Pain Goes Unnoticed
Chronic pain in cats is commonly underdiagnosed. Cats are so good at hiding their discomfort that it can come as a surprise to owners and even to some veterinarians to learn that they might be in pain. Owners aren’t always aware that syndromes such as glaucoma or diabetes are accompanied by pain.
Many behaviors can indicate pain in cats, including changes in functional mobility such as decreased grooming or difficulty in jumping on or off furniture; changes in sleep patterns or locations; changes in posture when sitting or sleeping; hiding; changes in litter box habits; unusual reluctance to be petted or groomed; and poor appetite. Anything that isn’t normal for a particular cat should be considered a possible sign of pain.
Causes of Chronic Pain in Cats
Many common feline diseases can cause chronic abdominal pain. Cats with this type of pain may not eat well or are nauseous and lethargic. Unless the pain is severe and constant, though, it may not be obvious when you palpate the cat.
Even once it’s identified, the level of pain can be difficult to assess. It can be a good idea to have owners keep a diary of the cat’s behaviors over a period of time or to have them complete a questionnaire.
Multimodal Relief
Managing chronic pain usually involves several types of therapy that all work together to help relieve discomfort. A combination of medication and physical therapies such as acupuncture, massage, or other rehabilitation techniques is usually most effective. Some trial and error may be necessary to find what works best.
We asked Alicia Z. Karas, DVM, DACVAA, at Cummings School of Veterinary Medicine at Tufts University, about her experience in recognizing and managing chronic pain in cats.
What should people know about pain in cats?
The first one is recognizing that the cat has pain. The cat might have arthritis, a degenerative joint condition, but nobody’s figured that out because the cat doesn’t limp. It might do things like not jump or not groom well. The other is not recognizing that a given syndrome is accompanied by pain. For many years, in dogs and cats, we thought of glaucoma as being something that threatened vision, but we know from people that glaucoma causes pain in humans and it’s a really difficult type of pain to treat. In cats and dogs, if they have an end-stage [case of glaucoma], we’ll take the eye out. Anybody who’s an ophthalmologist or who has removed an eye in an animal with glaucoma probably has heard from the owner that once that happened, the animal returns to almost a younger animal. They’ve had that chronic pain hanging over them, and once that was gone and that surgery has healed, they found their behavior much less inhibited by pain. So thinking about the fact that having skin disease or ear disease or eye disease or intestinal disease might not just be a problem for weight gain or thriving health but that it might impact pain is an important factor in terms of a barrier to pain treatment in animals.
What are some of the challenges of managing pain in cats?
When cats are resistant to being pilled, it can be a challenge. Sometimes cats need treatment for life and owners need to figure out how to get meds into the cat every day. Formulation of medication can also be a problem. One cat I treated with chronic post-trauma pain has to have one of her medications compounded because they don’t make the pills in a small enough size. They’re putting it in the food and the cat is eating it. Compounding can be very useful, but compounding medications has many drawbacks. It’s more costly, there is no guarantee that compounded medications will produce the same effects as the FDA-approved formulations, and the shelf life of compounded medications is much shorter.
What are some of the issues in treating chronic pain in cats?
A number of NSAIDs have been studied and approved for use in dogs, but that wasn’t done until fairly recently for cats. We’ve had two NSAIDs approved for use in cats for acute pain, but neither is approved for chronic use in cats in the United States, although NSAIDs are approved for long-term use in cats in Europe.
Are there other types of medications that can help cats with pain?
Gabapentin is an anti-seizure drug that was found serendipitously to have effectiveness for certain types of pain. Gabapentin can help cats with certain types of pain and is also something that can help sedate cats for car rides and vet visits. For smaller cats, though, this is a challenge because the smallest size pill that’s available is 100 mg. To reduce the amount we give requires it to be compounded or divided or made into a suspension that’s safe. People have also used tramadol in cats but it’s complicated by the fact that the taste is really bitter. We are using some things like amitriptyline, an antidepressant drug that isn’t used much for depression anymore but was found to have about five different ways that it could impact pain. It has potential use for chronic bladder pain, but some cats don’t tolerate it well. I have used other antidepressant-type drugs like Prozac in cats, at lower doses than for behavioral use, because it’s similar to amitriptyline, but maybe a little less complicated.
Can any supplements help with pain?
Cosequin is an oral joint supplement made for cats that can be useful for things like arthritis. There’s an injectable joint supplement called Adequan that is approved for use in dogs and is used off label in cats. And we’ll use things like fish oils and other supplement-type things as well.
What non-pharmacological treatments can help?
I use acupuncture in cats for chronic pain. I think that acupuncture can be very useful in cats. For acupuncture, you’d want to go once a week or once every other week at least for three to five sessions to see whether it’s going to have an effect on the cat, and then as needed, which might be monthly or every three months. It depends on the individual.
Can painful cats benefit from physical rehab?
I think people discount the benefit of physical rehab for cats, but I had one client who was pulling out all the stops for her older cat. She took him to a rehab specialist who was swimming him and doing massage and acupuncture and the cat had a really good response to that. It builds muscle, and muscle helps with joint problems. If you don’t have muscle because you haven’t been using your muscles, then you can’t support your joints, and your other muscles are really sore.
What can veterinarians suggest that owners do at home to help cats in pain?
When I see a cat for chronic pain—and I don’t see as many cats for chronic pain as I do dogs—I recommend a combination of lifestyle modifications. Those might be easier access to litterbox, ramps to furniture, and warm and cool places where they can go. Weight management is huge. If you have joint pain and you’re obese, you have way more pain than you need to because you can’t pull yourself around.
What else should be considered when managing pain in cats?
Probably the most important thing is to not be satisfied with the attitude “There’s nothing we can do.” With stomatitis, for example, taking all the teeth out is something that we commonly have done, and our dentists see at least several cats a month for this condition. If the cat isn’t a good anesthetic risk, there are medications that we don’t think of as traditionally analgesic. Certain antibiotics such as metronidazole have an anti-inflammatory effect. There are some times when joint disease affects cats and we might be able to do a surgery that helps them. We don’t do hip replacements in cats, but we can cut the hip joint and allow it to fuse and make a pseudojoint. That might help if there’s an instability. If there’s an ACL rupture or an unstable spine that’s causing back pain, surgery is the answer in combination with physical therapy and medication. I think that vets have a tendency to throw up their hands and say “It’s a cat, we can’t medicate it, there are no drugs approved for it, and it’s too much of a risk to use a medication.” Pressing on and saying ‘There is something I can do as long as I have the means or access to somebody who has different expertise’ is something that we can encourage.
This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.
Kim Campbell Thornton is content manager for Fear Free Pets and is a Level 3 Fear Free Certified Professional. She has been writing about dogs, cats, wildlife and marine life since 1985 and is a recipient of multiple awards from the Cat Writers Association, Dog Writers Association of America, and American Society of Journalists and Authors. When she’s not writing or editing, she’s competing in nose work trials with Harper, a Cavalier King Charles Spaniel.
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My cat Cleo is nearly 17 and receives sub-q fluids regularly at home. She used to grumble and try to get away but once I started Fear Free, I began giving her favorite crunchy treats before, during, and after administering fluids. Now she purrs through the whole procedure, and any time I approach the spot in the house where we do fluids, she walks up for “crunchie time.” I’ve been able to switch back to a larger needle because she doesn’t notice the poke while snacking, which makes administration faster, too.
Chewy had a lot of fear and anxiety at the veterinary clinic, causing her to behave aggressively and making it difficult to give her the care she needed. While training her, I observed various signs of pain, which were most likely adding to her anxiety. I alerted her caregiver to my observations so she could better assess and monitor her dog and update her veterinarian. Chewy and her caregiver had previously had negative and traumatic experiences at a veterinary clinic so I referred them to Keystone Veterinary Clinic, which has Fear Free Certified Professionals who created a handling plan to enable Chewy to have a thorough exam, radiographs, and other diagnostics in a safe and low-stress manner. I also worked with the owner to begin muzzle training. The combination of appropriate scheduling, handling, and sedation, Chewy was able to receive the diagnostics and treatment she needed.
Gus had developed severe resource guarding of his food and water bowls, as well as fear and anxiety regarding being touched and having his gear put on and taken off. As a result, he snapped at and bit a walker. We worked closely with his owners and utilized Fear Free strategies and positive reinforcement training to get Gus comfortable with having strangers in the home. We were eventually able to find a solution that allowed Gus to be comfortable having walkers touch and refill his water bowl and approach his food bowl without any signs of resource guarding or fear, anxiety, and stress. Now Gus happily greets his walker at the door, demands affection, and has no issues on his walk or in his home.
Eva, a spunky and energetic German Shorthaired Pointer, is a staff favorite for more than just her adorable, tongue-hanging-out smile, but there’s one thing Eva never liked: nail trims! Prior to the hospital’s transition to Fear Free in early 2017, it was a challenge to trim Eva’s nails, requiring three or four technicians to assist with restraint, plus a muzzle and calming cap. We started implementing Fear Free teachings right away with all of our patients, but one staff member has really gone above and beyond her commitment to Fear Free training to help Eva overcome her fear. Kayla McNeely volunteered to assist with Eva’s nail trims, and she can now perform Eva’s nail trims solo, standing, with minimal assistance from Eva’s mom, Sheila, who says, “Kayla’s patience and kindness have worked wonders with my girl.” Our hospital requires all staff members to go through Fear Free training to help ensure that all of our clients, patients, and staff have a pleasant experience during their exams. We have seen a tremendous difference in many patients at our hospital since our transition to Fear Free, but Kayla and Eva’s journey together is by far our most successful Fear Free adventure to date.
One-year-old Ruba disliked having her feet touched and her nails trimmed. We trialed trazodone for six months for all nail trim visits. It started to work well, and we discovered she preferred sitting in Dr. DaCosta’s lap. Ruba now comes in for frequent nail trims with minimal restraint and no trazodone needed. We are so proud of her progress and the team’s dedication to using Fear Free techniques.
Mikey Bear used to require sedation before blood draws, but I showed his amazing humans how to hold his back leg for a blood draw and wet the vein while giving him treats to get him used to the feeling. They worked on this for a month, and when they came back, the blood draw was a snap. I discovered they had added another step to the homework and were poking the vein with a toothpick at home.
When I worked at a veterinary emergency clinic, one of the dogs in the hospital was so fearful that he would begin to thrash and hit his head in the ground if anyone touched his leash. I sat in front of his cage with my back to him so he could become accustomed to my scent. Then I started placing treats in his cage and turning my back again. Eventually, I opened the door and put a leash on him and sat next to the door. When he came out of the cage on his own, I was able to walk him with no tension on the leash. Gaining an animal’s trust is a beautiful thing.
