Chronic Pain Assessment in Cats: Recognising Hidden Suffering

Cats are masters of concealing pain, making chronic pain recognition one of the most challenging areas of feline welfare. Validated assessment tools now help owners and vets identify and treat pain that would previously have gone unrecognised.

Key Facts

Chronic pain in cats is most commonly caused by osteoarthritis, dental disease, chronic kidney disease, inflammatory bowel disease, and cancer.
Feline osteoarthritis affects an estimated 61% of cats over 6 years and 90% over 12 years, yet is vastly underdiagnosed due to subtle signs.
Cats rarely vocalise or limp with chronic pain; instead they show reduced activity, reluctance to jump, altered grooming, changed social interactions, and hiding.
The Feline Musculoskeletal Pain Index (FMPI) and the Montreal Instrument for Cat Arthritis Testing (MI-CAT) are validated owner-completed questionnaires for arthritis pain assessment.
The Grimace Scale has been validated for acute pain assessment in cats; a chronic version (Feline Grimace Scale) is under development.
Meloxicam (NSAID) is effective for feline osteoarthritis pain; it can be used long-term with renal monitoring in most cats.
Grapiprant (a novel NSAID alternative targeting the EP4 prostaglandin receptor) is now available for cats with renal concerns.
Environmental modifications — ramps, lower-sided litter boxes, raised feeding platforms — are important non-pharmacological welfare interventions for arthritic cats.

Welfare Considerations

Chronic pain in cats is a major hidden welfare crisis. The majority of older cats live with significant arthritis pain that is unrecognised, untreated, and preventable. Because cats evolved to conceal weakness from predators, pain suppression is deeply ingrained — a cat in severe chronic pain may still appear superficially normal to an inexperienced observer. Validated questionnaires completed by attentive owners are more sensitive than veterinary examination alone for detecting chronic pain, because owners observe behaviour over time and in the home environment. Every untreated arthritic cat represents months or years of preventable suffering. Routine geriatric screening from age 7, combined with owner education about subtle pain signs, can transform the welfare of the rapidly growing population of elderly cats.

What You Can Do

Complete the FMPI or MI-CAT questionnaire for your senior cat and share with your vet — these tools detect pain that clinical examination may miss.
Schedule annual geriatric checks from age 7, including joint palpation and pain assessment.
Request meloxicam or grapiprant if your cat is diagnosed with osteoarthritis — effective pain relief is available and dramatically improves quality of life.
Make environmental modifications at home: install ramps, lower litter box sides, and raise food bowls to reduce the physical effort required by arthritic cats.
Learn to observe your cat for subtle pain signs: reduced grooming, reluctance to jump, changes in sleep location, and irritability when touched.