What Are Some Signs That My Cat Might Be In Pain?

First of all I believe that the most accurate determination that your cat might be in pain should be done by you, the cat’s owner – not your cat’s veterinarian and not by your cat’s score on standardized tests, metrology or questionnaires. Since cats can’t talk, one can only come to general conclusions based on hints – similar to situations that occur in non-verbal people. You know that cats act quite differently with strangers and in unfamiliar situations. So, an animal hospital, even a “cat-friendly one”, is not a good environment for attempts to accurately judge a cat’s pain level.

Here are some signs of an uncomfortable cat. Keep in mind that for every sign, there are many alternative health and psychological explanations. However, taken together, particularly in the absence of other exam findings that would explain them, these signs are things that would make me suspicious that pain is involved:

 Does your cat appear uncomfortable to you? Is it less active? Is it more reluctant to move? Is its playtime running jumping and climbing reduced? That can be just Father Time knocking. But in cats under the age of 11, a general health exam is indicated. 

 Has your cat become more temperamental, irritable or grumpy – particularly when handled, petted or interacting with its feline housemates?

  Is your cat less inclined to jump up on your bed than it used to be? Is it grooming itself less or has it begun to concentrate on just one or two areas? Has its hair become matted – particularly over its rump? 

 Cats are creatures of habit. Your cat has favorite sitting positions. Have they changed? Is your cat lying on its side more or less? Are its legs more extended and tense than they used to be? Does your cat seem more restless?

 Does your cat move about attempting to find a more comfortable position? Is Your cat limping or stiff? Does that limping and stiffness decrease with continued activity?

 Has your cat lost its normal interest in its surroundings? Is your cat less playful than it used to be?

If you touch or press various areas of your cat’s body or flex its joints, does it flinch, growl, meow, claw or bite? Has it become inclined to defecate next to its litter box rather than climb into it?

Do you need to trim your cat’s claws more frequently? Are your cat’s claws growing longer these days due to inactivity?

Is your cat having more potty accidents next to the litter box than it used to?

 Does your cat still purr when you stroke it? Does your cat hide more than it used to?

I let the owners of a cat make the decision. But there are plenty of veterinarians who take a more authoritarian, less passive, position than I do. Other than pompous bluster, they provide no evidence that they have a clue as to which cat needs what, how much and when. (read here)  

What Medications Are Options For Post-Surgical Pain In My Cat?

Narcotics:

Traditionally, veterinarians did not believe that cats were good candidates for receiving narcotic painkillers. They appeared to suffer a number of side effects uncommon to people or dogs that received the same medications. Cats receiving these older narcotics (opiates) had a high incidence of depression, muscle weakness, vocalization, tremors, twitching, vomiting, body temperate control issues and agitation. (read here  &  here) 

Buprenorphine  (Buprenex®/ Zorbium®)

However, more recent studies have found that cats tolerate a newer narcotic pain-relieving medication called buprenorphine considerably better than the older, traditional opiate narcotics when a moderate doses are given. How effective those lower doses are in relieving pain is still in question. (read here) Although study results are inconsistent, it shows promise in blocking acute post-surgical pain. There is a great deal of variation in its pain-blocking effectiveness and the drug dose required to achieve it. (read here)  Veterinarians know little about its possible effectiveness in relieving chronic pain in cats. If the drug conforms to the pattern of other narcotics used in humans, its effectiveness in countering pain would tend to decrease over time requiring the dose to be increased. Until recently, veterinarians used human buprenorphine products “off label” to lessen pain in cats and dogs. It is sold as Buprenex® and a number of other trade names. It is also available with your veterinarian’s prescription from compounding pharmacies such as Wedgwood. 

In 2022, the FDA approved a topical buprenorphine solution designed specifically for post-surgical pain in cats, Elanco’s Zorbium™ buprenorphine transdermal solution. The directions are to apply the correct amount to the skin of your cat’s dorsal neck (its nape). Elanco states that up to 4 days of pain relief can be obtained from a single application. 

In 2014, the FDA approved another buprenorphine medication, Simbadol® for post-operative pain in cats. That drug is administered daily by subcutaneous injection for up to three days starting with the first dose one hour before the surgery. 

Butorphanol (Torbugesic®/ Torbutrol®)

Butorphanol is also a narcotic. The primary use of butorphanol in people was as a nasal spray for the relief of (migraine) pain. The trade name was Stadol^® NS.  Butorphanol is also available for humans in injectable form and tablets. The tablets effectively control moderate to severe pain. The injectable liquid form can be a component of general anesthesia “cocktails” given to humans.  In humans the injectable form has been linked to a rise in liver enzymes that indicate possible liver damage. The spray has not. The spray is less commonly prescribed these days because butorphanol is highly addictive. 

For veterinarians, butorphanol is sold under the trade name Torbugesic® and Torbutrol®.  Those product are FDA-approved for use in horses to treat cough and to relieve the acute pain of intestinal colic. When given “off label” by injection to cats, butorphanol appeared to be as effective as buprenorphine in reducing surgical pain. (read here) But unlike buprenorphine, butorphanol did not appear to be effective in relieving pain when applied topically to cats. (read here)

Fentanyl Patch (Duragesic® patch) 

Fentanyl is a very powerful narcotic pain-relieving medication. It can be administered in many ways. It is most commonly used in cats as a portion of a human-size fentanyl patch (Duragesic® patch) folded over and placed on shaven skin. (read here  & here)   Fentanyl has a proven acute pain and hospice prolonged pain track record in humans. However, the drug is susceptible to diversion and misuse. For that reason, the DEA places many obstacles to its use in veterinary medicine. Many veterinarians –  dreading the complicated record keeping involved and the severe penalties possible when records do not meet DEA inspection – avoid or refuse to prescribe fentanyl patches. They do so even when these patches would probably be the most effective pain-relieving option available  

Bupivacaine (Nocita™)

If you have been to a dentist, you are acquainted with the lidocaine/Xylocaine®/Novocaine® used to numb your gums. It is very effective. However, its effect wears off in 3-5 hours.  The effect of bupivacaine (Marcaine®), a similar drug, lasts for up to 8 hours. bupivacaine has been used extensively for post-surgical pain relief in humans. (read here)

Bupivacaine appears to lessen post-surgical pain in cats as well. (read here)   It is a moderately priced drug, and since the DEA does not consider bupivacaine to have addiction potential, they do not hassle us veterinarians about administering it. As I mentioned earlier, judging the effect of all pain control medications in cats is a challenge. When bupivacaine is coated with a fatty layer (a liposomal suspension) its pain-relieving ability lasts even longer (up to 72 hours). That product, FDA-approved for cats and dogs, is marketed by Elanco as Nocita™  to reduce post-surgical pain. It is called. It can also be used to block specific nerves as well. (read here) The drug is unlikely to be a treatment option for chronic pain. 

Robenacoxib is the second NSAID that has been successfully used to treat post-surgical pain in cats. The drug is marketed in injectable and tablet form by Elanco as Onsior®. It carries the same FDA label warning as meloxicam regarding the potential for kidney damage. However, the European Medicines Agency (EMA) approved robenacoxib for the long-term treatment of arthritis in cats. 

When given by injection, robenacoxib might cause less pain and swelling at your cat’s injection site than meloxicam.  In that study, robenacoxib’s pain-relieving ability appears to be greater than meloxicam.  (read here) Another study in dogs reached the opposite conclusion. (read here)  I believe the two are probably identical or close to it in their ability to reduce pain in cats and in their potential for side effects. Quantifying the degree of pain in cats is exceptionally difficult and prone to error. Drug companies will always quote the studies that show their product in the most favorable light. 

What Medications Are Best For My Cat When Chronic Joint Pain, Arthritis Or Other Long-Term Pain Are The Issues?

The two products I mentioned above, meloxicam/Metacam® and robenacoxib/Onsior® are also options for treating chronic pain in cats.  If either of them effectively control the pain of arthritis at their label suggested doses or if those doses are low enough to avoid the possibility of kidney decline over time has yet to be fully determined. Kidney functional decline is quite common in the older cats that are most likely to suffer from arthritis. It will be very hard to judge the effect of these drugs on their rate of their kidney decline. Any cat receiving either meloxicam or robenacoxib needs pre-drug-administration baseline BUN and creatinine level determinations and frequent repeat tests thereafter, run at approximately the same time after their last meal. 

Frunevetmab (Solensia®) 

Frunevetmab, sold by Zoetis as Solensia® is the newest addition to long-term pain control in cats. It gained FDA and EMA approval in 2022. Frunevetmab/(Solensia®) is an artificially produced (bioengineered) antibody specifically designed to neutralize feline nerve growth factor (NGF). It is a monoclonal antibody or mAb. Feline nerve growth factor (NGF) has many known functions – and probably some as yet to be discovered. In fetal and immature animals, it guides the development of the nervous system. Later in life, it is important to maintain nerve health. NGF is also involved in the transmission of pain signal along nerve pathways, and it is known that monoclonal antibodies that reduce the amount of NGF relieve the pain of arthritis. (read here) Because cats tolerate so many other pain-relieving drugs poorly, Zoetis offers Solensia® as perhaps a safer option. Read about Solensia® in detail here. 

Less Proven And Unproven Products:

Glucosamine And Chondroitin

Veterinarians, trying to avoid the potential side effects of non-steroidal anti-inflammatory drugs (NSAIDs) and narcotics and cat owners unable to afford those more expensive medications often gravitate to “nutraceutical” products in an attempt to relieve chronic pain in their cats. They provide oral products such as Dasuquin® or Cosequin®  or have their veterinarians inject glycosaminoglycan products such as Adequan™.  Since no high-quality studies in cats or dogs exist we really have no solid evidence that those and similar products are helpful in relieving pain or encouraging healing. Experimental studies did not show them to have significant healing or pain-relieving abilities. (read here,   here  &  here) The oral products are natural components of food, the injectable ones are natural constituents of joint cartilage. I tend to rely on the Cochrane database conclusions. This is what they have to say.  These products are harmless when given to pets as directed. We can always be hopeful that they will help.  That is why 3 out of 5 people experiencing the pain of joint arthritis elect to take them. (read here) 

Gabapentin (Neurontin®)

Gabapentin is a drug that was initially developed to treat human epilepsy. It is considered one of the safest anti-epileptic medications to date. But it has gradually been replaced by levetiracetam (Keppra®), phenytoin (Dilantin®)  and other medications. One reason is that gabapentin doses must be given three times a day to be effective. Gabapentin also appears to be effective in reducing neuropathic pain. That is pain caused by damage or inflamed nerves themselves. It is much less likely to be effective against the pain of damaged tissues surrounding it such as bone or muscle. So, gabapentin is not likely to be a good candidate drug for bruises, surgery after care, bone fractures or arthritis. The effectiveness of gabapentin in cats to lessening the chronic pain of arthritis or the acute pain of surgery remains unknown. However, because the drug is inexpensive, has few if any side effects at the doses suggested and is not a controlled narcotic, it is often dispensed by veterinarians. Usually, the oral form is dispensed. However, injectable forms exist and even transdermal gabapentin patches have been tried on cats with mixed results.

Gabapentin appears to be both a sedative and an appetite stimulant in cats. Its sedative quality have led some to suggest that a dose be given to nervous cats 2 hours before their scheduled veterinary appointment. You can read more about gabapentin in cats   here,   here  &  here.  Having a daughter who took gabapentin for many years and having taken it myself, I have little faith in this drug’s value in reducing pain. 

Amitriptyline (Elavil®)