors
  • Animals
  • Colic / physiopathology
  • Colic / veterinary
  • Face
  • Female
  • Follow-Up Studies
  • Horse Diseases / diagnosis
  • Horses
  • Male
  • Observer Variation
  • Pain Measurement / methods
  • Pain Measurement / veterinary
  • Sensitivity and Specificity
  • Sex Factors
  • Visceral Pain / diagnosis
  • Visceral Pain / etiology
  • Visceral Pain / veterinary

Citations

This article has been cited 48 times.
  1. Tomberg C, Petagna M, de Selliers de Moranville LA. Horses (Equus caballus) facial micro-expressions: insight into discreet social information. Sci Rep 2023 May 27;13(1):8625.
    doi: 10.1038/s41598-023-35807-zpubmed: 37244937google scholar: lookup
  2. Kim SM, Cho GJ. Analysis of Various Facial Expressions of Horses as a Welfare Indicator Using Deep Learning. Vet Sci 2023 Apr 10;10(4).
    doi: 10.3390/vetsci10040283pubmed: 37104439google scholar: lookup
  3. Golzari K, Kong Y, Reed SA, Posada-Quintero HF. Sympathetic Arousal Detection in Horses Using Electrodermal Activity. Animals (Basel) 2023 Jan 7;13(2).
    doi: 10.3390/ani13020229pubmed: 36670768google scholar: lookup
  4. Carvalho JRG, Trindade PHE, Conde G, Antonioli ML, Funnicelli MIG, Dias PP, Canola PA, Chinelatto MA, Ferraz GC. Facial Expressions of Horses Using Weighted Multivariate Statistics for Assessment of Subtle Local Pain Induced by Polylactide-Based Polymers Implanted Subcutaneously. Animals (Basel) 2022 Sep 13;12(18).
    doi: 10.3390/ani12182400pubmed: 36139260google scholar: lookup
  5. Nielsen SS, Alvarez J, Bicout DJ, Calistri P, Canali E, Drewe JA, Garin-Bastuji B, Gonzales Rojas JL, Gortázar Schmidt C, Michel V, Miranda Chueca MÁ, Padalino B, Pasquali P, Roberts HC, Spoolder H, Stahl K, Velarde A, Viltrop A, Winckler C, Earley B, Edwards S, Faucitano L, Marti S, Miranda de La Lama GC, Costa LN, Thomsen PT, Ashe S, Mur L, Van der Stede Y, Herskin M. Welfare of equidae during transport. EFSA J 2022 Sep;20(9):e07444.
    doi: 10.2903/j.efsa.2022.7444pubmed: 36092762google scholar: lookup
  6. Ask K, Andersen PH, Tamminen LM, Rhodin M, Hernlund E. Performance of four equine pain scales and their association to movement asymmetry in horses with induced orthopedic pain. Front Vet Sci 2022;9:938022.
    doi: 10.3389/fvets.2022.938022pubmed: 36032285google scholar: lookup
  7. Emanuel D, Kästner SBR, Delarocque J, Grob AJ, Bienert-Zeit A. Influence of Butorphanol, Buprenorphine and Levomethadone on Sedation Quality and Postoperative Analgesia in Horses Undergoing Cheek Tooth Extraction. Vet Sci 2022 Apr 6;9(4).
    doi: 10.3390/vetsci9040174pubmed: 35448672google scholar: lookup
  8. Maśko M, Wierzbicka M, Zdrojkowski Ł, Jasiński T, Sikorska U, Pawliński B, Domino M. Comparison of Donkey, Pony, and Horse Dorsal Profiles and Head Shapes Using Geometric Morphometrics. Animals (Basel) 2022 Apr 5;12(7).
    doi: 10.3390/ani12070931pubmed: 35405919google scholar: lookup
  9. Lanci A, Benedetti B, Freccero F, Castagnetti C, Mariella J, van Loon JPAM, Padalino B. Development of a Composite Pain Scale in Foals: A Pilot Study. Animals (Basel) 2022 Feb 11;12(4).
    doi: 10.3390/ani12040439pubmed: 35203146google scholar: lookup
  10. Hernández-Avalos I, Mota-Rojas D, Mendoza-Flores JE, Casas-Alvarado A, Flores-Padilla K, Miranda-Cortes AE, Torres-Bernal F, Gómez-Prado J, Mora-Medina P. Nociceptive pain and anxiety in equines: Physiological and behavioral alterations. Vet World 2021 Nov;14(11):2984-2995.
    doi: 10.14202/vetworld.2021.2984-2995pubmed: 35017848google scholar: lookup
  11. Haunhorst FR, Hopster K, Schmicke M, Bienert-Zeit A, Kästner S. Clinical effect of buprenorphine or butorphanol, in combination with detomidine and diazepam, on sedation and postoperative pain after cheek tooth extraction in horses. Can Vet J 2022 Jan;63(1):39-46.
    pubmed: 34975166
  12. Farrell A, Kersh K, Liepman R, Dembek KA. Development of a Colic Scoring System to Predict Outcome in Horses. Front Vet Sci 2021;8:697589.
    doi: 10.3389/fvets.2021.697589pubmed: 34692803google scholar: lookup
  13. Barreto da Rocha P, Driessen B, McDonnell SM, Hopster K, Zarucco L, Gozalo-Marcilla M, Hopster-Iversen C, Esteves Trindade PH, Gonzaga da Rocha TK, Taffarel MO, Alonso BB, Schauvliege S, Luna SPL. A critical evaluation for validation of composite and unidimensional postoperative pain scales in horses. PLoS One 2021;16(8):e0255618.
    doi: 10.1371/journal.pone.0255618pubmed: 34352001google scholar: lookup
  14. van Loon JPAM, Macri L. Objective Assessment of Chronic Pain in Horses Using the Horse Chronic Pain Scale (HCPS): A Scale-Construction Study. Animals (Basel) 2021 Jun 18;11(6).
    doi: 10.3390/ani11061826pubmed: 34207290google scholar: lookup
  15. Andersen PH, Broomé S, Rashid M, Lundblad J, Ask K, Li Z, Hernlund E, Rhodin M, Kjellström H. Towards Machine Recognition of Facial Expressions of Pain in Horses. Animals (Basel) 2021 Jun 1;11(6).
    doi: 10.3390/ani11061643pubmed: 34206077google scholar: lookup
  16. de Oliveira MGC, de Paula VV, Mouta AN, Lima IO, de Macêdo LB, Nunes TL, Trindade PHE, Luna SPL. Validation of the Donkey Pain Scale (DOPS) for Assessing Postoperative Pain in Donkeys. Front Vet Sci 2021;8:671330.
    doi: 10.3389/fvets.2021.671330pubmed: 34179164google scholar: lookup
  17. Lundblad J, Rashid M, Rhodin M, Haubro Andersen P. Effect of transportation and social isolation on facial expressions of healthy horses. PLoS One 2021;16(6):e0241532.
    doi: 10.1371/journal.pone.0241532pubmed: 34086704google scholar: lookup
  18. Trindade PHE, Taffarel MO, Luna SPL. Spontaneous Behaviors of Post-Orchiectomy Pain in Horses Regardless of the Effects of Time of Day, Anesthesia, and Analgesia. Animals (Basel) 2021 May 31;11(6).
    doi: 10.3390/ani11061629pubmed: 34072875google scholar: lookup
  19. de Oliveira AR, Gozalo-Marcilla M, Ringer SK, Schauvliege S, Fonseca MW, Esteves Trindade PH, Prospero Puoli Filho JN, Luna SPL. Development and validation of the facial scale (FaceSed) to evaluate sedation in horses. PLoS One 2021;16(6):e0251909.
    doi: 10.1371/journal.pone.0251909pubmed: 34061878google scholar: lookup
  20. Torcivia C, McDonnell S. Equine Discomfort Ethogram. Animals (Basel) 2021 Feb 23;11(2).
    doi: 10.3390/ani11020580pubmed: 33672338google scholar: lookup
  21. Maskato Y, Dugdale AHA, Singer ER, Kelmer G, Sutton GA. Prospective Feasibility and Revalidation of the Equine Acute Abdominal Pain Scale (EAAPS) in Clinical Cases of Colic in Horses. Animals (Basel) 2020 Nov 29;10(12).
    doi: 10.3390/ani10122242pubmed: 33260428google scholar: lookup
  22. Ask K, Rhodin M, Tamminen LM, Hernlund E, Haubro Andersen P. Identification of Body Behaviors and Facial Expressions Associated with Induced Orthopedic Pain in Four Equine Pain Scales. Animals (Basel) 2020 Nov 19;10(11).
    doi: 10.3390/ani10112155pubmed: 33228117google scholar: lookup
  23. Rashid M, Silventoinen A, Gleerup KB, Andersen PH. Equine Facial Action Coding System for determination of pain-related facial responses in videos of horses. PLoS One 2020;15(11):e0231608.
    doi: 10.1371/journal.pone.0231608pubmed: 33141852google scholar: lookup
  24. Cohen S, Beths T. Grimace Scores: Tools to Support the Identification of Pain in Mammals Used in Research. Animals (Basel) 2020 Sep 23;10(10).
    doi: 10.3390/ani10101726pubmed: 32977561google scholar: lookup
  25. van Loon J, Verhaar N, van den Berg E, Ross S, de Grauw J. Objective Assessment of Acute Pain in Foals Using a Facial Expression-Based Pain Scale. Animals (Basel) 2020 Sep 10;10(9).
    doi: 10.3390/ani10091610pubmed: 32927590google scholar: lookup
  26. Orth EK, Navas González FJ, Iglesias Pastrana C, Berger JM, Jeune SSL, Davis EW, McLean AK. Development of a Donkey Grimace Scale to Recognize Pain in Donkeys (Equus asinus) Post Castration. Animals (Basel) 2020 Aug 13;10(8).
    doi: 10.3390/ani10081411pubmed: 32823676google scholar: lookup
  27. van Dierendonck MC, Burden FA, Rickards K, van Loon JPAM. Monitoring Acute Pain in Donkeys with the Equine Utrecht University Scale for Donkeys Composite Pain Assessment (EQUUS-DONKEY-COMPASS) and the Equine Utrecht University Scale for Donkey Facial Assessment of Pain (EQUUS-DONKEY-FAP). Animals (Basel) 2020 Feb 22;10(2).
    doi: 10.3390/ani10020354pubmed: 32098391google scholar: lookup
  28. Torcivia C, McDonnell S. In-Person Caretaker Visits Disrupt Ongoing Discomfort Behavior in Hospitalized Equine Orthopedic Surgical Patients. Animals (Basel) 2020 Jan 27;10(2).
    doi: 10.3390/ani10020210pubmed: 32012670google scholar: lookup
  29. Trindade PHE, Hartmann E, Keeling LJ, Andersen PH, Ferraz GC, Paranhos da Costa MJR. Effect of work on body language of ranch horses in Brazil. PLoS One 2020;15(1):e0228130.
    doi: 10.1371/journal.pone.0228130pubmed: 31990951google scholar: lookup
  30. Abass M, Picek S, Garzón JFG, Kühnle C, Zaghlou A, Bettschart-Wolfensberger R. Local mepivacaine before castration of horses under medetomidine isoflurane balanced anaesthesia is effective to reduce perioperative nociception and cytokine release. Equine Vet J 2018 Nov;50(6):733-738.
    doi: 10.1111/evj.12947pubmed: 29660154google scholar: lookup
  31. Bolesławska-Szubartowska J, Kucharczuk M, Skrabska A, Zbysław A, Adamowicz J, Alszko A, Domagalska-Stomska K, Durska M, Dziekcierów A, Janiszewska Z, Korzeniowska R, Kraujutowicz K, Kulesza K, Marciniak P, Pacyna Z, Przeborowska J, Siwek Z, Leonard M, Rapacz-Leonard A. Introducing an Innovative Pain Scale for Assessing Postpartum Pain in Mares: Preliminary Clinical Evaluation. Animals (Basel) 2025 Nov 30;15(23).
    doi: 10.3390/ani15233454pubmed: 41375512google scholar: lookup
  32. Maldonado Moreno N, Alves Moreira J, Araujo De Oliveira L, Sanches Gontijo A, Castilho Baldi ML, Rocha Wenceslau R, Beier SL. Analgesic and Gastrointestinal Effects of Methadone in Horses Undergoing Orchiectomy. Animals (Basel) 2025 Aug 11;15(16).
    doi: 10.3390/ani15162358pubmed: 40867687google scholar: lookup
  33. Braghetti M, Vichman L, Farhat N, Mills DS, Spadavecchia C, Zamansky A, Bremhorst A. Digitalising behavioural data collection through cloud-based technology in veterinary science and beyond. Front Vet Sci 2025;12:1600619.
    doi: 10.3389/fvets.2025.1600619pubmed: 40612154google scholar: lookup
  34. Van den Branden E, Salamone M, Broothaers K, Peere S, Polfliet E, Dewulf M, Van Steenkiste G, van Loon G, Smits K, Govaere J. Physiological and behavioral parameters of pain and stress in mares during and after transvaginal ultrasound-guided follicular aspiration. Front Vet Sci 2025;12:1574351.
    doi: 10.3389/fvets.2025.1574351pubmed: 40271484google scholar: lookup
  35. Guzmán JFC, Gontijo AS, Melgaço ES, Faria SA, Baldi MLC, Sousa LN, Wenceslau RR, Fantini P, Xavier ABDS, Beier SL. Analgesic and Gastrointestinal Effects of Morphine in Equines. Animals (Basel) 2025 Feb 17;15(4).
    doi: 10.3390/ani15040571pubmed: 40003052google scholar: lookup
  36. Lundblad J, Rhodin M, Hernlund E, Bjarnestig H, Hidén Rudander S, Haubro Andersen P. Facial expressions during compound interventions of nociception, conspecific isolation, and sedation in horses. Sci Rep 2025 Feb 13;15(1):5373.
    doi: 10.1038/s41598-025-89329-xpubmed: 39948238google scholar: lookup
  37. Sidwell AE, Duz M, Hill B, Freeman S, Hole SL. Application of the horse grimace scale in horses with dental disease: Preliminary findings. Vet Rec 2025 Feb 1;196(3):e4800.
    doi: 10.1002/vetr.4800pubmed: 39520383google scholar: lookup
  38. Chiavaccini L, Gupta A, Anclade N, Chiavaccini G, De Gennaro C, Johnson AN, Portela DA, Romano M, Vettorato E, Luethy D. Automated acute pain prediction in domestic goats using deep learning-based models on video-recordings. Sci Rep 2024 Nov 7;14(1):27104.
    doi: 10.1038/s41598-024-78494-0pubmed: 39511381google scholar: lookup
  39. Flores JEM, Terrazas A, Lara Sagahon AV, Aleman M. Parasympathetic tone activity, heart rate, and grimace scale in conscious horses of 3 breeds before, during, and after nociceptive mechanical stimulation. J Vet Intern Med 2024 Sep-Oct;38(5):2739-2747.
    doi: 10.1111/jvim.17174pubmed: 39150630google scholar: lookup
  40. Chiavaccini L, Gupta A, Chiavaccini G. From facial expressions to algorithms: a narrative review of animal pain recognition technologies. Front Vet Sci 2024;11:1436795.
    doi: 10.3389/fvets.2024.1436795pubmed: 39086767google scholar: lookup
  41. McCoy ES, Park SK, Patel RP, Ryan DF, Mullen ZJ, Nesbitt JJ, Lopez JE, Taylor-Blake B, Vanden KA, Krantz JL, Hu W, Garris RL, Snyder MG, Lima LV, Sotocinal SG, Austin JS, Kashlan AD, Shah S, Trocinski AK, Pudipeddi SS, Major RM, Bazick HO, Klein MR, Mogil JS, Wu G, Zylka MJ. Development of PainFace software to simplify, standardize, and scale up mouse grimace analyses. Pain 2024 Aug 1;165(8):1793-1805.
    doi: 10.1097/j.pain.0000000000003187pubmed: 39024163google scholar: lookup
  42. Feighelstein M, Riccie-Bonot C, Hasan H, Weinberg H, Rettig T, Segal M, Distelfeld T, Shimshoni I, Mills DS, Zamansky A. Automated recognition of emotional states of horses from facial expressions. PLoS One 2024;19(7):e0302893.
    doi: 10.1371/journal.pone.0302893pubmed: 39008504google scholar: lookup
  43. Lindinger H, Wehrend A. Characterization of Typical Behaviors of Mares in the Opening Phase of Parturition-Influence of Parity and Dystocia. Animals (Basel) 2024 Mar 28;14(7).
    doi: 10.3390/ani14071036pubmed: 38612275google scholar: lookup
  44. Benedetti B, Freccero F, Barton J, Elmallah F, Refat S, Padalino B. A Retrospective Study on the Status of Working Equids Admitted to an Equine Clinic in Cairo: Disease Prevalence and Associations between Physical Parameters and Outcome. Animals (Basel) 2024 Mar 6;14(5).
    doi: 10.3390/ani14050817pubmed: 38473201google scholar: lookup
  45. Auer U, Kelemen Z, Vogl C, von Ritgen S, Haddad R, Torres Borda L, Gabmaier C, Breteler J, Jenner F. Development, refinement, and validation of an equine musculoskeletal pain scale. Front Pain Res (Lausanne) 2023;4:1292299.
    doi: 10.3389/fpain.2023.1292299pubmed: 38312997google scholar: lookup
  46. Howard DL, Lancaster B, de Grauw J. Development and Preliminary Validation of an Equine Brief Pain Inventory for Owner Assessment of Chronic Pain Due to Osteoarthritis in Horses. Animals (Basel) 2024 Jan 5;14(2).
    doi: 10.3390/ani14020181pubmed: 38254349google scholar: lookup
  47. Ask K, Rhodin M, Rashid-Engström M, Hernlund E, Andersen PH. Changes in the equine facial repertoire during different orthopedic pain intensities. Sci Rep 2024 Jan 2;14(1):129.
    doi: 10.1038/s41598-023-50383-ypubmed: 38167926google scholar: lookup
  48. Reed RA, Krikorian AM, Reynolds RM, Holmes BT, Branning MM, Lemons MB, Barletta M, Quandt JE, Burns CC, Dantino SC, Sakai DM. Post-anesthetic CPS and EQUUS-FAP scores in surgical and non-surgical equine patients: an observational study. Front Pain Res (Lausanne) 2023;4:1217034.
    doi: 10.3389/fpain.2023.1217034pubmed: 37502312google scholar: lookup
Subscribe to our newsletter
Join 99,780 horse owners like you who receive our email updates on horse health and nutrition.