How to Tell if Your Cat Is in Pain

Analysis by Dr. Karen Shaw Becker

how to tell if your cat is in pain

Story at-a-glance -

  • Felines are masterful at hiding pain, but behavior and body language can provide valuable clues to your cat’s health and comfort level
  • There are 25 behavioral signs considered by veterinary experts to be reliable for the assessment of pain in cats
  • Another pain measurement tool is the Feline Musculoskeletal Pain Index (FMPI), an online assessment that’s easy for cat parents to use
  • A more recently developed pain measurement tool for cats, the Feline Grimace Scale (FGS), scores five “facial action units” that indicate pain in cats
  • Pain is almost always a serious medical problem requiring treatment; managing feline pain is extremely important and should be accomplished using an integrative protocol

It’s often much more challenging than it should be to determine whether your cat is in pain, or simply displeased (especially since many cats are easily irritated!). Feline family members are experienced professionals at keeping their aches, pains, disorders and diseases hidden from us for as long as possible.

This is by design, because in nature, smaller wildcats are prey for larger animals. Showing vulnerability in that setting invites predation. That’s why virtually all felines appear “normal” while dealing with even a terminal disease. And in addition, since kitties tend to make themselves scarce when they’re not feeling well, it’s easy to misinterpret or simply overlook signs your furry family member is hurting.

Thankfully, researchers are working diligently to develop tools that both pet parents and veterinarians can use to decipher the body postures and behaviors most commonly seen in painful cats.

Your Cat’s Behavior Is a Window to His Pain

A 2016 U.K. study investigated signs of pain in cats.1 Signs of feline pain are primarily behavior-related, which is why I always encourage cat guardians to routinely monitor kitty’s behavior for signs of a problem.

The U.K. researchers surveyed an international panel of 19 veterinary experts across a variety of disciplines. The experts were first asked to list disorders they considered to be consistently, inherently painful in cats. Next, they were asked to evaluate pain-related behavior in cats according to specific criteria.

Based on survey results, the researchers identified 25 signs considered sufficient to indicate pain. However, no single sign of the 25 was considered necessary for a cat to actually be in pain. The 25 behavioral signs considered by veterinary experts to be “reliable and sensitive for the assessment of pain in cats, across a range of different clinical conditions” are:

Lameness

Hunched-up posture

Difficulty jumping

Shifting of weight

Abnormal gait

Licking a particular body region

Reluctance to move

Lower head posture

Reaction to palpation

Blepharospasm (eyelid contraction)

Withdrawn or hiding

Change in form of feeding behavior

Absence of grooming

Avoiding bright areas

Playing less

Growling

Appetite decrease

Groaning

Overall activity decrease

Eyes closed

Less rubbing toward people

Straining to urinate

General mood

Tail flicking

Temperament

The Feline Musculoskeletal Pain Index

Cats with musculoskeletal pain due to degenerative joint disorders are much easier to evaluate in their own homes vs. a veterinary clinic, because they’re less stressed and more likely to move around. The Feline Musculoskeletal Pain Index (FMPI) is designed for use not only by veterinary staff, but also by cat owners.

“Using language accessible to cat owners, the questionnaire asks a series of simple questions about movement, behavior, sleep and mood,” writes feline practitioner Dr. Elizabeth Colleran.

“Pain associated with bones, joints and muscles results in compensatory behavior alterations that can be seen by a caregiver who’s known the cat for a period of time. A score is attached to the completed form which is used to evaluate the degree to which the cat has changed over time.”2

If you’re interested in the FMPI, visit PainFreeCats.org. The questionnaire can be repeated over time to see how your cat is progressing. It’s also important to discuss the results with your veterinarian. Since your cat’s health will naturally change over her lifetime, the FMPI can help you track trends, identify patterns of behavior, and make adjustments to her treatment protocol as necessary.

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Changes in Your Cat’s Facial Expressions May Signal Pain

The Feline Grimace Scale (FGS)3 is a recently developed pain measurement tool for cats that describes five “facial action units” (ears, eyes, muzzle, whiskers, head) that signal pain:4

  1. Ear position — Ears facing forward, pulled slightly apart, or flattened and rotated outward
  2. Orbital tightening — Eyes opened, partially opened, or squinted
  3. Muzzle tension — Muzzle relaxed (round), mildly tense, or tense (elliptical)
  4. Whisker position — Whiskers loose and curved, slightly curved or straight, or straight and moving forward
  5. Head position — Head above the shoulder line, aligned with the shoulder line, or below the shoulder line or tilted

Each facial action unit receives a score of 0, 1, or 2. A score of 0 indicates absence of pain in the facial action unit, 1 is moderate appearance of pain or uncertainty, and 2 is obvious appearance of pain. The maximum total score is 10; a total score of 4 or more means the cat is in pain and needs analgesia.

Why It’s Crucial to Manage Your Cat’s Pain

Pain is a serious medical problem requiring treatment. Chronic pain can cause inactivity, reduce your kitty’s overall quality of life, and damage the bond you share with him 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 can be of much longer duration than normal pain and considerably more challenging to treat. One of the best ways to avoid “pain wind up” from the beginning is to effectively address pain immediately.

I regularly see clients who are fearful of using appropriate pain drugs when necessary and opt instead for natural support. In my opinion, even the most potent herbs and nutraceuticals won’t address moderate to profound pain to the degree necessary to be considered humane.

However, 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. After the patient’s pain is well managed on appropriate pharmaceuticals, the vast majority of cats can be weaned onto all-natural protocols (or a blended protocol including a reduced amount of pain killers) that do a great job of handling mild to moderate pain.

There are also a number of alternative therapies that can alleviate your kitty’s pain naturally, including chiropractic adjustments, therapeutic massage, stretching exercises, acupuncture, laser therapy, and the Assisi loop, which is a form of pulsed electromagnetic field therapy.

There are also supplements that can be added to an arthritic 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 her down to a healthy weight to decrease the amount of inflammation in her body, since inflammation is a primary feature in all types of pain. It’s also important to feed an anti-inflammatory diet, which means eliminating foods that create inflammation and make the pain cycle worse.

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 and nutraceuticals often work wonders for cats dealing with chronic pain, as does cannabidiol (CBD) oil. Many kitties also tolerate turmeric and omega-3 fatty acids, Esterified Fatty Acid Complex (EFAC), as well as boswellia added to their food, all of which help naturally reduce inflammation.

I recommend working with an integrative veterinarian to determine how to best treat chronic pain conditions in cats.