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Pain in Cats: Signs, Causes, & Treatment

By 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. Perhaps she’s not pestering you as much around feeding time. Or no longer jumps up on the kitchen counter quite as often as he once did.

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.

Signs of Pain in Cats

There are many ways felines attempt to hide their discomfort; however, the signs can be broken down into two categories: behavioral and physical.

As previously stated, 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. There are some behavioral characteristics cats present that are now associated with post-operative pain in felines. It seems we’re getting smarter on this issue.

Some behavioral differences that indicate pain would be excessive sleeping, avoiding movement, isolation from family, or a general change in attitude. If your happy-go-lucky cat who loves to snuggle suddenly is defensive and keeping to itself, that is a big sign of something being off.

Physical signs can range from limping, licking paws, changes in urination and expulsion, changes in appetite, and so on. Below, we have outline common causes of pain in cats and their correlating symptoms.

Possible Causes of Pain in Cats

With that in mind, here are seven painful conditions my feline-owning clients often overlook:

Ingrown Claws

This happens when especially curly claws don’t get trimmed. This is most common in older cats whose claws tend to grow thicker and longer due to their more limited exercise.

Look for: limping, licking paws, and walking around less, especially on harder surfaces

Feline Idiopathic Cystitis

This inflammatory bladder disease is considered highly painful. Thankfully, many cats do demonstrate their discomfort, usually by urinating about the house (often while straining). When they don’t…

Look for: Going in and out of the litterbox more often than usual and urinating in small volumes (sometimes you can tell, depending on the kind of litter you use)

Periodontal Disease

Cat afflicted with periodontal disease will typically show no signs of having painful teeth and gums. Even when cavity-like lesions (feline resorptive lesions) painfully expose the pulp of their teeth, cats will act as if nothing’s wrong.

Look for: Reduction in appetite, a messy feeding area (they often move their head erratically as they painfully ingest their food), eating with their head to one side, taking longer to eat than usual, regurgitating dry food (because they’re not chewing it), and exhibiting a preference for one kind of food over another (not necessarily wet over dry).

Stomatitis

This inflammatory condition of the mouth is kind of like periodontal disease, only more sudden and more painful. But still, we tend to overlook it. While there are not many options for limiting pain associated with stomatitis, there are procedures to help remedy the issue

Look for: Drooling, staring at the food bowl as if hungry but unwilling to eat, head shaking, a less groomed appearance (most won’t groom as much), and sometimes even yowling when eating

Osteoarthritis

Some researchers have suggested that the incidence of osteoarthritis in cats is higher than in dogs. Which will probably come as a surprise to those of you who had no idea cats could even get arthritis.

Look for: Decreased overall activity, less jumping (especially on higher surfaces), and, only rarely, limping

Otitis

Ear pain happens when chronic skin disease of the external ear canal leads to infection and ulceration we call otitis. One or both ears may be affected.

Look for: Head shaking, scabs from scratching around the head and face, holding the head to one side, hair loss around the ears

Ocular disease

Ever seen your cat squint at you with one eye? If so, you can be pretty sure she wasn’t trying to be cute. More than likely she was experiencing some degree of ocular discomfort. Corneal ulceration, where the cornea is injured, is perhaps the most severely painful, but cats suffer more commonly from uncomfortable viral infections of the tissues surrounding the eyes, such as conjunctivitis. This can occur in one of both eyes.

Look for:  Squinting, ocular discharge, weepy eyes, red or swollen eyes or lids

Embrace covers dental illnesses, alternative therapies for arthritis, and more in order to keep your beloved pet as comfortable as possible.

Treatment of Pain in Cats

Pain relief, in particular, is a surprisingly frustrating issue in feline medicine. 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, such as osteoarthritis.

Still, 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. 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.

In terms of researching options for chronic pain, 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

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 stronglyagainst the use of oral Metacam for long-term care. It’s just too toxic to the kidneys

Onsior

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)

It is suggested to use these options with caution. Nonetheless, they have been used across the board 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.

If your cats have been diagnosed with any of the above conditions, definitely ask your veterinarian for progressive pain control measures.

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