SHOW ME WHERE IT HURTS

Cats are very adept at hiding their pain, but as veterinarians we are getting better at finding the clues that denote pain. As a feline practitioner, I have a great passion for detecting and treating pain in cats. Thanks to my recent attendance at many conferences of the American Association of Feline Practitioners, I was able to improve both my skills and my pain toolbox. Some methods can be used to help cat guardians evaluate acute and chronic pain at home. For instance, some impressive research by l’UdeM’s Faculté de Médecine Véterérinaire (FMV) has led them to develop the Feline Grimace Scale, which can be found online at www.felinegrimacescale.com. We at La Clinique Véterérinaire  des Chats are using this new tool daily and educating our clients on this exciting advancement.

THE WHY
No one wants their beloved cat to be in pain. Clients are often troubled when after a full physical we discuss our medical findings of pain. “How did we not see it?” Cats are very crafty in the art of masking pain.
Why would any species evolve in such a way as to decrease outward signs of pain? The answer lies in the fact that predators will attack the weakest of the pack. So, if you are an animal whose ecological niche is in the prey category, you learn that in order to survive, you have to hide your pain. While we mostly think of cats as predators, they also can be preyed upon. Therefore, they do their utmost to avoid showing pain.
Further compounding cats’ natural behaviour was the mentality in veterinary medicine that a cat is a small dog. As a result, we were using the same tools to detect pain in cats as we did in dogs. In other words, we were not finding pain in our feline patients because we were looking in the wrong way. A good example of this lack of detection occurred during the great declaw debate. As veterinarians we could not agree if declawing caused chronic pain. In fact, there were several well-cited articles claiming that it didn’t. However, many of us in mixed and feline practise were convinced by what we were seeing in our declawed patients that it did. Then, along comes a progression in our ability to detect pain. We now know that declawing can and does cause chronic pain. (Please note that we are a strictly NO DECLAW clinic).
In medicine, the probability of detecting a problem will greatly increase once you start to look for it. This doesn’t mean that we are making up the problems. Feline pain was always there — we were just not looking for it.
So now that we have better tools, better scoring systems, better treatments, what more is there to do?
We need to teach cat owners what we have learnt. When we as veterinarians can teach our clients what to look for, guide you in the early detection of clinical signs, and then get you to evaluate if our treatments are working at home, together we will be able to decrease pain in our beloved cats.

THE WHAT–PHYSIOLOGY OF PAIN
In order to understand pain, we need to get better acquainted with how pain happens.
Let us start by familiarizing ourselves with the different types of pain.
First, pain can be acute, meaning that it comes on very quickly. Acute pain exists to teach us not to repeat the same mistake. For example, if a cat experiences paw pain when walking on a hot surface such as the stove top, they will respond by jumping off the painful surface and hopefully learn to avoid the stove in the future. This is called adaptive pain, as it teaches us to avoid certain situations which can result in pain.
Now let us say that the same cat does not get the proper pain management and treatment of his burnt paws. At this point, we move from acute pain to chronic pain.
Chronic pain is more difficult to diagnose and treat. When a cat suffers from chronic pain, less and less painful stimulus is required to provoke a greater pain response in the brain. As a result, we can end up with a phenomenon known as “windup”. Along one part of the chain that inputs information to the central nervous system known as the dorsal root horn, numerous chemicals get involved in an amplifying cascade. Since cats are so good at hiding their pain, they are usually already in this “windup” state by the time they are presented to their veterinarian.

WHEN
Cats can suffer pain at many stages in their lives.
When a young kitten is subjected to extreme pain, it can lead to them having a lower pain threshold throughout their lives. Inadequate pain management during early surgeries such as neutering can lead to this phenomenon. Pain control before, during and after the procedure is therefore crucial and should never be presented as optional.
By the age of three, it is estimated that 70 percent of cats suffer from some level of dental disease. We know that any pain in the face or mouth area can be more intense than pain in other parts of the body—think of your last cavity. While dogs alert their owners with their excessively smelly breath, cats don’t seem to be affected by halitosis to the same degree. So once again, dental pain often goes unnoticed by even the most well-intentioned cat guardian. Unfortunately, dental disease will then only become more painful if left untreated. Inflammation of the gums can and does lead to severe inflammation of the tissue in the back of the mouth over time.
Another type of pain we often see in cats is abdominal pain. We now think that many of those persistent belly lickers are in fact cats who are suffering from chronic abdominal pain. One of the leading causes for this is constipation. It is important for you as cat guardians to know what normal cat poop looks like. (We refer to Purina’s stool chart in our clinic.) Another factor is obesity. Abdominal fat is an organ, meaning it produces hormones that can lead to inflammation. The result? Fat cats are more likely to have sore tummies.
We once thought that arthritis only occurred in old cats. Now we know that young cats can be affected as well.
Cats suffering from kidney disease often have sore joints. They get dehydrated so their joints are not well lubricated. In addition, kidney disease results in a loss of lean muscle mass.
So unfortunately pain in cats is all around us, it is just not detected.

THE HOW
Fortunately we have some new tools to detect pain. Many of these can be shared with cat guardians so that together we can better evaluate pain both at home and in the clinic.
One such tool, developed by l’Université de Montréal’s Faculté de Médecine Vétérinaire, is a way to assess cats’ facial details to help us detect acute pain. For more information on this, the “Feline Grimace Scale” can be found online at www.felinegrimacescale.com
When it comes to assessing oral pain at home, cat guardians can also gently open their cats’ mouths to look for any signs of swelling or inflammation. We recommend doing this every month. If signs are found(examples?), chances are, your cat may be in some oral pain, meaning it is time to have them seen by a veterinarian. Thanks to your early detection of clinical signs, your veterinary team will then be able to assess the level of pain and need for medication and other treatments before the problem progresses.
Muscle and joint pain is another form of pain cat guardians may want to look out for at home. In fact, some methods of evaluating this type of pain can only be achieved at home. Gait evaluation (observing how a cat walks), for instance, is almost impossible to do in-clinic. Our patients will just lie on the floor and refuse to move. At home, however, by placing a smart phone at the cat’s walking level and having two people use treats to get the cat to move between them, we can obtain invaluable videos showing if one or more legs are “out of step”. This can be a major indicator of arthritic pain or even injury.
Home observation can also include observing your cat’s mobility as they jump up or down from surfaces. Are you finding more claw marks on your furniture? Does your cat now need a stool to get up to their favourite resting area? How do they handle stairs? Are they circling many times before they lie down? Are they neglecting their grooming?

CHANGES IN CATTITUDE
Many behavioural variations can result from chronic pain. We often find inappropriate urination in older cats to be linked to pain in their joints. For example, joint pain may make it difficult or painful for these cats to reach the area where their litter box is located. They may even struggle to step into the box due to the height of the box wall. You may also start to find more urine on the floor near the box than inside the box. This can be due to the fact that they are no longer able to squat down.
Cats are naturally very flexible, as demonstrated when they groom themselves– but as pain increases they may no longer be able to stretch to reach the farthest locations on their bodies. This leads to a scruffy matted coat that often feels greasy. Looking out for similar appearance changes in your cat can be another way of detecting pain from home.

TREATMENT
Cats do not need to suffer the level of pain that many of them are currently dealing with. Together as a team, we can detect clinical signs so that we can alleviate pain from our beloved felines.
We use a multimodal approach to treat pain in cats. This includes adapting the home environment, weight management, proper and consistent use of combinations of drugs, gentle massage of the affected muscles, and low level laser therapy on the joints and nearby muscles. Our goal is to ensure that your cat’s quality of life is optimized. Each patient is unique and there is no “one size fits all” when it comes to pain management.

SUMMARY
Acute and chronic pain in cats is underdiagnosed. Cats will often hide their pain. Advanced training and new tools are enabling us to better detect and treat their pain. Book an appointment with us for a full examination for pain evaluation.

 

 

 

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