Objective Assessment of Chronic Pain in Horses Using the Horse Chronic Pain Scale (HCPS): A Scale-Construction Study

The objective assessment of chronic pain is of utmost importance for improving welfare and quality of life in horses. Freedom from disease and pain is one of the 'five freedoms' that are necessary for animal welfare. The aim of this study was to develop a pain scale for the assessment of chronic pain in horses (Horse Chronic Pain Scale; HCPS), which is based on behavioural and facial expressions. The scale was used to assess 53 horses (26 horses diagnosed with chronic painful conditions by means of clinical examination and additional diagnostic procedures (consisting of osteoarthritis, chronic laminitis, chronic back and neck problems, chronic dental disorders) and 27 healthy control animals). Animals were assessed once daily for three consecutive days by two observers that were blinded to the condition of the animals and were unaware of any analgesic treatment regimens. The HCPS consists of two parts, the Horse Chronic Pain Composite Pain Scale (HCP CPS, with behavioural parameters) and the EQUUS-FAP (Equine Utrecht University Scale for Facial Assessment of Pain). The HCP CPS had good inter-observer reliability (intraclass correlation coefficient (ICC) = 0.84, p < 0.001), while the EQUUS-FAP component (with facial expression-based parameters) had poor inter-observer reliability (ICC = 0.45, p < 0.05). The inter-observer reliability of the combined HCPS was good (ICC = 0.78, p < 0.001). The HCPS revealed significant differences between horses with chronic painful conditions and control horses on 2 out of 3 days (p < 0.05). In conclusion, we tested a composite pain scale for the assessment of chronic pain in horses based on behavioural and facial expression-based parameters. Further studies are needed to validate this pain scale before it can be used in practice.