Feline Chronic Pain: Recognition and Management

A welfare-focused guide to chronic pain recognition and management in cats, addressing the challenge of pain assessment in a species that hides suffering.

Key Facts

Cats are masters of hiding pain — evolutionary pressure as both predator and prey has selected for stoicism, meaning chronic pain in cats is massively underdiagnosed and undertreated.
Chronic pain in cats most commonly arises from osteoarthritis, dental disease, chronic kidney disease, and neoplasia — multiple pain sources often co-exist in older cats.
The Feline Grimace Scale (FGS) is a validated pain assessment tool based on facial action units: orbital tightening, muzzle tension, whisker position, ear position, and head position changes.
Cats with chronic pain show behavioral changes rather than vocalizing: reduced interaction, grooming changes (over- or under-grooming), altered sleep, reluctance to jump, and house soiling.
NSAIDs (meloxicam, robenacoxib) are the most evidence-based analgesic for cats with musculoskeletal pain — they require renal monitoring but are safe for long-term use in appropriate patients.
Gabapentin and maropitant are increasingly used for neuropathic and visceral pain in cats — multimodal analgesia is more effective than single-drug approaches.
The 2022 ISFM Feline Chronic Pain guidelines recommend systematic pain assessment at every veterinary visit using validated scales — implementation remains inconsistent.

Welfare Considerations

Chronic pain in cats is pervasive and persistently undertreated because cats hide their suffering. Learning to recognize the subtle behavioral signs of feline chronic pain — reduced jumping, altered grooming, changed interaction patterns — enables earlier intervention. Any cat over 7 years should have a pain assessment at every vet visit. Advocate for routine use of the Feline Grimace Scale in veterinary practice.

What You Can Do

Learn to use the Feline Grimace Scale (felinegrimacescale.com) to assess your cat for pain at home
Discuss systematic pain screening at every veterinary visit for cats over 7 years
Ensure cats with diagnosed osteoarthritis receive appropriate analgesia (NSAIDs, gabapentin)
Provide environmental modifications for painful cats: ramps, low-sided litter boxes, heated beds