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Pain in Cats

Animals on left show no pain; center, moderate pain; right, severe pain.
Animals on left show no pain; center, moderate pain; right, severe pain.
J. Hofve

Cats are notoriously stoic. They don't show signs of pain; at least, not until the pain is severe.

In evolutionary terms, cats are not only predators, but they're also potential prey for larger animals. A cat that walks around looking sick or painful will soon become lunch for a fox, coyote, or owl. (This is also why, when they really are sick, cats tend to burrow into closets, corners, or other protected places to hide.)

Pain management is a relatively new discipline in veterinary medicine. It has only recently been recognized that animals suffer pain that should be treated. Just a decade or two ago, veterinarians deliberately withheld painkillers from animals post-surgery, on the misguided philosophy that “the pain will keep them quiet so they don’t hurt themselves.” Even today, many veterinarians maintain that attitude, and fail to adequately treat pain related to illness, injury, or surgery.

Even today, there are only 70 certified pain specialists in the U.S. Dr. Michael Petty, DVM, past president of the International Veterinary Academy of Pain Management (IVAPM), said in an interview with Tufts University, “I have to believe that over 95 percent of animals in pain are not getting proper treatment." (Emphasis added.) That's a horrifying statistic.

Animals tend to develop more pain as they get older. However, as they repeatedly told us in vet school, age itself is not a disease. If pets are losing interest in daily activities, like eating, playing, or grooming, or have more “accidents” in the house, it’s more likely due to pain than to old age.

A survey of veterinarians published in 2000 found that 30% of veterinarians used no pain meds at all for declaw surgery, one of the most painful procedures performed on animals. Of the others, the majority (70%) used primarily butorphanol, a drug known to be largely ineffective in cats.(1) While the study's author believes that the situation has improved, it's still not uncommon for surgical pain, particularly declaw pain, to be treated inadequately. Research has proven that cats who undergo declaw surgery (which is actually amputation of the last bone of their toes) are noticeably painful for at least 12 days post-op, yet even the most aggressive pain management protocol only treats pain for 7 or 8 days. Inadequately treated post-op pain from declaw surgery is known to lead to chronic pain. Surveys have estimated that 20-25% of U.S. cats have undergone declaw surgery; how is it acceptable to have up to a quarter of our cat population suffering with chronic pain?

Recently, The Ohio State University looked for signs of pain in dogs and cats brought in to the veterinary school’s emergency clinic. They documented pain signs in 56% of dogs and 54% of cats. These numbers are much higher than previous research had found. This is most likely because we now have broader knowledge about the more subtle signs of pain; signs that were previously unrecognized.(2)

A number of “Grimace Scales” have been developed to assess animals' facial expressions for signs of pain. So far, there are Grimace Scales for rats, mice, rabbits, horses, and humans; but not for cats. Such signs include: turned-back ears, pulled-back whiskers, wrinkled nose, cheek bulging, and squinted eyes.

Of course, cats show these signs of pains, but there aren't any “official” criteria at this time, and most veterinarians are not yet trained to recognize the signs. The drawing above shows the established Mouse Grimace Scale, and a similar scale for cats showing what a Cat Grimace Scale might look like

Unfortunately, too many veterinarians are still dismissive of animal pain. The profession as a whole must take pain in animals more seriously. Chronic pain isn’t just painful; it causes stress, which suppresses the immune system; disrupts metabolism; and shortens lifespan.(3)

It’s up to you to carefully observe your cat. If you’re seeing signs of pain, please discuss it with your veterinarian, and insist on treatment. Most vets will give your pet a trial treatment of pain medication (even if it's just to shut you up!). Then you can see for yourself if your cat’s behavior changes when the pain goes away.

Fortunately, here in Denver and along the Front Range, we have access to several excellent, certified pain management specialists; as well as the Veterinary Teaching Hospital at Colorado State University in Ft. Collins. (Click here for the directory of the International Veterinary Academy of Pain Management.)

Nobody cares more about your cat's welfare than you do; so you must be the #1 advocate for your feline friend when it comes to pain. If your veterinarian is resistant, consider getting a second opinion. It's that important!

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(1) Wagner AE, Hellyer PW. Survey of anesthesia techniques and concerns in private veterinary practice. J Am Vet Med Assoc. 2000 Dec 1;217(11):1652-1657.

(2) Wiese AJ, Muir WW 3rd, Wittum TE. Characteristics of pain and response to analgesic treatment in dogs and cats examined at a veterinary teaching hospital emergency service. J Am Vet Med Assoc. 2005 Jun 15;226(12):2004-9.

(3) Riera CE, Huising MO, Follett P, et al. TRPV1 Pain Receptors Regulate Longevity and Metabolism by Neuropeptide Signaling. Cell. 2014;57(5):1023-136.