Margaret Gruen, DVM, MVPH, PhD, DACVB

Feline chronic pain is finally getting the attention it deserves, with an increase in research and attention and a new FDA-approved monoclonal antibody treatment for the control of pain associated with osteoarthritis (one of the most common causes of chronic pain in cats).¹ Chronically painful conditions may affect a majority of cats, particularly those over 12 years of age.² However, chronic pain in cats remains underdiagnosed, in part due to an overall lower number of veterinary visits for cats compared to dogs and the difficulty with assessing pain in cats.^3,4

Approaching Feline Pain from the Fear Free Perspective

Taking a Fear Free approach is critical to the diagnosis of feline chronic pain, as cats displaying fear, anxiety, and stress (FAS) are unwilling to demonstrate normal behaviors in the clinic, thus complicating our assessment. Use of cat-friendly principles will help minimize FAS and allow veterinarians and veterinary professionals to observe and examine cats in the clinic. This includes providing secure footing and comfortable examination areas, minimizing exposure of cats to sounds and odors from other pets, keeping the number of transitions into and out of the exam room low, and using soft voices during veterinary procedures.

Examination of cats in the clinic begins with observation of their behavior, demeanor, and appearance. Cats can be observed for how they exit their carrier and how willing they are to interact with veterinary team members. Their performance on “functional tests” such as walking across the room, jumping up (if possible) or down from a chair or table should be noted. Other features such as their haircoat, muscle mass, and posture can be assessed from a distance while the cat becomes comfortable in the room.

For physical examinations, the recommendation is to handle painful areas last in order to be able to accomplish as much of the exam as possible. For orthopedic examinations, observation and history from caregivers may point toward areas of the body likely to be affected by pain. With osteoarthritis, it is sometimes better to reverse order for this part of the exam and target areas that are likely to be affected, rather than beginning with unaffected joints. Extension of joints can be initially uncomfortable for most cats, who tend to keep appendicular joints in flexion, so beginning with unaffected joints may lead to resistance from the cat even in the absence of osteoarthritis.

Watch cats for any change in behavior during gentle flexion and extension of joints; it is not necessary or advisable to evoke extreme reactions or vocalization to diagnose pain. Keep in mind that cats frequently develop bilateral osteoarthritis; if a joint on one side is painful, be sure to examine the same joint on the other side. Use of gabapentin or other pre-visit pharmaceutical is recommended for cats who exhibit FAS with veterinary visits and will not preclude assessment or diagnosis of joint pain.

A Fear Free approach also includes maximizing the information we can get from cat caregivers, who know their cats well and are able to observe their behavior in the home. It is important to engage with caregivers about the behaviors that are altered with chronic pain in cats, so that they can be watching for these behavioral changes and being proactive when changes occur. Most causes of chronic pain will have associated behavioral signs that are best observed in the home. For pain associated with osteoarthritis, these are often associated with performance of particular activities (jumping up, jumping down, climbing up and down stairs, running, and playing or chasing objects).

Importantly, in early stages cats won’t stop performing these behaviors, but how they perform them will begin to change, and this is when we can focus on improved detection. Use of checklists, educational tools and videos, and standardized questionnaires such as the Feline Musculoskeletal Pain Index⁵ can be helpful for engaging clients and collecting data for tracking progression and response to treatment. Short videos of cats in the home are extremely valuable for evaluating behaviors that are not easily observed in the clinic. Caregivers can be given specific instructions for collecting short videos of their cats which can also be used for monitoring progression and response to intervention.

Approaching feline chronic pain from a Fear Free perspective means maximizing the comfort of the cat in the clinic in order to observe behavior, understanding the importance of observation in the clinic as an integral component of the overall exam, using sedation when needed (particularly for radiography), and engaging with cat owners to assess behavior in the home. Using a Fear Free approach will allow continued advancement of awareness and treatment for feline chronic pain and bring needed relief to the millions of cats with chronically painful conditions.

References

1. Lascelles BD, Henry JB, 3RD, Brown J et al.: Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats. Vet Surg 2010; 39: 535-44.
2. Hardie EM et al. Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994–1997) J Am Vet Med Assoc 2002;220(5):628-632.
3. AVMA U.S. Pet Ownership & Demographics Sourcebook, 2022.
4. Enomoto M, Lascelles BDX, Gruen ME. Development of a checklist for the detection of degenerative joint disease-associated pain in cats. J Feline Med Surg. 2020;22(12):1137-1147.
5. Translational Research in Pain (TRiP) – Clinical Metrology Instruments. NCSU College of Veterinary Medicine. Accessed October 5, 2022. https://cvm.ncsu.edu/research/labs/clinical-sciences/comparative-pain-research/clinical-metrology-instruments/

This article was reviewed/edited by board-certified veterinary behaviorist Dr. Kenneth Martin and/or veterinary technician specialist in behavior Debbie Martin, LVT.