By Dr. Karen Shaw Becker
Cats present a special health challenge for both their owners and veterinarians because they're so skilled at masking pain and discomfort when they're injured or ill. As your kitty's primary advocate, it's important to realize that pain is a serious medical problem requiring treatment. It can delay or prevent proper healing from an injury or surgery. It can also cause a loss of appetite that can become life threatening.
Chronic pain can cause inactivity and loss of overall quality of life. It can also damage the bond you share with your kitty if his personality or behavior changes or he becomes aggressive. In addition, when pain isn't managed effectively, it can progress from what we call adaptive pain — pain caused by a specific injury or condition — to pain that is maladaptive.
Maladaptive pain is its own disease and must be dealt with in addition to routine pain management. Maladaptive pain can be of much longer duration than normal pain and considerably more challenging to treat. For all these reasons and more, it's very important to have your cat examined by your veterinarian as soon as you suspect the presence of a painful condition.
Causes of Pain in Cats
There are many things that can a kitty to feel painful. Some of the most common include:
Trauma or injury
Infections of the eyes, ears, skin
Gastrointestinal tract disturbances
Ingestion of poisons
Diseases of the back or spine
Dental/oral infections and diseases
Surgery (including dental surgery)
Major diseases like cancer
Some causes of pain in cats are more obvious than others, for example, most cat parents know when their pet has been injured, or is recovering from surgery, has gum disease, or a problem with an eye, ear or patch of skin. Less obvious reasons for pain are an underlying urinary tract problem, arthritis, a tummy ache or even a headache — anything going on inside your cat where you can't see it.
Older cats often develop osteoarthritis, intervertebral disc disease and spondylosis (joint degeneration), all of which cause pain. If you notice even subtle signs of pain in your cat, I recommend having her evaluated by your veterinarian. The sooner you find out the cause of her pain, the sooner you can begin to help her feel better.
Signs of Pain to Watch For
The reason cats hide pain is because in the wild, they're prey for other animals. A cat showing pain is seen as weak and vulnerable by predators. Recently, a team of researchers developed a list of 25 behavioral signs that indicate pain in cats:
Reluctance to move
Reaction to palpation
Withdrawn or hiding
Absence of grooming
Overall activity decrease
Less rubbing toward people
Shifting of weight
Licking a particular body region
Lower head posture
Blepharospasm (eyelid contraction)
Change in form of feeding behavior
Avoiding bright areas
Straining to urinate
Most cats in pain do not vocalize, however, if your cat almost never howls or cries but suddenly starts, it could be a sign there's something painful going on. And sometimes the only symptom is a new behavior, for example, your cat skips a meal or is suddenly hiding under the bed.
The Importance of Managing Pain in Cats
Since relieving kitty's pain is the first priority, often we have to treat the pain separately while we diagnose and start treatment for the underlying cause. If your cat requires surgery there will be pain involved, no matter how minor or routine the procedure is. Ask your veterinarian how he or she intends to manage pain before, during and after surgery.
For example, premedication before anesthesia not only helps decrease the patient's pain response, it can also increase the effectiveness of the anesthesia so your kitty requires less of it during surgery. This is a very important point, because it's shocking how many veterinarians still aren't administering routine pain management during surgical procedures. Instead, they wait for the patient to show pain and only provide pain relief at that point.
Not only is that approach unkind to the animal, it actually prevents pain management from being optimally effective. Managing a cat's anticipated pain proactively is not only kind, it's smart. Ideally you're dealing with a vet who understands the importance of pain management and is well-versed in the most appropriate drugs for felines to prevent and alleviate the pain that accompanies surgery.
Alleviating Stress in Painful Cats During Vet Visits
The vast majority of cats experience a great deal of stress during veterinary visits. Fear and anxiety make pain worse, as does being restrained for any reason. So if your already painful kitty gets really stressed during vet visits and an office procedure must be performed while you're there, your vet should offer — or you can ask for — an anti-anxiety drug for your pet.
For extremely stressed cats, the kindest option is a few puffs of gas anesthesia (think nitrous gas for the anxious dental patient), rather than unnecessarily harsh restraint for an already overstressed patient. Inhalant gas is a safe, gentle and appropriate approach when your vet needs to perform diagnostics on your cat.
You can also inquire whether the veterinary clinic uses synthetic feline facial pheromones to help calm cat patients. These pheromones, known to help many cats cope with stressful situations, come in diffusers that can be plugged into exam rooms. They can also be sprayed on tables, towels and hands.
I also like to coach owners of highly stressed cats through some things they can do at home before the veterinary visit, including using flower essences. There are dozens to choose from, such as Rescue Remedy that are very safe and beneficial for the highly stressed feline patient.
Finding the Source of Your Cat's Pain
Diagnosing pain can be challenging, but if your veterinarian can't find the source of your kitty's discomfort, I recommend seeing another type of practitioner. For example, you can get a second opinion from an animal chiropractor or a rehabilitation (physical therapy) practitioner.
Many of my clients also report that animal communicators and reiki masters have been incredibly helpful in identifying the underlying source of discomfort in their cats when their vet isn't able to. The point is to keep looking for the root cause of pain in your cat until it is found.
Don't let your veterinarian send you off with pain pills and no diagnosis as to what's causing your kitty's pain. Pain medication for cats requires special knowledge and careful attention. For example, certain opioids (narcotic painkillers) cause fewer side effects in cats than other types of painkillers.
Most NSAIDs (nonsteroidal anti-inflammatory drugs), on the other hand, actually create more side effects in cats than in other species. It's not that we can't use NSAIDs in cats, it's that we have to be very, very cautious of the type of NSAID, the dose, and the duration of therapy.
Many veterinarians like to use steroids such as prednisone. While steroids manage inflammation quite well, unfortunately, they can have potential long-term consequences for your pet's health.
Again, your veterinarian should be very well versed in the latest research and most appropriate medications for feline pain management. If your vet is using drugs on a short-term basis to manage undiagnosed pain, ask what his or her plan is for identifying the underlying source.
As most of you know, I'm always very cautious about using medications on a long-term basis, whether it's vaccines, antibiotics, steroid therapy, flea and tick preventives or any other pharmaceutical or pesticide agent that carries potential side effects.
However, the alleviation and management of an animal's pain is often a different ball game, and I'm not shy about using appropriate pain relief drugs as needed. I use them to make the patient as comfortable as possible while I'm trying to find the underlying reason for the pain.
In some cases, such as terminal bone cancer, I rely heavily on painkilling drugs for the remainder of pets' lives to keep them comfortable. But with the vast majority of my patients, I'm often able to wean them off drugs and onto a variety of other nondrug complementary therapies.
With an integrative approach, it's possible to dramatically reduce the frequency and dose of the drugs needed to manage pain, because we're able to balance the patient on a variety of other nontoxic options that do an effective job of pain management.
Alternative Approaches to Pain Management
Since felines are physiologically very unique, there are few effective pharmacologic agents that can be safely given long-term to control the pain of chronic conditions like arthritis. However, there are a number of alternative therapies that can alleviate your kitty's pain naturally, including chiropractic, therapeutic massage, stretching exercises, acupuncture, laser therapy and the Assisi Loop, which is a form of pulsed electromagnetic field therapy.
In the case of arthritic pain, there are supplements you can add to your cat's diet to provide the raw materials for cartilage repair and maintenance and slow down progression of the disease. These include glucosamine sulfate, methylsulfonylmethane (MSM) and eggshell membrane.
If your cat is overweight, it's important to safely diet him down to a healthy weight to decrease the amount of inflammation in his body. It's also important to feed an anti-inflammatory diet, which means eliminating pro-inflammatory foods that create inflammation and make the pain cycle worse.
You'll need to eliminate all grains in your cat's diet, as well as foods in the nightshade family, such as potatoes, which are found in most grain-free cat foods. Grain-free processed diets aren't carbohydrate-free, and carbs create an inflammatory response in cats. Homeopathic remedies often work wonders for cats dealing with chronic pain, as does cannabidiol (CBD) oil. Many kitties also tolerate turmeric and omega-3 fatty acids, as well as boswellia added to their food, all of which help naturally reduce inflammation.
I recommend working with a holistic or integrative veterinarian to determine how to best treat your kitty's chronic pain condition. As I mentioned earlier, once we discover the most effective alternative treatments for kitties with chronic painful conditions, we can begin to gradually reduce or even eliminate the need for painkilling drugs.
Maintaining Your Cat's Quality of Life
When we feel pain, we can talk about it with family members or a doctor or another health care provider. But in the case of your cat, the pain she's feeling is whatever you or your veterinarian interpret it to be. And the same is true of your pet's quality of life — it is what you determine it to be.
The quality of life of pets is primarily assessed in terms of the level of pain an animal is perceived to be enduring. Mobility should be part of the assessment as well, along with kitty's interest in engaging in play and being petted.
Just like people, kitties living in a barren environment and without adequate human interaction will focus on the pain. Environmental enrichment is very important in maintaining your cat's quality of life. An environment that provides stimulation, playing and petting can be powerful distractions for cats with chronic pain conditions.