The Curious Case of Pain In Cats

Dr. Patty Khuly

Pain in Cats

Do you think you’d know if your cat was showing signs of pain? If you’re like most owners, you’re likely to assume you’d be a great judge of pain. If your cat were suffering any discomfort, surely you’d be alert to it.

Unfortunately, the truth is less comforting than we’d like. Not only are owners poor judges of pain in their own cats, veterinarians have historically been equally oblivious to the discomforts of the feline species. We’ve only recently begun to suspect the true depths of pain and dysphoria cats can feel –– all without showing any obvious sign.

So, if their pain is so hard to identify, how do we know they’re really experiencing pain, you ask? Turns out we use many of the same indicators used in pediatric medicine to assess infant pain. Which is a nifty trick that’s especially helpful when it comes to actually treating pain in cats. Except that pain in cats can be tricky.

Why? As far as drugs are concerned, cats have historically been treated like small dogs. And dogs, in turn, have been regarded (pain-wise) as small humans. Given the limitations inherent to these allegories, is it any wonder we’ve got so few drugs that really work well for our cats?

Pain relief, in particular, is a surprisingly frustrating issue in feline medicine for a couple of reasons:

  1. Pain in cats is a tough thing to assess. Their silent stoicism, while admirable, doesn’t exactly lend itself well to ready interpretation in the event of pain. Even severe pain often goes undiagnosed in cats. Here’s an article that addresses the behavioral characteristics we’ve now come to associate with post-operative pain in felines. It seems we’re getting smarter on this issue.
  2. Few reasonable alternatives to long term pain control in cats exist. So while severe acute or post-op pain can be managed with heavy-duty narcotics (strong opiates like hydromorphone), there’s little available to treat long term illnesses (like osteoarthritis, a very common condition in cats).

Still, I’m proud to report that pain relief in cats has come a long way over the last couple of decades. Here’s an excerpt from a 2003 World Small Animal Veterinary Association meeting lecture on the subject to illustrate the [newly enlightened] motivation for feline analgesia:

“Pain interferes with healing and can, in fact, make the disease process more harmful. Hypotension, gastrointestinal injury, hypothermia and immunosuppression may all occur as negative physiologic results of pain. The body, in response to the trauma, releases all sorts of leukotrienes: some of these are helpful, but many aggravate the problem. As a result, if a patient has, or is going to have tissue trauma, analgesic therapy is required.”

It’s more than just the humane approach, it also happens to be the more effective approach when it comes to healing. That’s because it’s now become clear that to deny a patient a pain control drug on the basis of "safety" may not make so much sense if the patient’s degree of pain is significant. The impact of severe pain on the patient’s long term well being is now considered in a more "holistic" manner. And that’s undoubtedly a good thing.

But the sad truth remains that few drugs are available for certain kinds of pain. While opiates (morphine-like drugs) are eminently useful, they’re only helpful for relatively short term pain control or hospice care. With some exceptions, cats are just too “out of it” on these meds to live normal lives.

Yet there are some exceptions. Transdermal fentanyl patches, tramadol, and, butorphanol are all opiates that are used for acute and sub-acute pain control (as in an end-of life hospice setting). But for more chronic pain control (for arthritis, for example), these drugs are typically considered too life altering. But not for all. Sometimes it is worth a try to see how an individual cat will react.

Despite the dearth of options for chronic pain, it’s not because we haven’t been trying at all. There have been attempts to identify NSAIDs that cats will tolerate. This class of drug has been responsible for much of the chronic pain control in dogs and humans over the past few decades.

But, for cats, NSAIDs have been tricky. Gastrointestinal and renal side effects are much more common with NSAIDs when used in cats. Though we will tap these meds for their anti-inflammatory effects, we tend to do so only in well-hydrated cats whose renal status is demonstrably normal... and typically only for a short period of time.

Metacam (meloxicam) is one such drug whose one-dose injectable formulation is approved by the FDA for use in cats. But it’s not for those who suffer chronic pain, as in the case of arthritis, or slow-moving cancers that require some anti-inflammatory palliation. In fact, a recent FDA labeling advisory cautioned us strongly against the use of oral Metacam for long-term care. It’s just too toxic to the kidneys.

Onsior (robenacoxib) is another. But it’s also approved for only three short days’ use.

Here are other NSAIDs that are sometimes used instead:

  • Aspirin
  • Ketoprofen
  • Ketorolac tromethamine
  • Carprofen (Rimadyl)

But I approach these with caution, and I suggest you do the same. Nonetheless, I’ve used them all to great effect in cats. After all, there is no "one size fits all" in medicine. Even less so when it comes to controlling pain, and nowhere is this more true than when trying hard to control pain in cats. In the absence of approved drugs, sometimes cautious creativity is the best approach.

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