Pain indicators list Webform

Date

Pet Parent Name

Email address

Pet name

Note

Please note that 0 would represent the pain indicator is not present at all and 10 would represent the worst manifestation of the pain indicator.

Pain indicators list

Questions	1	2	3	4	5	6	7	8	9	10	N/A
1. Droopy head	1	2	3	4	5	6	7	8	9	10	N/A
2. Droopy ears	1	2	3	4	5	6	7	8	9	10	N/A
3. Tucked tail	1	2	3	4	5	6	7	8	9	10	N/A
4. Does not want to play	1	2	3	4	5	6	7	8	9	10	N/A
5. Lack of social interaction	1	2	3	4	5	6	7	8	9	10	N/A
6. Does not enjoy games	1	2	3	4	5	6	7	8	9	10	N/A
7. Subtle lack of alertness gradually increasing to a deep apathy (early sign will be subtle)	1	2	3	4	5	6	7	8	9	10	N/A
8. Diminished appetite	1	2	3	4	5	6	7	8	9	10	N/A
9. Body tension	1	2	3	4	5	6	7	8	9	10	N/A
10. Facial tension	1	2	3	4	5	6	7	8	9	10	N/A
11. Accepting treats or food gingerly (particularly if pet used to accept them enthusiastically)	1	2	3	4	5	6	7	8	9	10	N/A
12. Lack of interest in walks	1	2	3	4	5	6	7	8	9	10	N/A
13. Doesn't respond when called	1	2	3	4	5	6	7	8	9	10	N/A
14. Worried or sad facial expression	1	2	3	4	5	6	7	8	9	10	N/A
15. Ears pulled back or flattened	1	2	3	4	5	6	7	8	9	10	N/A
16. Eyes wide open to expose “white of the eye”	1	2	3	4	5	6	7	8	9	10	N/A
17. Avoidance of direct eye contact	1	2	3	4	5	6	7	8	9	10	N/A
18. Lips may be retracted, exposing the teeth in a submissive grin (dogs)	1	2	3	4	5	6	7	8	9	10	N/A
19. Almond shaped eyes (caused by facial tension)	1	2	3	4	5	6	7	8	9	10	N/A
20. Whiskers pulled back against cheeks (caused by facial tension)	1	2	3	4	5	6	7	8	9	10	N/A
21. Uncomfortable when resting	1	2	3	4	5	6	7	8	9	10	N/A
22. Shifts frequently when resting	1	2	3	4	5	6	7	8	9	10	N/A
23. Head held abnormally low	1	2	3	4	5	6	7	8	9	10	N/A
24. Difficulty getting up	1	2	3	4	5	6	7	8	9	10	N/A
25. Excessive panting (particularly when it is not hot)	1	2	3	4	5	6	7	8	9	10	N/A
26. Shivering/trembling/shaking	1	2	3	4	5	6	7	8	9	10	N/A
27. Unsettled	1	2	3	4	5	6	7	8	9	10	N/A
28. Pacing	1	2	3	4	5	6	7	8	9	10	N/A
29. Difficulty moving after a long rest	1	2	3	4	5	6	7	8	9	10	N/A
30. Difficulty lying down	1	2	3	4	5	6	7	8	9	10	N/A
31. Slow or unusual gait	1	2	3	4	5	6	7	8	9	10	N/A
32. Limping	1	2	3	4	5	6	7	8	9	10	N/A
33. Hunched back	1	2	3	4	5	6	7	8	9	10	N/A
34. Compulsive licking or rubbing of a certain body part	1	2	3	4	5	6	7	8	9	10	N/A
35. Looking at sides or other body part suddenly and/or worriedly	1	2	3	4	5	6	7	8	9	10	N/A
36. Suddenly running away from “nothing in particular”	1	2	3	4	5	6	7	8	9	10	N/A
37. Can't jump on couch or bed	1	2	3	4	5	6	7	8	9	10	N/A
38. Reluctance to lie down	1	2	3	4	5	6	7	8	9	10	N/A
39. Sleeps in a position that avoids a certain body part from touching the ground or bed	1	2	3	4	5	6	7	8	9	10	N/A
40. Any change in normal sleep patterns	1	2	3	4	5	6	7	8	9	10	N/A
41. Purplish tongue color (NOT gums: tongue)	1	2	3	4	5	6	7	8	9	10	N/A
42. ”Guards” a particular body part	1	2	3	4	5	6	7	8	9	10	N/A
43. Reluctance to be touched in a certain area	1	2	3	4	5	6	7	8	9	10	N/A
44. Reluctance to be picked up	1	2	3	4	5	6	7	8	9	10	N/A
45. Lying down at a distance from everybody and somewhat isolated	1	2	3	4	5	6	7	8	9	10	N/A
46. Disinterested in surroundings	1	2	3	4	5	6	7	8	9	10	N/A
47. Unusual attention seeking	1	2	3	4	5	6	7	8	9	10	N/A
48. Flinching when touched in a certain area	1	2	3	4	5	6	7	8	9	10	N/A
49. Doesn't rest easily when lying down	1	2	3	4	5	6	7	8	9	10	N/A
50. Aggressive behavior to protect a particular area	1	2	3	4	5	6	7	8	9	10	N/A
51. Aggressive behavior on a usually docile pet	1	2	3	4	5	6	7	8	9	10	N/A
52. Crying when a particular area is touched	1	2	3	4	5	6	7	8	9	10	N/A
53. Wakes up at night	1	2	3	4	5	6	7	8	9	10	N/A
54. Does not sleep well	1	2	3	4	5	6	7	8	9	10	N/A
55. Refusal to go on walks	1	2	3	4	5	6	7	8	9	10	N/A
56. Moaning	1	2	3	4	5	6	7	8	9	10	N/A
57. Whimpering	1	2	3	4	5	6	7	8	9	10	N/A
58. Refusing to eat	1	2	3	4	5	6	7	8	9	10	N/A
59. Pressing head against wall (if head pain is present)	1	2	3	4	5	6	7	8	9	10	N/A
60. Unable to get up	1	2	3	4	5	6	7	8	9	10	N/A
61. Crying in pain	1	2	3	4	5	6	7	8	9	10	N/A
62. Teeth clenched, biting down on an object (particularly cats)	1	2	3	4	5	6	7	8	9	10	N/A
63. Howling/screaming uncontrollably	1	2	3	4	5	6	7	8	9	10	N/A

Pain indicators list Webform

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