Bristol Rabbit Pain Scale (BRPS): clinical utility, validity and reliability

summary of:
Bristol Rabbit Pain Scale (BRPS): clinical utility, validity and reliability
Rabbits on a farm
L.Benato, J. Murrell and N. Rooney
Published in:
September 2022
Type of access:

Open access

In our edition of: Dec 2022
In our categories of: exotics

our summary:

Benato, L., Murrell, J. and Rooney, N. (2022) Bristol Rabbit Pain Scale (BRPS): clinical utility, validity and reliability. BMC Veterinary Research, 18, no. 341.

The aim of this study was to assess the clinical utility, validity, and reliability of the Bristol Rabbit Pain Scale (BRPS).   authors hypothesised that there would be a statistically significant difference between pre-and post-surgery in terms of pain scoring, that there would be a correlation between the BRPS and a numerical rating score (NRS) for pain, that there would be agreement in pain scores given by multiple participants for the same animal, and that participants would be consistent in their pain scores repeatedly over time.

For the clinical utility test, veterinary surgeons and veterinary nurses working with rabbits in the UK were contacted by email in November 2019 and asked to assess up to four rabbits using the BRPS and to record the average time required to assess the rabbits. They were then asked to complete a questionnaire containing ten questions on how easy and quick it was to use the BRPS and to provide general comments on its use.

To assess the validity and reliability of the BRPS, nine final year students studying BSc in Veterinary Nursing and Companion Animal Behaviour were asked to watch five-minute video clips of 20 rabbits, taken before and after surgery, and to pain score them using either using the BPRS (day 1) or the NRS (day 14). The videos were of rabbits undergoing elective ovariohysterectomy or orchiectomy at four UK veterinary clinics. The participants were blind to whether the rabbits in the videos were before or after surgery.

There were twenty-one participants in the clinical utility test. Results showed that the median time to pain score the rabbits using the BPRS was four minutes, overall, the respondents reported finding the BPRS quick and easy to use, that it provided clinically useful information and that it could be incorporated into routine practice. Results from the video assessments showed that using the BPRS, there was a statistically significant difference between pre- and post-surgery pain scores and a strong correlation between the BPRS and NRS scores.

Limitations of the study include the small number of participants and that the participants for the validity and reliability tests were all female veterinary nurses, which may have had an impact on the pain scoring.

Take Home

The results of this study suggest that the Bristol Rabbit Pain Scale is a suitable tool for assessing pain in rabbits and that it could easily be incorporated into routine veterinary practice.


Benato, L. et al. (2021) Development of the Bristol Rabbit Pain Scale (BRPS): A multidimensional composite pain scale specific to rabbits (Oryctolagus cuniculus). PLoS ONE, 16 (6), p.e0252417.

The Bristol Rabbit Pain Scale (BRPS) is a composite pain scale of six categories (Demeanour, Locomotion, Posture, Ears, Eyes and Grooming) with four intensities of pain (0, 1, 2, and 3), and a total score of 0–18

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