Canine Chronic Pain Scales: CSU Chronic Pain Scale, CBPI, LOAD and HCPI
The Colorado State University canine chronic pain scale and the validated owner questionnaires for osteoarthritis pain: CBPI, HCPI and LOAD.
The Colorado State University Canine Chronic Pain Scale rates a dog from 0 to 4 using behaviour, posture and the response to palpation of the affected joint, and a score of 2 or more prompts a review of the analgesic plan. For tracking chronic pain over weeks, most guidelines lean on owner questionnaires such as the Canine Brief Pain Inventory (CBPI), the Liverpool Osteoarthritis in Dogs (LOAD) and the Helsinki Chronic Pain Index (HCPI). The technician's job is to collect the same tool, from the same owner, at every visit.
Quick Reference
- CSU Canine Chronic Pain Scale: NG Robinson and SL Shaver, 2008, scored 0 to 4 by the clinic team.
- CBPI: 4 pain severity questions and 6 pain interference questions, each 0 to 10, completed by the owner.
- HCPI: 11-item owner index, validated in dogs with osteoarthritis.
- LOAD: owner-completed osteoarthritis questionnaire, validated against force-platform data.
- Acute pain scales such as the Glasgow CMPS-SF are not designed for chronic pain.
Acute vs Chronic Pain: Why the Tools Differ
Acute pain follows surgery, trauma or a sudden illness. It is usually scored in the hospital, over minutes to hours, by someone watching and handling the patient. The Glasgow CMPS-SF and the CSU acute scales were built for that setting.
Chronic pain, such as osteoarthritis, changes slowly and affects how the dog lives at home. A dog may hide its pain in the clinic but struggle with stairs, the car or long walks. Reid and colleagues describe chronic pain instruments as tools that measure the impact of pain on quality of life, completed by the owner. The 2022 AAHA Pain Management Guidelines also stress that capturing the owner's evaluation is important for chronic pain.
The Colorado State University Canine Chronic Pain Scale
The CSU Veterinary Medical Center produced a chronic pain form in the same style as its acute scales. It is credited to NG Robinson and SL Shaver, 2008. The header warns that many signs of chronic pain are non-specific, so anxiety, poor general health and systemic disease should be ruled out as part of a full workup.
| Score | Psychological and behavioural | Postural | Response to palpation |
|---|---|---|---|
| 0 | Happy, energetic, interested in surroundings, seeks attention | Comfortable at rest, stands and walks normally, bears weight on all limbs | Minimal body tension, no reaction to joint palpation |
| 1 | Subdued to slightly unsettled, distracted easily, may not initiate interaction | Stands normally, may shift weight, slight lameness when walking | Mild tension, turns head when the joint is palpated |
| 2 | Anxious, uncomfortable, not eager to interact, loss of brightness in eyes, reluctant to respond when beckoned | Abnormal weight distribution, moderate lameness, may be uncomfortable at rest | Pulls limb away during palpation of the affected joint. Reassess analgesic plan |
| 3 | Fearful, agitated or aggressive, avoids interaction, may lick the painful area | Abnormal posture, does not bear weight on the affected limb when walking, guards by shifting position | Vocalises or responds aggressively to joint palpation. Reassess analgesic plan |
| 4 | Stuporous, depressed, potentially unresponsive, difficult to distract from pain | Reluctant to rise, will not walk more than 5 strides, does not bear weight, uncomfortable at rest | Barely tolerates any touch, will not allow joint palpation. Reassess analgesic plan |
Is there a "modified" CSU chronic pain scale?
Searches for a "modified Colorado State University canine chronic pain scale" are common, but we did not find a separately published modified version. The form in circulation is the 2008 Robinson and Shaver scale. Clinics sometimes adapt forms for their own records. If you use an adapted version, keep in mind that its scores may not be comparable with the original, and check with your veterinarian which version your practice uses.
Owner Questionnaires for Chronic Pain
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Owner questionnaires are called clinical metrology instruments. They are scored the same way each time so that changes can be tracked. These three have published validation in dogs with osteoarthritis.
Canine Brief Pain Inventory (CBPI)
The CBPI was developed at the University of Pennsylvania. It has 4 questions on pain severity, each scored 0 (no pain) to 10 (extreme pain), averaged into a pain severity score. It has 6 questions on how pain interferes with the dog's normal activities, each scored 0 (does not interfere) to 10 (completely interferes), averaged into a pain interference score.
In a double-blind trial of 70 dogs with osteoarthritis, the CBPI detected improvement in dogs given carprofen for 14 days. Median pain severity scores fell from 4.25 to 2.25 in the carprofen group, with no significant change in the placebo group. The authors noted that placebo-treated dogs can also improve a little, partly because owners often seek care during a run of bad days. This is why the same owner should complete the CBPI each time, and why a single good or bad score should be read with caution.
Helsinki Chronic Pain Index (HCPI)
The HCPI was developed at the University of Helsinki. In its validation study of 61 dogs with osteoarthritis, it behaved as an 11-item, single-construct index of chronic pain, with high internal consistency and test-retest reliability. It also detected the difference between dogs given carprofen and dogs given placebo. In a later study of 253 dogs after cranial cruciate ligament repair, an HCPI score of 12 or more was used to indicate chronic pain.
Liverpool Osteoarthritis in Dogs (LOAD)
LOAD was developed at the University of Liverpool. In a study of 222 dogs with osteoarthritis, LOAD, the CBPI and the HCPI all correlated moderately with each other. LOAD and CBPI scores also showed a weak but significant correlation with force-platform gait data. The authors concluded that LOAD is convenient to use and can be recommended for measuring canine osteoarthritis.
| Tool | Completed by | Structure | Best use |
|---|---|---|---|
| CSU Canine Chronic Pain Scale | Clinic team | One row, 0 to 4 | Quick in-clinic snapshot |
| CBPI | Owner | 4 severity and 6 interference items, 0 to 10 | Tracking response to treatment |
| HCPI | Owner | 11 items | Tracking osteoarthritis pain |
| LOAD | Owner | Questionnaire | Measuring osteoarthritis impact |
The Technician's Role in Chronic Pain Assessment
- Use one tool consistently. Pick the questionnaire your practice uses and give the same one at every recheck.
- Ask the same owner. Different family members see the dog at different times of day and may score differently.
- Record a baseline before treatment starts. Without it, you cannot show whether a drug, weight loss or rehabilitation plan helped.
- Combine owner scores with your exam findings. Note lameness, weight bearing, joint response and body condition.
- Educate the client. Explain the signs of chronic pain they may miss, such as reluctance to jump, stiffness after rest or reduced play. Client education on pain assessment is a listed task in the VTNE Communication domain.
How This Appears on the VTNE
The AAVSB content outline gives Pain Management and Analgesia 10 scored items. Its tasks include recognising the need for analgesia and helping develop and carry out the pain management plan. The Communication domain includes educating the client about pain assessment and management. Expect questions that ask which tool fits a case: an in-hospital acute scale for a fresh surgical patient, or an owner questionnaire for an older dog with osteoarthritis. Also review the drug side of chronic pain in the pain management study guide and the pharmacology review.
Related Resources: CSU Acute Pain Scales · Pain Scoring Systems Overview · Pain Management Practice Questions · Communication Study Guide
Frequently Asked Questions
What is the Colorado State University canine chronic pain scale?
It is a 0 to 4 descriptive scale from the CSU Veterinary Medical Center, credited to Robinson and Shaver in 2008. It scores behaviour, posture and response to palpation of the affected joint, and prompts a review of the analgesic plan at 2 or more.
What is the difference between the CSU acute and chronic pain scales?
The acute scale is for postoperative or injury pain and includes a body map and body tension. The chronic scale focuses on posture, weight bearing and joint palpation, and reminds you to rule out other causes of the signs.
Which chronic pain questionnaire is best for dogs?
The CBPI, HCPI and LOAD all have published validation in dogs with osteoarthritis and correlate moderately with each other. The most useful one is the one your clinic uses consistently, with the same owner, at every visit.
Can I use the Glasgow pain scale for arthritis?
No. The Glasgow CMPS-SF was validated for acute pain. Use a chronic pain tool or owner questionnaire for osteoarthritis.
Key Takeaways
- CSU Canine Chronic Pain Scale: 0 to 4, reassess the plan at 2 or more.
- Rule out anxiety, poor general health and systemic disease first.
- CBPI gives a pain severity score and a pain interference score.
- HCPI has 11 items; LOAD is validated against gait data.
- Same tool, same owner, every visit, with a baseline before treatment.
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- Robinson NG, Shaver SL. Colorado State University Veterinary Medical Center Canine Chronic Pain Scale. 2008. Form (PDF)
- Brown DC, Boston RC, Coyne JC, Farrar JT. Ability of the Canine Brief Pain Inventory to detect response to treatment in dogs with osteoarthritis. JAVMA. 2008;233(8):1278-1283. PMC2896492
- Hielm-Bjorkman AK, Rita H, Tulamo RM. Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis. American Journal of Veterinary Research. 2009;70(6):727-734. doi.org/10.2460/ajvr.70.6.727
- Molsa SH, Hielm-Bjorkman AK, Laitinen-Vapaavuori OM. Use of an owner questionnaire to evaluate long-term surgical outcome and chronic pain after cranial cruciate ligament repair in dogs: 253 cases (2004-2006). JAVMA. 2013;243(5):689-695. doi.org/10.2460/javma.243.5.689
- Walton MB, Cowderoy E, Lascelles D, Innes JF. Evaluation of construct and criterion validity for the Liverpool Osteoarthritis in Dogs (LOAD) clinical metrology instrument and comparison to two other instruments. PLoS One. 2013;8(3):e58125. PMC3591443
- Reid J, Nolan AM, Scott EM. Measuring pain in dogs and cats using structured behavioural observation. The Veterinary Journal. 2018;236:72-79. doi.org/10.1016/j.tvjl.2018.04.013
- Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA Pain Management Guidelines for Dogs and Cats. JAAHA. 2022;58(2):55-76. doi.org/10.5326/JAAHA-MS-7292
- AAVSB. VTNE Candidate Information Handbook (content outline). aavsb.org