Chronic Pain Management for Cats
There are many causes of chronic pain, and your veterinarian should be consulted if you suspect your cat lives with any form of discomfort.
Like stoic warriors, our cats conceal pain for the same reason — pain equals weakness and vulnerability to attack from enemies. Hiding pain is an instinctual survival strategy for cats, and because they are so masterful at concealing pain, it can sometimes take owners a long time to realize that something is amiss.
“Chronic pain is pain that continues for two to three weeks, or longer — even months or years, after the anticipated healing time,” explains pain medicine specialist Alicia M. Karas, DVM, MS, DACVAA, an assistant professor at Tufts Cummings School of Veterinary Medicine. The most common cause of chronic pain is degenerative joint disease, or arthritis, and studies indicate that 60 to 90 percent of older cats experience arthritis in joint sites such as hips, elbow, shoulder and spine, among other joints.
There are many causes
However, cats of any age may experience chronic pain from a variety of causes. “It can start with surgery, trauma, or an accident, a burn for example. Other kinds of chronic pain are associated with an ongoing disease process, such as inflammatory bowel disease, cancer or uveitis — an inflammation inside the eye — that can be chronically painful.
“Dental disease — including ulcerative stomatitis, an ulcerative disease of the mouth in which the gums are inflamed and is terribly painful — is another common cause,” says Dr. Karas.
Because recognizing signs of pain in cats can be so difficult, owners may not notice until a condition is severe or advanced. Some signs of arthritis may include difficulty when climbing stairs, a decrease in play and over grooming a painful area. Decreased grooming — due to an inflexible spine which makes it difficult, and painful, to reach the back half of the body —is also common. Spinal pain and inflexibility may also contribute to eliminating outside the litter box because the box is too high to climb into or too small in which to turn around and comfortably crouch. That’s why it’s especially important to talk to your veterinarian if your cat eliminates outside the litter box to determine if it’s a behavioral issue, a medical condition or possibly related to pain.
Decreased jumping is a sign
Another sign of pain due to arthritis is a decreased willingness to jump to favorite places such as windowsills, sleeping spots or feeding areas. “Cats commonly jump five to seven times their height to get something they want, and jumping repeatedly wreaks havoc with joints,” says Dr. Karas.
“Signs of oral pain include difficulty chewing, dropping food and a chattering movement of the jaw if their gums or teeth really hurt — you can just imagine trying to crunch dry food when your mouth hurts,” says Dr. Karas. In general, for any kind of pain, the cat may be irritable, may not want to be touched or picked up, and the relationship with other cats, dogs or people in the household may change.
How to reach a diagnosis
Diagnosing pain isn’t always straightforward, either. “One of the best resources we currently have in terms of animals and pain is the home video. Take a video so you can show your veterinarian,” says Dr. Karas. “It can be difficult on examination to tell if a cat has physical pain, and it’s important for the vet to make sure that the cat doesn’t have something like a ruptured ligament or a disc that needs to be surgically fixed.
“Getting X-rays is always a good idea, but the cat could have arthritis pain with no visible changes in the joint, visible changes in the joint with no pain or visible changes and pain. Much of it comes from what the owner says about the cat’s history at home. When there’s obvious, severe pain you can see it — but some cats become so stressed or irritable at the vet’s office that it becomes difficult to examine them.”
Limited medication options
For cats diagnosed with a painful condition, the first priority is to treat the underlying disease or cause, if possible. After that has been addressed, there are two approaches to treating chronic pain in cats: pharmaceutical and non-pharmaceutical. “There are zero medications approved for chronic pain in cats in the United States; several for dogs but not one single one for cats. Cats are an underserved veterinary population,” says Dr. Karas.
Does that mean cats in chronic pain must suffer? Fortunately, the answer is no. There are a few medications, not officially approved, that are used to treat cats with chronic pain that your veterinarian may be able to prescribe. This practice is called “off-label,” which means that a medication is used for something other than which it is intended. “Non-steroidal anti-inflammatory drugs (NSAIDs) are used to control pain and inflammation in the body, but they are a particularly challenging class of pain medications for cats due to their inability to metabolize this class of drug, and if they are used off label it must be done very carefully and with informed consent,” explains Dr. Karas. “NSAIDs must be used with caution due to the potential risk of liver, kidney, stomach and/or intestinal problems.”
Human medication: never!
Never give any pain relief medication for humans to your cat. Cats weigh a fraction of what we weigh, so there is no dose specifically sized to their weight, and some over-the-counter medications are dangerous to cats. “Acetaminophen (brand name, Tylenol) is toxic, and just one dose is fatal,” says Dr. Karas.
There are other medications used to treat chronic pain that include opioids and gabapentin. “We use opioids for severe chronic pain, for example terminal pain experienced by a cat dying from cancer. Opioids may offer a better quality of life to cats in severe pain, but they may cause behavior changes, loss of appetite and constipation,” says Dr. Karas.
Gabapentin — an anti-epileptic medication — is prescribed as another option for chronic pain in cats. “The smallest capsule is too large for cats, so in many cases it has to be compounded into a liquid form and made into a more suitable dose adjusted for cats,” says Dr. Karas. “It has to be tailored to that particular cat, at that particular weight and the stage of disease, and then adjusted as the condition progresses.”
There are other medications used for treating chronic pain and your veterinarian should review the options with you, and then choose the most appropriate medication for your cat’s treatment. “Regardless of the pain medication prescribed by your vet, risks can be minimized by using the lowest effective dose and watching closely for signs toxicity such as vomiting, diarrhea or loss of appetite,” says Dr. Karas.
Some non-pharmaceutical approaches to managing chronic pain include making environmental or lifestyle changes, such as providing foam stairs or ramps to reach high places like the couch, bed or favorite windowsill. Other suggestions include providing larger, open, shallow litter boxes for easier access, raised food and water dishes that are easily accessible without having to jump up to the feeding spot, and increased play or activity.
Weight loss is especially beneficial to cats with arthritis not only because carrying the extra weight hurts the joints, but also because fat causes inflammation, which has been learned from chronic inflammatory diseases in people, according to Dr. Karas.
Other forms of treatment
Complementary treatments used to successfully manage chronic pain in many cats include acupuncture, massage, and the use of nutraceuticals such as fish oils and glucosamine chondroitin. Dr. Karas explains that nutraceutical approaches may help reduce inflammation, but will take some time to have an effect, up to six to eight weeks.
Providing a pain-free quality of life for our feline companions starts by being observant to changes in normal behavior and sharing this information with your vet. While the methods for managing chronic pain in cats are currently limited, there are options to help alleviate pain and offer improved quality of life. — Ramona Marek, Ms Ed.