Chronic pain in cats — from osteoarthritis, dental disease, neuropathic conditions, or other sources — is widespread and profoundly affects quality of life. The stoic nature of cats means chronic pain is dramatically underdiagnosed and undertreated, representing a major unmet welfare need in companion animal medicine.
Cats experiencing chronic pain rarely vocalise or display the obvious pain behaviours seen in acutely injured animals. Instead, they adapt their behaviour to avoid activities that cause pain — reducing jumping, grooming, and social interaction. These changes are often attributed to 'old age' or 'slowing down' rather than recognised as signs of unmanaged pain. Studies using validated pain scales after analgesic treatment — measuring the improvement in quality of life when pain is treated — confirm that chronic pain was previously present but unrecognised.
Several validated tools now enable systematic chronic pain assessment: Feline Musculoskeletal Pain Index (FMPI) — owner-completed questionnaire measuring activity limitation. Client-Specific Outcome Measures (CSOMS) — owner identifies specific activities their cat is less able to perform and rates them over time. Veterinary assessment using Feline Grimace Scale and orthopaedic examination. Accelerometry — activity monitors tracking daily movement (reduction in activity indicates pain or disease). Using these tools routinely in senior cats enables earlier pain detection.
Primary sources of chronic pain: Osteoarthritis (affects 90%+ of cats over 12 years radiographically — joint inflammation and degeneration causing pain, stiffness, and activity limitation); Dental disease (periodontal disease, tooth resorption — causes chronic oral pain that impairs eating and quality of life); Neuropathic pain (damage to peripheral nerves — may follow surgery, injury, or degenerative conditions — causes abnormal sensations and chronic discomfort); Interstitial cystitis (chronic bladder inflammation — episodic pain and discomfort).
Chronic pain management for cats has expanded significantly: Solensia (frunevetmab) — a monoclonal antibody targeting nerve growth factor, licensed for feline OA pain — monthly injection providing significant, sustained pain relief with good safety profile. Meloxicam — NSAID licensed for long-term use in cats with renal monitoring; effective for inflammatory pain. Gabapentinoids (gabapentin, pregabalin) — for neuropathic pain components. Environmental modification — ramps, heated beds, low-sided litter trays — reduces the functional impact of pain. Physiotherapy and hydrotherapy — improving mobility and muscle strength. Multimodal approaches combining medication and environmental management provide better outcomes than single-agent treatment.
Owner-reported quality of life changes are the most sensitive indicators of chronic pain treatment response in cats. Asking owners to specifically report on activities their cat was doing less frequently — jumping onto favourite spots, grooming, playing, seeking social interaction — provides sensitive outcome measures. Repeat assessment using validated owner questionnaires at 4-8 week intervals tracks treatment response and guides dose adjustment. Video recording of the cat at home provides objective behavioural data that supplements clinical examination findings.
Improving chronic pain welfare in cats requires system change beyond individual treatment decisions: routine chronic pain assessment in all cats over 8 years as part of wellness examinations, training veterinarians and nurses in pain recognition beyond acute injury signs, educating owners to recognise subtle pain indicators, and normalising the expectation that older cats should be assessed for pain and treated when found. The welfare gains from identifying and managing previously unrecognised chronic pain in the feline population are potentially enormous.