Recognising pain is very important because our pets are unable to speak up for themselves, so it is down to us as vets and owners to interpret their behaviour.
Many animals have evolved to hide pain and suffering from others, but just because they are not expressing pain in the same way as us, does not mean they are pain-free. It is part of our duty of care as vets and owners to ensure our furry friends are happy and comfortable, which means we must relieve pain should it arise, and use preventative care whenever a painful incident is suspected.
The following pain score chart which has been developed by International Cat Care can be used to help determine if your cat is in pain. This form should be brought to your vet for discussion.
Cat Chronic Pain Score Chart
How do I complete the Cat Chronic Pain Score Chart?
The Pain Score Chart is a short questionnaire which acts as a guide to help you recognise some of the most common symptoms of pain due to mobility disorders (such as arthritis) in your cat.
It can also be used to monitor change over time and assess response to treatment.
For each section please consider your cat's behaviour and demeanour for the last 2 weeks. Then score that behaviour from 0 (does not apply/does not do this) to 3 (does this nearly every day).
Please remember there are no right or wrong answers to the questions, and do not worry if you feel some do not apply to your pet.
We will use this information as part of our discussion into your cat's overall health and wellbeing at their next appointment so please bring your completed chart with you.
What are the benefits of treating pain?
Treating pain has many benefits both in the short and long term. Pain is never beneficial and has a big impact on quality of life, we are all happier with a life free from pain!
Pain can cause behaviour changes such as depression, lethargy and even aggression. It also causes stress, which lowers the immune system and can cause delayed wound healing. Reduced mobility due to pain can lead to ulcers (bed sores) and urine scalding. An animal in pain is be less likely to eat, which can lead to weight loss, muscle wastage and electrolyte imbalances.
Acute pain when left untreated can develop into chronic pain, which can be more difficult to manage. Repeated painful experiences can cause 'sensitisation', which means that a normally non-painful event can provoke a pain sensation. It can also lead to long term behavioural changes.
Therefore, here at Maven we use a variety of techniques to reduce pain, both in the hospital and at home. We want our patients to have a positive experience when they come to us, which involves making their visits as comfortable and enjoyable as possible.
How do cats show pain?
Cats are very good at hiding the signs of pain, and the signs can be subtle, especially with chronic conditions such as dental disease or arthritis. Pain can be caused by many different diseases, trauma, or following surgical procedures, and we will always advise you on appropriate strategies for pain management with any condition.
If you are concerned your cat may be in pain please DO NOT give a human medication (paracetamol, ibuprofen, naproxen) as these are toxic to cats and can cause severe organ damage.
If you have painkillers at home from a previous condition or for a different animal, please contact the clinic for advice on use as they may not be appropriate for your cat
Signs of acute pain in cats (e.g. after trauma or surgery):
- Hunched posture/tucked up rather than sleeping in normal curled up position
- Squinting of eyes, ears held back or flat
- Agitation (being unsettled, restless, trembling or shaking)
- Vocalising (cry, growl, hiss)
- Sensitivity to touch/reluctance to be handled
- Limping or reduced ability to walk/move/jump
- Reduced appetite
- Rapid shallow breathing
Signs of chronic pain in cats
(e.g. osteoarthritis, dental pain, chronic illness):
- Reduced activity (sleeping more, reduced exercise or play)
- Difficulty standing/walking
- Reduced ability to jump up to or down from surfaces
- Decreased grooming (matted fur, 'unkempt' appearance)
- Decreased appetite and weight loss
- Change in urination or defaecation habits (e.g. missing the litter tray)
What medical treatments are available to manage pain in my cat?
Drug Therapies include:
Non-Steroidal Anti-inflammatory Drugs (e.g. Loxicom, Carprieve, Previcox)
These drugs manage inflammatory pain and come in injectable and oral forms. They are very useful not only as part of the treatment for acute pain, such as after trauma or surgery, but they are also very important in the management of chronic conditions such as osteoarthritis.
Precautions and possible side effects: The main side effects of these drugs are vomiting and diarrhoea, but in rare cases they can cause ulcers in the stomach or intestines. These medications generally must be given with food to reduce the likelihood of this side effect. If your pet is not eating, or develops vomiting or diarrhoea, please stop this medication and call the clinic asap for advice. These drugs must be used with caution in patients with liver or kidney disease, and we recommend animals that are on these medications long term receive regular health checks and blood tests to ensure that these drugs are still suitable.
Opioids (Methadone, buprenorphine, fentanyl, tramadol)
These are strong pain killers that are very important in the management of acute pain. They are generally available only as injections, but some oral or topical forms are available. All animals undergoing procedures at Maven Vets will receive a strong opiate, usually methadone, before surgery. They are frequently reassessed for pain during and after the procedure and additional doses are given as required. For more invasive procedures, such as orthopaedic surgery or major abdominal surgery, we often keep patients in for at least 24hours so that appropriate pain relief can be given. We also sometimes use long acting pain relief patches (Fentanyl patches) to give lasting opioid pain relief at home. The oral forms can be very useful for managing pain at home, either in addition to NSAIDs for severe pain, or instead of NSAIDs in patients that cannot tolerate them.
Precautions and possible side effects
The main side effects are sedation (sleepiness, wobbliness) and nausea or vomiting. We reassess our patients regularly in the hospital for this and adjust doses accordingly. These drugs are generally safe to be given to older patients and patients with liver or kidney problems.
These completely block all sensation including pain so are one of the most effective ways to manage acute pain. At Maven Vets we use local anaesthetic injected into the gum prior to all dental extractions, using long acting drug that lasts 4-6 hours. We also use local anaesthetic during invasive surgeries such as orthopaedic surgery and large lump removals. In some cases, we place an indwelling drain so local anaesthetic can repeatedly be applied to the painful area, providing long lasting pain relief.
Precautions and possible side effects: these medications generally have few side effects. They can cause transient irritation at the site of application, and in rare cases allergic reaction.
What non-medical treatments are available to manage pain in my cat?
Non-medical treatments include:
Nutraceuticals (joint supplements e.g. Nutraquin, Nutraquin +)
Increasing intake of essential fatty acids, and supplements containing glucosamine and chondroitin have been shown to help support joints and increase comfort levels in dogs and cats with osteoarthritis. This can help to reduce the dose of drugs that are required to control pain, therefore reducing the chances of drug-related side effects. There are a variety of products available and we would be happy to discuss them with you at your next appointment should you have any questions.
Often animals that are experiencing pain will require additional TLC at home, such as extra padded bedding, raising food and water bowls to make them easier to access, and ramps or steps to help them into the car or onto furniture. In some cases, for example after fracture repair surgery, we may recommend restricting their movement by keeping them in a cage whilst they heal, or they may need to be on a special exercise program.
Therapeutic exercise can be used in cases of osteoarthritis or after surgery to rehabilitate the muscles and reduce pain. We refer our patients to Joanne Boddy BSc MCSP SRP Category A ACPAT.
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There is growing evidence that acupuncture can be very useful as part of the treatment for chronic pain in both cats and dogs. At Maven we can arrange a referral for acupuncture if this is appropriate.