Cat Chronic Pain: Assessment and Management

Cats are masters of hiding pain, making chronic pain recognition and management one of the most important and challenging welfare issues in feline medicine. Evidence-based pain assessment tools have transformed our understanding.

Key Facts

Chronic pain in cats is most commonly caused by degenerative joint disease (DJD), dental disease, cancer, and inflammatory conditions — all highly prevalent in older cats
Cats hide pain as an evolutionary survival mechanism (showing weakness attracts predators); this makes owner and veterinary recognition extremely difficult without validated assessment tools
The Feline Grimace Scale (FGS), developed and validated by researchers in Montreal, assesses ear position, orbital tightening, muzzle tension, whisker position, and head position to score acute pain reliably
For chronic pain, behaviour-based tools including the CMSPS (Client-Specific Outcome Measures for Pain in Cats) and owner questionnaires capture changes in activity, posture, and interaction over time
Studies suggest that a significant proportion of cats over 6 years have radiographic evidence of DJD; prevalence approaches 90% in cats over 12 years — yet most receive no pain management
NSAIDs are the cornerstone of feline chronic pain management but must be used with great care — cats lack certain liver enzymes for NSAID metabolism and are at high risk of toxicity; only licensed feline formulations should be used
Anti-nerve growth factor (anti-NGF) treatment (frunevetmab) is now licensed for feline OA pain — a monthly injection that provides pain relief with a more favourable safety profile than long-term NSAIDs
Environmental modifications — ramps, low-sided litter trays, elevated feeding stations, warm bedding — can dramatically improve quality of life for cats with chronic musculoskeletal pain

Welfare Considerations

Chronic pain in cats represents one of the most significant and widespread underacknowledged welfare problems in companion animal medicine. The scale is enormous: millions of older cats live with unrecognised and untreated chronic pain from dental disease, OA, and other conditions, their suffering invisible behind stoic behaviour that owners interpret as normal ageing. The development of validated pain assessment tools has been transformative — they provide owners and vets with objective frameworks to identify and monitor pain that would previously have been missed. The welfare gain from appropriate chronic pain management in cats is profound: owners who begin anti-NGF treatment or NSAIDs in their arthritic cats frequently report that their cat has "come back to life" — grooming more, playing more, and engaging more actively with their environment.

What You Can Do

Familiarise yourself with the Feline Grimace Scale — it is freely available online and can be used to assess your cat's pain at home
If your cat is over 7 years old, discuss chronic pain screening with your vet at annual checks
Never give cats human NSAIDs (ibuprofen, aspirin) or paracetamol — these are highly toxic; only use licensed feline products
Implement environmental modifications for arthritic cats: ramps to favourite spots, low-sided litter trays, and warm beds
Ask your vet about frunevetmab (Solensia) for OA pain — this monthly injection is a significant welfare advance for feline chronic pain