Chapter 26
Recognition and Assessment of Pain in Cats
It is possible!
Beatriz Monteiro1 and Paulo Steagall2
1Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, Canada
2Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Canada
- Q. Why is it important to recognize and treat pain in cats?
- A. Pain negatively affects quality of life, delays recovery, induces behavioral changes that affect owner–companion animal bond, and causes unnecessary fear, anxiety, and stress. It may lead to sympathetic nervous system activation, and alter food intake and metabolism. In that sense, veterinary caretakers have a moral and ethical responsibility to mitigate animal suffering to the best of their ability [1]. Pain is now considered to be the fourth vital sign, and its assessment should be incorporated into the clinical evaluation of all patients.
- Q. What is the difference between acute (adaptive) and chronic (maladaptive) pain?
- A. Acute pain is also known as adaptive pain where inflammation and nociception prevail (i.e., post-operative pain). It is generally associated with potential or actual tissue damage and serves to avoid or minimize damage during healing. It is usually self-limiting [1].
Chronic pain is also known as maladaptive pain and is characterized by neuropathic or functional pain, such that the degree of pain does not necessarily correlate with the pathology observed or perceived by the individual. It is not associated with healing. It persists beyond the expected course of an acute disease process and it has no clear end-point [2].
In some cases, acute pain can persist and become pathologic and maladaptive especially when neuropathic pain (e.g., limb amputation) is involved or pain was not addressed properly at the time of initial injury.
- Q. What is the difference between acute (adaptive) and chronic (maladaptive) pain?
Acute Pain
The website www.animalpain.com.br provides multilanguage, free and extensive training in the recognition and assessment of acute pain in cats.
- Q. What are the causes of acute pain in cats?
- A. Acute pain is commonly caused by tissue injury, trauma, and inflammation. Examples may include orthopedic and soft tissue surgery (amputations, abdominal surgery, fractures, etc.), trauma (“hit by car”), dental extractions, incision and drainage of abscesses, and so on. The intensity and duration are related directly to the severity and duration of tissue injury. Some medical and infectious conditions may cause severe acute pain in cats. These include idiopathic cystitis, pancreatitis, lymphocytic-plasmacytic gingivitis and stomatitis, chronic inflammatory bowel disease, ocular ulcers, and so on.
- Q. What is the approach for assessment of acute pain in cats in the clinical setting?
- A. In the clinical setting, cats are first examined without being removed from their cages and without being disturbed. Then the cat is approached, spoken to, and the cage door opened while observing its reactions and behaviors (aggression, posture, hiding, abnormal gait, etc.). The cat is gently handled, petted, encouraged to interact with the observer, to walk, and to move around. The incision site or area of tissue injury and surrounding skin are gently touched and palpated and the reaction to palpation is evaluated. Individual variability in response to analgesic therapy and palpation is important. In addition, the cat’s normal behavior (according to the owners or before surgery) should be taken in consideration. Analgesic treatment (supplemental or interventional analgesic administration) is given when the cat presents pain-related behaviors (see below) and/or overreacts (flinching, vocalizing, etc.) to palpation of the area of tissue injury. Analgesic treatment can also be a diagnostic tool in evaluating pain – if the cat’s behavior improves then it is likely that pain was contributing to the abnormal behaviors observed.
- Q. What are the behavior changes associated with acute pain in cats?
- A. Assessment of pain is an important part of the clinical examination (temperature, pulse, and respiration). Some behaviors may help in this process:
- Non-painful cats will continue grooming and using the litter box. Cats that are sleeping, resting, or curling up are usually comfortable and should not be disturbed in the post-operative period. Of importance, bandages may induce agitation in cats that is not necessarily pain-induced.
- The cat’s normal behavior should be known and owners can provide useful information in this regard. The presence of new behaviors in the post-operative period may guide the clinician in identifying pain and discomfort. For example, a friendly cat becomes aggressive, or it tries to hide or escape during physical examination.
- Abdominal tension, hunched-up position, vocalization, and/or escape reaction are indicators of pain after abdominal surgery [3]. In this case, cats will have a low “hung head” and their elbows drawn back. Some cats will demonstrate excessive licking of the painful area.
- Abnormal gait or shifting of weight (i.e., after declawing), and sitting or lying in abnormal positions may reflect discomfort and protection of an injured area [1].
- An immobile cat and reluctance to move can be signs of severe pain after surgery.
- Other non-specific behaviors may include reduced activity and demeanor, aggression, depression, loss of appetite, quietness, hissing, growling, and tail flicking.
- Declawing may induce licking, shaking and chewing of the feet. The cat appears to be walking as if on “hot coals.” The cat may not tolerate their feet being touched and may spontaneously vocalize for no apparent reason, or have periods of suddenly sitting still, or periods of aggression [4].
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- Q. What are the behavior changes associated with acute pain in cats?
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