Paws into Grace owner Dr. Elizabeth Benson has worked with hundreds of hospice patients over the years. As a cat lover and owner, she wanted to share her knowledge and experience with cats and pain with our Paws into Grace family. Knowing when your cat is in pain can be challenging,
“There is a quote that really resonates with me when it comes to pain — Lord Kevin said, ‘If you cannot measure it, you cannot improve it.’
My apologies that there is no simple, step-by-step cookbook recipe to detect pain in your cat.
Cats have evolved, but still evade us when it comes to pain.
They are not martyrs and mask pain well. This leaves us puzzled with how to determine if a cat is in pain or suffering. We need to ask ourselves, ‘What does pain look like and what do cats do when they are in pain?’
Signs of pain may be subtle, such as behavior changes. Cats are rarely obvious and this is no different. When trying to recognize pain, we need to take a holistic approach. We need to look at different possible clues and assess cats at home whenever possible. If we answer ‘yes’ to most of these, then the evidence suggests there is pain present.
Get out your pen and paper. Write these clues down and observe closely.
- Posture and comfort: Specific postures such as a hunched or tense posture may indicate acute or chronic pain. Cats should have a normal curled up and relaxed sleeping position.
- Activity: Watch closely as your cat gets up after sleeping or when moving about the room. If there is decreased moving in general, less jumping, stiffness, or less fluid movement, most likely there is pain present. A good indicator may be after sleeping when cats have the typical downward dog Yoga stretch. If this is suddenly absent then there may be pain present restricting movement. Another simple test would be to pet them as usual to see if there is a different response. Would they normally engage with you rubbing the head or body along you and arch the back and now this has changed? If so then likely there may be restricted mobility and pain is present.
- Attitude and demeanor: These terms encompass psychological pain elements. Your veterinarian would use the words: depressed, uninterested, indifferent or content as an alternative. Other words may include: indifferent, lethargic, anxious or aggressive. All of these are not specific or only present with pain but definitely are more common when there is discomfort.
- Social interaction: We all know that some cats are just not that into you. The key is looking for a sudden, gradual change or sudden aggression.
- Response to touch, pressure and palpation: If you are able to gently apply pressure to an area that may be sore and have a withdrawal, growl check the box for pain. Another indicator may be grooming a particular area excessively or even total lack of grooming compared to before.
- Appetite: Cats in pain will eat and there are many causes of inappetence or anorexia other than pain but . . . If there is a decreased appetite along with these other clues mentioned than you guessed it your cat most likely has some discomfort.
- Facial expression: This one is subtle. I have to admit that I have not recognized the facial expression or understood the “Grimace Scale” until I was able to really study hundreds of hospice patients closely. The facial expression of pain is partially closed eyes with tension around the muzzle. The ears are typically lower than normal or flattened. Here’s a photo because again this is really subtle.
So these are the clues and, if we put them all together, then this gives us an idea of pain or no pain. We don’t hang our hat on any one clinical sign. It is the overall picture or presence of multiple clues that confirms our suspicion. Another reference worth glancing at for help with this conundrum is the Glasgow Pain Scale.
My last thought I will leave you with and what I remind myself with every hospice patient is this– you should assume a pet is in pain if the physiology makes reasonable sense for them to be, and use treatment response as the diagnosis. In simpler terms: does it make sense that my cat would be in pain ? If yes, treat for pain and monitor the response. In these cases, the benefit of the doubt should be given to the patient. Use the cat’s response to pain medicate to confirm pain is, indeed, present. As a veterinarian, I give a patient pain medication then ask the owner to monitor for all of the clues above. If there is significant improvement, then pain was present.
If you feel you need help with this assessment, our Paws into Grace veterinarians are well versed in hospice and palliative care, and are able to schedule a Quality of Life Evaluation to help.
“Feline Anesthesia and Pain Management,” Sheilah Robertson, pgs. 109-209. John Wiley & Sons, 2018.