I have been a veterinarian for 18 years, though pain management was not always a primary focus in my practice. Like many of my peers, I treated pain as part of clinical care. Early in my career, we did not fully grasp the critical importance of recognizing and addressing it comprehensively. My first work experience after graduation was in a rural mixed-animal practice in the U.S.—a very James Herriot-like setting. We treated every kind of animal and did our best to find solutions, especially in a community where referrals were not feasible. Reflecting on those early days with the knowledge we have now, I realize I could have been more adequately addressing pain, and I deeply regret that. This realization drives me to dedicate the rest of my career to ensuring our profession—on a global scale—embraces the necessity of recognizing and treating pain in every patient, every time. As the senior veterinary trainer for the Veterinary Welfare Training Program, a newly established initiative by Animals Asia at the Chengdu Bear Rescue Center in China, and the newest member of the World Small Animal Veterinary Association (WSAVA)’s Pain Council, I have the privilege of dedicating my time and energy to advancing veterinary knowledge, developing practical teaching programs, and enhancing the welfare of animals under veterinary care. Species-specific pain assessment tools can help better diagnosis and plan treatments. Photo courtesy Animals Asia Pain in animals Assessing pain in animals has long been one of veterinary medicine’s most challenging and essential tasks. Without the ability to self-report, animals often suffer in silence, leaving us to rely on behavioral cues. However, developing species-specific pain assessment tools offers a breakthrough in achieving more accurate diagnoses and tailored treatment plans. Pain scales such as the Feline Grimace Scale and novel tools designed for specific species, such as farm animals, laboratory animals, and companion animals, are paving the way for a new standard in animal welfare and pain management, supporting practitioners in delivering compassionate and effective care. The evolution of pain assessment Historically, pain in animals has been evaluated through subjective measures, often depending on a veterinarian’s interpretation of behavior or movement changes. However, as the veterinary profession has grown, so has the recognition pain assessment tools can offer critical benefits for diagnosis and treatment. Studies reveal that tools, such as the Glasgow Composite Pain Scale, originally developed for dogs, not only improve assessment accuracy but also reduce caregiver bias, offering a consistent and replicable method of pain recognition.1 Further, standardized tools improve the ability to track patient progress and adapt treatment plans over time, creating a paradigm shift in how veterinarians approach pain management. Why pain scales matter The incorporation of standardized pain scales in practice has demonstrated clear benefits for both clinical and client-facing aspects of veterinary care: Improved client communication. Pain scales offer veterinarians a way to convey the severity of an animal’s pain to caregivers in an understandable format. Visual tools, such as the Feline Grimace Scale, help clients grasp the need for pain management interventions, building trust, and supporting adherence to treatment.2 Better treatment outcomes. Standardized scales enable precise pain assessments and allow practitioners to adjust treatments based on quantifiable data, improving recovery times and patient satisfaction.3 Reduced subjectivity. Pain scales provide an objective approach to pain measurement, helping to minimize potential biases and inconsistencies in pain recognition across different cases and species.4 Implementing pain scales To effectively integrate these tools, veterinarians can take several practical steps: Training and education. Clinics can host training sessions to familiarize staff with tools like the Feline Grimace Scale or other species-specific pain measures, promoting consistency in assessments.5 Routine assessments. Integrating pain scales into regular health checks allows for early detection of pain symptoms, which can be especially beneficial in aging patients or species prone to chronic pain. Client education. Explaining pain assessment tools to clients improves understanding and support for pain management plans, reinforcing the importance of follow-through with prescribed treatments.6 Advances from across the globe The author presenting about pain scales to a group of veterinarians. Photo courtesy Animals Asia Having worked with rescued Asiatic black bears at our China and Vietnam sanctuaries, the Animals Asia team saw the need for validated scales to assess lameness and pain. I recently published the first-ever lameness scale for Asiatic black bears, a species for which traditional lameness scales are inadequate due to anatomical and behavioral differences. This tool considers factors, such as stride length, body posture, and limb use, providing a foundation for further research and enhancing pain management protocols in wildlife and sanctuary settings. Such species-specific tools are vital as they acknowledge the unique pain expressions across taxa, paving the way for customized welfare strategies.7 Building on the lameness scale, we are now working with international pain experts to develop a chronic pain questionnaire for Asiatic black bears. Chronic pain assessment poses a unique challenge in all animals, particularly in a species where pain research has not been conducted. We looked at the existing chronic pain scales for dogs and chose the relevant questions for bears under human care. This tool aims to address long-term pain symptoms, emphasizing physiological and behavioral markers specific to this bear species. Research suggests chronic pain scales, like those used in canines, improve long-term quality of life for animals, especially in captive and rehabilitative settings.8 We are also collaborating with the developers of the Vetpain App,9 part of the Pain and Quality of Life in Animals project created at the School of Veterinary Medicine and Animal Science (FMVZ) of Unesp, Botucatu campus (SP), Brazil. Led by Stelio Pacca Loureiro Luna, DVM, Msci, PhD, DipECVAA, CVA , this initiative has produced validated pain scales for a wide range of species, including horses, donkeys, cattle, pigs, goats, rabbits, rodents, and companion animals. The app integrates these tools with tutorials and an intuitive platform, allowing users to assess and score animals’ pain in real-time. Conclusion As the field of pain management evolves, so too must veterinary practice. Validated pain assessment scales, such as the Feline Grimace Scale, and species-specific tools for wildlife species, such as Asiatic black bears, represent a vital step forward. Veterinarians are encouraged to adopt these tools as a routine part of their clinical assessments, supporting animal welfare and the human-animal bond through compassionate, evidence-based care. As research continues to expand, the future of pain assessment in veterinary medicine promises more refined and comprehensive tools that will transform animal care standards worldwide. If only I could return to my early days in practice with the knowledge we have today—I know I could have been a stronger advocate and a better veterinarian for my patients. While I cannot change the past, I feel I have been given a second chance, through my work at Animals Asia, and the WSAVA Pain Council. I am determined to use every ounce of energy, enthusiasm, and passion to ensure pain is consistently recognized and adequately addressed for the animals—always. Mandala Hunter-Ishikawa BS, MS, DVM, has been a veterinarian for almost two decades, working with companion animals, large animals, and wild animals. Dr. Hunter-Ishikawa was the center director of Born Free Ethiopia’s wildlife sanctuary and senior veterinarian at the Animals Asia Bear Rescue Centres in Vietnam and China. She is currently the senior veterinary trainer for Animals Asia’s Veterinary Welfare Training Program. To elevate veterinary welfare education in China, she lectures at conferences and shares practical information with vet professionals and pet guardians. Hunter-Ishikawa is a member of the World Small Animal Veterinary Association (WSAVA)’s Pain Council. References Evangelista MC, Watanabe R, Leung VSY, Monteiro BP, O'Toole E, Pang DSJ, Steagall PV. Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale. Sci Rep. 2019 Dec 13;9(1):19128. 2. Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA Pain Management Guidelines for Dogs and Cats. J Am Anim Hosp Assoc. 2022 Mar 1;58(2):55-76. Hunter-Ishikawa, M; Nakatani, J; Miller, D. 2024. Modification of Domestic Animal Lameness Scales for Use in Asiatic Black Bears (Ursus thibetanus). Available online: https://www.researchgate.net/publication/374959213_Modification_of_Domestic_Animal_Lameness_Scales_for_Use_in_Asiatic_Black_Bears_Ursus_thibetanus. Mills, D.S.; Demontigny-Bédard, I.; Gruen, M.; et al. Pain and Problem Behavior in Cats and Dogs. Animals 2020, 10, 318. Monteiro BP, Lee NH, Steagall PV. Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A large bilingual global survey. Journal of Feline Medicine and Surgery. 2023;25(1). Reid, J.; Nolan, A.M.; Hughes, J.M.L.; et al. 2007. Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score. Animal Welfare, 2007, 16(S): 97-104. Available online: https://www.newmetrica.com/wp-content/uploads/2016/09/Reid-et-al-2007.pdf Robinson AR, Steagall PV. Effects of training on Feline Grimace Scale scoring for acute pain assessment in cats. J Feline Med Surg. 2024 Oct;26(10):1098612X241275284. Steagall PV, Monteiro BP. Acute pain in cats: Recent advances in clinical assessment. J Feline Med Surg. 2019;21(1):25-34.
