TREATING
PAIN
WITH
NSAIDsTreating chronic (long-lasting) painwith NSAIDs: a guide for caregivers
Non-steroidal anti-inflammatory drugs(NSAIDs) are medications commonly given
to treat pain in cats. When used correctly,
NSAIDs can greatly benefit cats experiencing
chronic (long-lasting) pain. Discuss with yourveterinary team the best way to ensure
your cat is comfortable.
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Introduction: pain andquality of life
Cats, just like people, can experience pain forvarious reasons, including illness and injury.
There are now different types of medications
available to reduce pain and, in combination
with appropriate changes in the home, thesecan make a cat much more comfortable.
This guide focuses on management of chronic(long-lasting) pain with the use of NSAIDs.
International Cat Care’s Cat Carer Guide to‘Changes to the home environment for catswith muscle/joint pain or mobility problems’(available at icatcare.org/advice/cat-carerguides) describes how simple modificationsin the home can improve a cat’s comfort andquality of life.

Types of pain

Pain can be ‘acute’ or ‘chronic’. Acute painrefers to sudden onset pain that is expected to
be of short duration (eg, after surgery), and isdiscussed in International Cat Care’s Cat Carer
Guide to ‘Recognising and managing acutepain in cats’ (available at icatcare.org/advice/cat-carer-guides). Chronic pain lasts longer
term and can seriously affect a cat’s quality oflife, but fortunately can normally be managed.

can help to determine if a cat is showing
signs of osteoarthritis (also calleddegenerative joint disease); this tool
can additionally be used to monitor if
signs are improving or worsening.

Causes of chronic pain
Conditions that cause lasting pain inpeople can also be expected to cause
pain in cats. Examples of conditions
causing chronic pain that needtreatment include:• Osteoarthritis;• Dental disease (Figure 1);• Diseases affecting the stomach,intestines or pancreas;• Nerve (neuropathic) pain;• Cystitis (bladder inflammation);• Cancers (anywhere in or on the body).
If your cat has been diagnosed witha health condition, discuss pain
management with your veterinary team.

Signs of chronic pain
As caregivers, we may not always notice theslow onset, often subtle behavioural changes
associated with chronic pain vs the changes
that can be seen in cats with acute (suddenonset) pain. However, there are clues to lookout for and to discuss with your veterinary
team (see box on page 3). For pain involving
muscles and joints (musculoskeletal pain),
there are pain assessment ‘tools’ available
to help caregivers; one such tool is the Feline
Musculoskeletal Pain Index. Caregivers canalso download a free ‘mobility checklist’, which2

Figure 1: Dental disease is common in cats
and causes chronic pain. This cat has soregums and extensive dental disease that
requires treatment. Source: Rachel PerrySigns of pain in cats
Chronic pain in cats may be less obvious
than expected, as cats can hide pain
and adjust their behaviour to try to avoid
discomfort. Subtle changes in behaviour
may be the only indication. Signs to lookout for include:• Moving more slowly or stiffly (often
most noticeable when the cat is going up
or down stairs);• Limping, or holding up or avoiding usinga front/back leg;
• Reluctance or hesitation to jump up to,or down from, furniture, windowsills, etc;
• Reduced interest in play and/orinteractions with family or other pets;• Altered sleeping patterns (eg, sleeping
more, or less, than usual or in unusual
places such as under beds);• Altered sleeping positions (sleeping andresting in a hunched-up, stiff position, rather
than a normal relaxed, curled-up position, oreven sleeping/resting sitting up; Figure 2);• Backing away from being stroked orbrushed (when previously enjoyed);• Changes in appetite; eg, becoming more
fussy/selective with certain types of food/treats, or walking away from the food bowl;• Change in eating behaviour, such as
chewing abnormally (eg, on one side of themouth), swallowing biscuits whole rather
than chewing, dropping food from themouth or pawing at the mouth after eating;• Teeth grinding; typically, this is noticed
as an unpleasant scraping soundaccompanied by side-to-side or
up-and-down jaw movements, sometimes
when the cat is offered or trying to eat food;Figure 2: Thiscat withpainful joints
is resting ina stiff uprightposition,rather thana relaxed,
curled-up
position.
Source:Sam Taylor

Management of chronic
painChronic pain in cats is best managed with a
combined approach of medical treatment andchanges to the home environment. Adjustments
may be required to find the most suitable• Changes in toileting, including defecating
and urinating outside the litter tray, and/ordefecating less frequently or with difficulty;• Grooming less, leading to a dull, scaly
haircoat or knotted/matted hair;• Twitching skin, biting or overgrooming
areas of skin, or pulling hair out; these aresigns of possible nerve pain;• Pawing at the face or mouth; this is
a common sign of feline orofacial pain
syndrome or other pain in the mouth;• Change in temperament; eg, a cat that
normally enjoys being stroked might hiss,move away or try to bite.

If you have any concerns that your cat
may be in pain, contact yourveterinary clinic.

medication or combination of medications
for your cat. See International Cat Care’s
Cat Carer Guide to ‘Changes to the homeenvironment for cats with muscle/jointpain or mobility problems’ (available aticatcare.org/advice/cat-carer-guides)
for more information on non-medical
ways to help affected cats.

3How NSAIDs work to manage pain

NSAIDs are a type of pain relief (‘analgesic’)
medication that can be used to manage
chronic pain in cats by blocking pathways
leading to the production of chemicals thatcause pain and inflammation. They are
given orally (by mouth) as a liquid or tablet,which makes them suitable for caregivers
to give at home. They may, for example, beused long-term to reduce discomfort in a catwith osteoarthritis (see below). NSAIDs canalso be used to treat acute pain, such as thatassociated with a surgical procedure.

When NSAIDs might benefit
a cat longer term

Some causes of pain can be treated and will
resolve (eg, dental disease may be helped byremoving a painful tooth), but other conditions
are lifelong and affected cats will require
medication on an ongoing basis to maintaincomfort. In some situations, a veterinarian
may decide to prescribe NSAIDs that havebeen specifically developed for cats tomanage chronic pain. Most commonly, NSAIDs
are used for musculoskeletal pain, such as
osteoarthritis, but these medications may also
benefit cats with other conditions, such as
cancer or nerve pain, or may be used fora longer period after surgery.

syringe or as a tablet, it is importantto give the correct dose. NSAIDs aredosed according to a cat’s body weight,
and veterinary professionals shouldclearly explain how to draw up liquid
medications into a syringe to the correct
level, and how many tablets or fractionsof a tablet are needed, and how
frequently (usually once a day).
It is important to try to give NSAIDs at asimilar time each day. Medicating cats
is not always easy, but most NSAIDs can(and, in fact, should) be given withfood or a treat. Liquid treats (Figure 3)
can be particularly useful for giving
liquid-formulation NSAIDs, while NSAIDs
in tablet form can be pressed into more
solid, moldable treat products. Contact
your veterinary team if you are at all
unclear about the dose or how toadminister the NSAID, or are struggling
to give the prescribed medication.
Combining NSAIDs with some othermedications (eg, corticosteroids) canresult in side effects, so it is importantyour veterinary team are aware of
all medications (prescription andnon-prescription) your cat is receiving.

Speak to your veterinarian about using
medications such as NSAIDs to manage
your cat’s pain.

How to give NSAIDs
to your cat
When NSAIDs are used at home, they are given
orally – this means either directly into the cat’s
mouth, or in their food or hidden in a treat.
Whether administered as a liquid with a

Never give your cat human pain medications
Many drugs that are effective for us – for example, paracetamol(acetaminophen) and ibuprofen – can cause severe illness and evendeath in cats. Only give medications prescribed by your veterinary clinic.

4Figure 3:
Liquid treats
can be a
useful way
to givemedications(eg, NSAIDsin liquidform ortablets ifthey canbe crushed).
Source:Sam Taylor

Looking after a caton NSAID treatment
It is important that cats receiving NSAIDs eat
and drink well. This is to avoid potential sideeffects that can arise when NSAIDs are given
to dehydrated cats. Consult your veterinary
clinic before giving the dose of NSAID if
your cat is not eating as normal. Supplying
several sources of water and types of drinking
vessel, including water fountains (Figure 4),
wide-brimmed ceramic bowls or bowls placedoutside to collect rainwater, may encouragecats to drink and thereby help to avoiddehydration. Further ideas are provided inInternational Cat Care’s Cat Carer Guide to‘Encouraging your cat to drink’ (available aticatcare.org/advice/cat-carer-guides).
If your cat is not eating or is showing any othersigns of illness, such as sickness, diarrhoea orexcessive drinking, or if they seem very tired orFigure 4: Encouraging cats to drink can
avoid dehydration, which can be particularly
detrimental for cats receiving NSAIDs.
Source: Sam Taylor

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think your cat has lost or gained weight,
ask for a weight check at the veterinary clinic,
or weigh them at home using scales designed
for infants.
Given that cats show pain in subtle ways,
monitoring the effect of NSAIDs can bechallenging. As well as looking for evidence
that signs of pain (see page 3) are improving
or resolving, mobility questionnaires can beused before and after NSAID treatment.

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6Side effects to look out forin cats treated with NSAIDs

Any medication can cause side effects,and NSAIDs are no exception. If you notice
any concerning changes in your cat after
starting NSAID treatment, withhold themedication and contact your veterinary
team before giving the next dose.
In particular, monitor your cat for refusal
to eat or a reduced appetite, episodesof sickness or diarrhoea, increased
drinking, and any other changes inbehaviour or normal activity and habits.