Table 3.

Multidimensional Composite Pain Scale (Brondani et al., 2011 [31]).

Posture	The cat is in a natural posture with relaxed muscles (it moves normally)	0
	The cat is in a natural posture but is tense (it moves little or is reluctant to move)	1
	The cat is sitting or is in sternal recumbency with its back arched and head down; or the cat is in dorsolateral recumbency with its pelvic limbs extended or contracted	2
	The cat frequently alters its body position in an attempt to find a comfortable posture	3
Comfort	The cat is comfortable, awake, or asleep and interacts when stimulated (it interacts with the observer and/or is interested in its surroundings)	0
	The cat is quiet and slightly receptive when stimulated (it interacts little with the observer and/or is not very interested in its surroundings)	1
	The cat is quiet and is “dissociated from the environment” (even when stimulated it does not interact with the observer and/or has no interest in its surroundings); the cat may be facing the back of the cage	2
	The cat is uncomfortable, restless (frequently changes its body position), and slightly receptive when stimulated or “dissociated from the environment”; the cat may be facing the back of the cage	3
Activity	The cat moves normally (it immediately moves when the cage is opened; outside the cage it moves spontaneously when stimulated or handled)	0
	The cat moves more than normal (inside the cage it moves continuously from side to side)	1
	The cat is quieter than normal (it may hesitate to leave the cage and if removed from the cage tends to return; outside the cage it moves a little after stimulation or handling)	2
	The cat is reluctant to move (it may hesitate to leave the cage and if removed from the cage tends to return; outside the cage it does not move even when stimulated or handled)	3
Attitude	A: satisfied, the cat is alert, is interested in its surroundings (explores its surroundings), and is friendly and interactive with the observer (plays and/or responds to stimuli); the cat may initially interact with the observer through games to distract it from the pain; carefully observe to distinguish between distraction and satisfaction games; B: uninterested, the cat does not interact with the observer (is not interested in toys or plays a little and does not respond to calls or strokes from the observer); in cats which do not like to play, evaluate interaction with the observer by its response to calls and strokes; C: indifferent, the cat is not interested in its surroundings (it is not curious; it does not explore its surroundings); the cat can initially be afraid to explore its surroundings; the observer needs to handle the cat and encourage it to move itself (take it out of the cage and/or change its body position); D: anxious, the cat is frightened (it tries to hide or escape) or nervous (demonstrating impatience and growling, howling, or hissing when stroked and/or handled); E: aggressive, the cat is aggressive (tries to bite or scratch when stroked or handled)
	Presence of the mental state A	0
	Presence of one of the mental states B, C, D, or E	1
	Presence of two of the mental states B, C, D, or E	2
	Presence of three or all of the mental states B, C, D, or E	3
Miscellaneous behaviors	A: the cat is lying down and is quiet but is moving its tail. B: the cat contracts and extends its pelvic limbs and/or contracts its abdominal muscles (flank); C: the cats eyes are partially closed (eyes half closed); D: the cat licks and/or bites the surgical wound
	All of the above behaviors are absent	0
	Presence of one of the above behaviors	1
	Presence of two of the above behaviors	2
	Presence of three or all of the above behaviors	3
Reaction to palpation of the surgical wound	The cat does not react when the surgical wound is touched or pressed; or there is no change from presurgical response (if basal evaluation was made)	0
	The cat does not react when the surgical wound is touched but does react when it is pressed; it may vocalize and/or try to bite	1
	The cat reacts when the surgical wound is touched and when it is pressed; it may vocalize and/or try to bite	2
	The cat reacts when the observer approaches the surgical wound; it may vocalize and/or try to bite; the cat does not allow palpation of the surgical wound	3
Reaction to palpation of the abdomen/flank	The cat does not react when the abdomen/flank is touched or pressed; or there is no change from presurgical response (if basal evaluation was made); the abdomen/flank is not tense	0
	The cat does not react when the abdomen/flank is touched but does react when it is pressed; the abdomen/flank is tense	1
	The cat reacts when the abdomen/flank is touched and when it is pressed; the abdomen/flank is tense	2
	The cat reacts when the observer approaches the abdomen/flank; it may vocalize and/or try to bite; the cat does not allow palpation of the abdomen/flank	3
Vocalization	The cat is quiet, is purring when stimulated, or miaows interacting with the observer but does not growl, groan, or hiss	0
	The cat purrs spontaneously (without being stimulated or handled by the observer)	1
	The cat growls, howls, or hisses when handled by the observer (when its body position is changed by the observer)	2
	The cat growls, howls, or hisses spontaneously (without being stimulated or handled by the observer)	3