By Teresa Garden, DVM
We all know what pain feels like. We know it negatively impacts our quality of life. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is considered the “4th vital sign” in people. People can easily communicate verbally and nonverbally to let us know they are in pain. Dogs, too, are fairly demonstrative in showing pain through physical symptoms, facial expression, and changes in behavior. Most dog owners are very perceptive to changes that may reflect pain in their canine companion. But cats are an enigma. Did you know 70% of cat owners are unsure what pain looks like in their cat? Even veterinarians have difficulty assessing pain in our feline patients. Pain is under recognized in cats. Their indicators are subtle and easily missed by their owners and their doctors.
Cats are naturally stealth, silent, and stoic. They show pain differently than people or dogs. Cats may hide their pain as a natural protective behavior. There is an art to understanding the subtle changes in a painful cat. It is important to observe their facial expression, posture and overall behavior in order to pick up the “clues of pain”.
The eyes may be the window to the soul, but they can also reflect pain. Squinting is often a sign of generalized pain. So is staring with dilated pupils. A normal cat will hold its head up. A painful cat will hold the head down or below the body. The back may be hunched up. Severe pain may be indicated by a cat lying flat out on its side rather than curled into a ball. Licking the lips may indicate nausea arising from pain. Cats may be restless from pain and have trouble lying down and sleeping normally. A change in attitude can indicate pain. A sweet friendly social cat may become anxious, irritable, aggressive, dull or quiet. A cat that is normally independent may become clingy. A lack of grooming or lack of food or water intake may be from pain. Reaction to touching a painful body part includes tensing, withdrawing, vocalizing, or trying to bite.
There are various conditions associated with pain. Abscesses arise from cat bite wounds. They present as painful soft tissue swellings draining purulent discharge. Bladder infections can cause painful urination resulting in straining to urinate, frequent urination, bloody urine, or urinating outside the litter box. Constipation can be a common painful malady in older cats. Signs are straining to defecate and passing small, hard, marble-like stools. Instead of defecating daily, the cat may only have a bowel movement every 2-3 days. The cat may associate pain with the litter box and, therefore, may defecate outside the box.
Diseases of the mouth and oral cavity can be painful. Signs of mouth pain are decrease in food intake, taking longer to eat, avoiding dry food, throwing food to one side of the mouth, excess salivation, bloody saliva, foul mouth odor, and rubbing at the mouth. Conditions that can result in mouth pain are loose teeth, oral tumors or ulcers, resorptive lesions on teeth, or infected teeth.
As cats age, they commonly are afflicted with arthritis in their spine, hips, stifles, and elbows. Cats may not be able to jump up as high as they did when younger. They may not be able to jump at all. Their backs may be hunched and you may notice they walk slower, run slower, and climb stairs slower. These symptoms can reflect pain….not just “getting old”. Our geriatric feline friends can have trouble just getting into and out of a litter box with high sides.
Pain that is not promptly managed can lead to a variety of other problems: anxiety, lethargy, aggression, inappetence, weight loss, delayed wound healing, increased risk of infection, urine and fecal retention, and self-mutilation. Once the source of pain has been identified it can be treated. Acute pain may resolve as soon as the underlying cause is properly treated. Chronic pain, on the other hand, requires a multi-modal approach to improve the quality of life of the cat. The goal of pain control is to restore normal daily activities and normal behavior. Fortunately, veterinary medicine is making progress in identifying and treating pain in cats. Drugs such as opioids and NSAIDS may be employed to relieve pain. Other treatment modalities that can be effective and part of a pain control program include therapeutic laser, acupuncture, nutracueticals, and environmental enrichment.
Dr. Teresa Garden is chief veterinarian/owner of Animal Health & Healing, a full-service holistic and conventional veterinary practice in the Maplewood/Richmond Heights area. 314-781-1738. www.AnimalHealthandHealing.com.