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ACUTE
PAIN

Recognising and managing
acute pain in cats:
information for owners/caregivers
If your cat is undergoing surgery, has suffered an
accident or has an underlying illness causing pain,
it is important for you to recognise the signs ofdiscomfort and know how you and yourveterinarian will work together to manage yourcat’s pain.
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Introduction
Just like you and I, cats can experience pain
associated with illness, injury or surgicalprocedures. In recent years our knowledgeof feline pain and its detection andmanagement has increased.
Owners/caregivers play a crucial role inrecognising their cats are in pain, and inworking with veterinary professionals as partof the team to institute pain management.
Early intervention and treatment of pain canprevent some of the negative consequences.
Owners may be involved in administeringmedications, but pain management extends
beyond purely providing medical treatments,
and cat owners/caregivers can help withother strategies to ensure their cat’s comfort.

Types of pain
‘Acute pain’ refers to pain that comes on
suddenly and is expected to be of shortduration (hours to days), nonethelesscausing suffering and impacting your cat’swelfare. It may be treated in the veterinary
clinic and medications may also be given
at home. ‘Chronic pain’ is pain of longer
duration, such as pain caused by dental
disease or osteoarthritis. This article andrecently published International Society ofFeline Medicine (ISFM) Guidelines focus onacute pain.

Causes of acute pain in cats
Most cats will undergo at least one surgicalprocedure in their lifetime, most commonly
neutering and dental procedures, and any
surgery is likely to be associated with somepain. Additionally, illnesses such as
pancreatitis, infections, abscesses andcancers, plus traumatic injuries such as
broken bones or bruising from a car accident,
or bites and scratches inflicted during a cat
fight, will cause acute pain. It is reasonable toassume that anything that would cause us
pain, will also cause pain in cats and be justas distressing for them.

2

Figure 1: This cat is experiencing abdominal
pain associated with severe constipation.
Veterinary professionals look at ear position(in this case, ears drawn backwards withincreased distance between the ear tips),
eyes (partially closed), muzzle tension,
whiskers (straight) and head position toindicate pain using the Feline Grimace Scale(felinegrimacescale.com). This pain
assessment tool can also be used byowners/caregivers at home.
Source: Dr Paulo Steagall

Signs of pain in catsCats cannot tell us they are in pain, andas a species they are very good at hiding
when they are in discomfort. However,much work has been done on pain
recognition, so we can identify when acat is in pain, and also determine whentreatment of pain has been effective.
Within the veterinary clinic, veterinarians,
nurses and technicians may use a ‘pain
assessment tool’, which looks for signs ofpain by assessing the cat’s facial
expression (Figure 1), posture and resting
position (Figure 2), and its response to its
wound area being gently touched, whererelevant, and assigns a score. This may
prompt additional pain management,
and the assessment is then repeated toensure the cat’s comfort levels haveimproved. Of course, for this type of pain
assessment and treatment the cat needs
to be brought into the veterinary clinic.

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Figure 2: This cat
is painful after asurgical procedure.
He looks stiff in
posture, sitting
upright andnot resting
comfortably likethe cat in Figure 3.
Source: Dr SamTaylor

At home, the owner/caregiver may noticea change in their cat’s normal behaviour,and this tends to be the most significant
sign that a cat is in pain. For example, anormally friendly and interactive cat may
not want to be stroked or groomed (either
moving away or vocalising), may interact
less with the family and other pets, may
move around less and may have a reduced
appetite. Other signs that a cat may be inpain include:• Spending more time sleeping• Sleeping in unusual places/hiding(eg, under beds, in wardrobes)• Sleeping or resting in a hunched-up
position, rather than curled up and relaxed(Figure 3)
Figure 3: This cat
is curled up in anormal sleeping
position (a ‘bagel’or ‘doughnut’shape). Painfulcats tend not
to adopt thisposition and findit hard to settle
to sleep.
Source: Dr Sheilah
Robertson• Moving differently, limping, walking
stiffly, appearing reluctant or hesitant tojump (up onto, or down from, furniture forexample) or to climb stairs• Showing less interest in play
• Grooming less, leading to poor coatcondition• Refusing food, eating differently or
being more choosy with types of food
• Changes in urination and defecation(eg, urinating/defecating outside thelitter tray)• Temperament changes, such as
showing aggression towards people orother animals• Not wanting to be stroked or groomed(moving away or miaowing)• Changes in facial expression, as shownin Figure 1; typically, narrowed eyes, ears
held further back, a tense muzzle and/or
whiskers projecting straight out from thesides of the face, rather than loose andcurved.
If you have any concerns that yourcat may be in pain,
please contact your veterinary clinic.
The freely available ‘Feline Grimace
Scale’ phone application (Android andApple) educates owners/caregivers
about pain assessment and has been
demonstrated to be reliable when usedby non-veterinary professionals. It may
help with pain assessment in the homeenvironment.

Management of pain
Management of pain is about more thanjust administering medications, although
clearly they are important. Nursing carein the clinic and optimising the homeenvironment also play a fundamentalrole.

Medications
If a cat is in pain, or pain is expected due
to a surgical procedure or medical3

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condition, pain medications (analgesicdrugs) will be prescribed by theveterinarian. The choice of medication will
depend on the individual case and may
involve more than one type of analgesic,
and sometimes the inclusion of ‘local
anaesthesia’ as well. Types of pain
medication are discussed below.
Opioids
Opioids include methadone,buprenorphine and morphine. These drugs
are very effective and are included in mostpain management plans. They are often
given prior to surgical procedures as well
as afterwards.
Non-steroidal anti-inflammatory drugs(NSAIDs)
These drugs belong to a group of
medications that provide pain relief andanti-inflammatory effects. Often usedaround the time of surgery or to treat otherpainful conditions, they may also be given
orally (by mouth) when a cat goes home.
Local anaesthesia
Local anaesthesia is the technique of
applying an anaesthetic agent to an area
to numb that region. The anaesthetic may
be injected; for example, around an
incision site at surgery, around the spinal
cord for an epidural or to desensitise themouth before dental extractions. In somecases, the anaesthetic may be provided
by other means (eg, local anaestheticcream). This type of pain management
can be very effective and provide comfort
for some time after a procedure.
Other medications
Various other pain medications areavailable including, for example, ketamine,gabapentin and tramadol. Additionally,medications may be given to control
nausea (feeling sick), for anxiety and totreat an underlying illness.

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Creating a comfortable andnon-threatening environment
in the veterinary clinic
An important component of pain
management is ensuring cats are notfrightened during their hospital stay.
They should have a comfortable bed(Figure 4) and somewhere to hide, andshould always be handled gently andkept away from dogs. ISFM Cat Friendly
Clinic and AAFP Cat Friendly Practiceaccredited clinics have worked hardto ensure that cats are cared forappropriately in the veterinary
environment. (See catfriendlyclinic.org
and catvets.com/cfp for more
information and to find a clinic.)Figure 4: Hospitalised cats should have a
comfortable bed and somewhere to hide,and should be kept away from dogs.
Source: Dr Sam Taylor

Cat friendly nursing careat the veterinary clinic
Veterinary nurses and technicians area vital part of pain assessment andmanagement in the veterinary clinic(Figure 5). They monitor patients, perform
pain assessment, check wounds anddressings, administer medications andensure patients are hydrated, clean,newlayoutCat carer guide.qxp_FF Layout1 25/11/2021 09:23 Page 5

How an owner/caregiver canhelp their cat at home

Figure 5: Nursing care and a quiet and calm
environment with gentle handling areimportant aspects of pain management
in a veterinary clinic. Source: ISFM

groomed and fed. They may also be
involved in providing non-medical pain
control such as using cold packs on soreareas.

Care at home
The owner/caregiver is part of the pain
management team. As well as monitoringfor signs of pain, the owner/caregiver canensure the cat coming home from the clinic
after a surgery, or treatment for a painful
illness, has every chance of a rapidrecovery. Cats should have a comfortable
bed, in a quiet and clean environment,
away from people and other pets, to allow
rest. Other resources should also be in easyreach such as litter trays, food and water.
Further ideas for helping a cat on its road torecovery are provided in the box opposite.

• Monitor for signs of pain as discussed
in this guide, and contact yourveterinary clinic if you feel your cat
is uncomfortable• Some cats, for example after
orthopaedic surgery, may need to
avoid jumping or stairs, or may evenneed to be cage rested, so ask yourveterinarian how much activity isappropriate• Cats that normally have outdoor
access, may need to be kept indoors
temporarily and provided with a littertray• Monitor wounds for redness,discharge or pain by gently touchingaround the wound (do not touch thewound directly)• Provide options for quiet rest, ensuring
the bed is in easy reach; for example,
move the bed to a lower level or provide
steps up so that the cat does not needto jump
• Ensure essential resources are also inreach, including food, water, litter trays
and resting areas. The recovering cat
may not want to move too far• Tempt the cat to eat, warming food orproviding favourite foods (if suitable forthe cat’s underlying illness). If your cat
refuses food, or eats very little, informyour veterinary clinic• Give medications as directed by yourveterinarian (see page 6)• Keep other pets and children away
if they are likely to disturb the cat orinterfere with a wound dressing, forexample• Attend all follow-up appointmentswith the veterinary clinic but get incontact sooner if you are at all worried
about your cat

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Giving pain medications(analgesics) at homeCats in pain and/or recovering fromillness or surgery may be prescribedongoing pain medications to be given
at home. Medicating cats is not always
easy, so be sure you are clear on theprecise amount to administer (eg, byasking for a demonstration on drawing
up liquids into a syringe), how long togive the medication for, how frequently,
and if the medication can be given infood or a treat; if medication is put
directly into the cat’s mouth, ask
the veterinarian or veterinary
nurse/technician to show you how(Figure 6) (see icatcare.org/advice/howto-give-your-cat-a-tablet/). Always
contact your veterinary clinic if you
are struggling to give prescribed
medications. They will understand thechallenges and can often help by
providing alternative medications, forexample. If your cat seems comfortable,
do not stop the pain medication unless
told to do so by your veterinarian, as thismay allow pain to develop and ultimately
become harder to control.

Figure 6: Giving medications to cats, including
pain medications, can be challenging, but isvital to prevent pain developing after anillness or surgery. Contact your veterinary
clinic if you are struggling to medicate yourcat and do not stop pain medications, even if
the cat seems comfortable, unless directedby your veterinarian. Source: ISFM

6Conclusions and information
Acute pain can now be well managed incats using a combination of medications,
local anaesthesia, and nursing and homecare. Veterinary professionals andowners can work together to create apain management plan for cats withpainful illnesses or undergoing surgery.
Useful links are provided below:• The Feline Grimace Scale —felinegrimacescale.com• ISFM Cat Friendly Clinic Scheme —catfriendlyclinic.org
The International Cat Care website
has information on all things cat:
icatcare.org

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