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system takes into account dog comfort, motion and carprofen; although there was improvement noted
posture, clinical findings in the orthopedic exam, using the two assessment methods, there was no
and radiographic changes, among others, to stage direct correlation between them, [342] and the reason
the disease and make therapeutic decisions. according to the authors could be that as an owner,
• Another tool to assess the outcome of therapeutic the most valued progression is the ability to move
measures in clinical trials in orthopedic patients is and walk, rather than single limb use. However,
the Canine Orthopedic Index (COI). It is designed another study found a correlation between LOAD
to be used by owners, evaluating stiffness, gait, func- and CBPI scores and also between these scores and
tion, and quality of life. [346–348] force plate kinetics. [354]
• Electromyography: this is not as readily available • Hudson Visual Analogue Scale (VAS): developed
to all clinicians, though. at Texas A&M University and used to assess mild-
• Assessment of quality of life is probably the to-moderate lameness in dogs; includes questions
most comprehensive way to evaluate clinical pro- about behavior and mobility, and the owner’s
gression. Having a scientifically validated way to assessment. The answer to each is marked on a
measure this is an extremely valuable tool for prac- 10 cm line. Results of this scale correlate with
titioners. There are several disease-specific tools, force plate kinetics. [343] Check it out in Appendix
but only one validated generic scale that measures A4.
the impact of chronic pain on quality of life, which • Helsinki Chronic Pain Index (HCPI): uses an
was published in 2013 by Reid et al. [349] It includes 11-item questionnaire, originally in Finnish, includ-
scores in four domains: vitality, pain, distress, ing ratings about general mood, willingness to play
and anxiety. The original scale had 46 items, but and exercise at different paces, complaining vocali-
recently a shorter form, comprising 22 items, was zations, ease of lying down/rising up and ability to
validated and published [350] and is now available perform daily movements. [355, 356]
for use by practitioners and owners online (www. • Liverpool Osteoarthritis in Dogs (LOAD) [354] :
newmetrica.com). There is also a 20-item question- includes questions about the patient’s background,
naire for cats. lifestyle, and mobility.
• To keep track of how much an animal is moving, • Feline Musculoskeletal Pain Index (FMPI): devel-
body-mounted, accelerometer-based activity mon- oped by Benito et al. in 2013 at the Comparative
itors are gaining popularity, easily available in prac- Pain Research Laboratory of the North Carolina
tice, and the results can also be monitored by the State University, [357, 358] uses a 17-item question-
owner. They are currently being included in clinical naire (was initially 21), and rates each item from 0
trials, and represent a valuable tool to objectively (impossible to perform) to 4 (normal). Questions
monitor feline activity changes associated with pain are about mobility, daily activities, and willingness
and its relief. [334, 351] to play and interact. So total scores can range from
0 (impossible to perform any of the activities) to 68
9.6.1 Musculoskeletal pain assessment (all normal). A change of about 10% has been pro-
posed as the relevant threshold. This scale has been
Several scales have been developed for chronic and further validated in several studies and is easy to
musculoskeletal pain assessment. perform. [334, 359, 360] You have the full questionnaire
in Appendix A5 and you can also download it from
• Canine Brief Pain Inventory (CBPI) (available at https://cvm.ncsu.edu/research/labs/clinical-scien
https://www.vet.upenn.edu/research/vcic-clinical- ces/comparative-pain-research/labs-com parati ve-
trials/our-services/pennchart): uses a numerical pain-research-clinical-metrology-instrume nts -fe
rating scale in an 11-item questionnaire to describe line-musculoskeletal-pain-index/.
the pain over the last few days, and how much that
pain affects the ability to perform different activi- The placebo effect has to be considered for any pain
ties [352, 353] (see Appendix A3). A clinical study com- treatment. It can actually be present to some extent
pared the owner’s assessment using the CBPI and when you interview the owner about the animal’s pro-
changes in force plate kinetics in dogs treated with gression. This has been noted in clinical trials evaluating

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