Stub your toe, bump your head or cut your thumb while peeling an apple, and you’re apt to give out a yell that will let the world — or at least the other members of your household — know that you’re in pain. When it comes to dealing with pain, however, cats simply aren’t like that.
To be sure, a cat is apt to let out a momentary howl if he happens to step on a tack or a hot cinder. But he’s not going to go on and on vocalizing about his bad luck. Eons of experience in the wild have taught cats to conceal any sort of physical disability, as best as they can, from potential enemies. It’s part of their natural survival instinct to hide the fact that they have been injured or otherwise weakened and are thus susceptible to attack from a predator.
Signs to look for
Then how can an owner tell whether a cat is suffering pain? According to Michael Stone, DVM, a specialist in small animal internal medicine at Tufts, “If a cat is experiencing pain, the owner is apt to notice such behavioral changes as a decline in grooming, a tendency to hide and an abnormal sensitivity to gentle handling.” Other possible signs include soiling outside the litter box, aggression when approached, unusual posture, uncharacteristic vocalization, an altered sleep pattern and reduced appetite.
Although these behaviors — and many others as well — may be prompted by pain, they may also be exhibited by healthy, happy cats who are free of physical discomfort. Consequently, the signs should be considered by the cat’s owners in the context of what is normal for that individual cat. At the same time, says Dr. Stone: “You can assume that your cat might be experiencing pain — even if he’s not exhibiting dramatic behavioral signs — if you notice him withdrawing from normal activity, showing lameness or having difficulty jumping onto or off of elevated surfaces.”
If an owner observes any such indicators of pain, an affected cat should be examined by a veterinarian without delay. Although the behavioral signs may be more telling than physiologic signs, a veterinarian will examine the cat for such potential indicators of a painful disorder as abnormal heartbeat, body temperature, respiratory rate, blood pressure and an elevated level of certain stress hormones in the patient’s blood.
The veterinarian is also likely to ask the owner about such details of the patient’s routine activities as the cat’s typical eating and grooming habits, his normal sleep patterns, the use of his litter box, and the way he typically interacts with his owners and other animals in the household.
Unpleasant as it is, pain can play an important role in maintaining a cat’s health and well-being by alerting the animal’s brain to the fact that something, somewhere in his body, has gone awry and needs attention. This is a protective mechanism, enabled by sensitive receptor cells located throughout the body — in the skin, the bones, joint surfaces, artery walls, just about everywhere. These specialized cells — which are stimulated by harmful forces or substances (pressure on a limb or internal organ, extreme heat or cold, the consumption of a poisonous substance, inflammation in a joint, for example) — transmit electrical impulses along nerves to the spinal cord and then to the cat’s brain.
In some situations, the initial five or 10 minutes of pain can be life-saving, due to increased cardiovascular output, certain muscle reactions and the triggering of the fight-or-flight instinct that will prompt a cat to escape from the source of the pain. But if the pain persists for an appreciable length of time or occurs without a readily identifiable cause, it will serve no positive purpose.
Dr. Stone notes that feline pain, like human pain, can be acute (or adaptive) — the kind of intense but comparatively short-term discomfort that may be caused, for example, by a bite wound or surgical incision. Or it can be chronic (or maladaptive), persisting constantly or intermittently for an extended period as a gradually intensifying consequence of an injury or long-standing physical disorder, such as severe dental disease or arthritis. Pain can also be categorized, he points out, as visceral, neuropathic or musculoskeletal.
“Visceral pain means that it is deep within the body,” explains Dr. Stone. “The discomfort might stem from, for example, intestinal upset or pancreatitis. Neuropathic pain originates from direct nerve involvement, resulting from trauma to the head, say, or a slipped vertebral disc. And musculoskeletal pain can result from such things as a sprain, a muscle strain or arthritis.”
To determine whether a cat is experiencing acute or chronic pain, a veterinarian, in consultation with an animal’s owner, is likely to consider the following:
Changes in a cat’s normal behavior, including a noticeable decrease in ambulation, activity, grooming or appetite;
An increase in abnormal behavior, such as inappropriate elimination, vocalization, aggression, hiding or restlessness;
Increased body tension and reaction to touch, including flinching in response to petting of an area that has been injured.
“I will use gentle manipulation to assess a cat’s reluctance to having a particular area touched,” says Dr. Stone. “Some animals are more stoic than others. Some are more timid. I try to integrate my findings with what the owner is noticing at home.”
What methods and pharmaceuticals will a veterinarian typically use or suggest for the treatment of feline pain? “Drugs, physical therapy, cold or heat treatment, ultrasound and dietary adjustment therapy for weight control might be used,” says Dr. Stone, “as well as resolution of a specific underlying problem, such as removal of a painful growth. Each cat’s treatment will be individualized.”
Currently, feline pain is treated primarily with two types of analgesics: opioids, which function as numbing agents that dull pain; and nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation. A veterinarian will select a painkiller that is appropriate, depending largely on the source of the pain, the intensity of a cat’s discomfort, and the length of time that is prudent and desirable for an animal to be given the drug.
Owners should be aware that some pain-relieving medications that have been formulated for humans (such as Tylenol) could be fatal to a cat and must never be used to treat feline pain. In fact, no painkiller should be given to a cat unless the medication has been specifically prescribed by a veterinarian.
Using multiple treatments
Regarding current progress in the treatment of feline pain, he adds: “Longer-lasting pain medications have recently become available, and the use of acupuncture is becoming more common. Multi-modality treatment — which uses a combination of drugs and techniques — has become the new approach to pain control.”
Dr. Stone advises owners never to ignore clear indications that a cat may be experiencing sudden-onset, acute pain: Veterinary consultation should be pursued without delay. Owners should also be aware that a cat with long-lasting chronic pain may develop coping strategies for concealing discomfort; in that case, a routine checkup could reveal the presence of osteoarthritis or some other source of persistent pain.
Regarding the likelihood that, with proper up-to-date care, a cat’s acute or chronic pain can be significantly reduced, Dr. Stone is optimistic. Indeed, he says, “Feline pain can be lessened with appropriate care in almost every situation.” — Tom Ewing