Assessing pain in cats can be challenging. No agreed-on tool or clear consensus exists to determine what qualifies as a sign of pain in cats. 

An international panel of veterinary experts from various clinical backgrounds and specialties participated in surveys about feline pain. In 4 rounds, 19 participants were asked to list conditions believed to be reliably, inherently painful in cats. They were then asked to evaluate behavioral signs according to 4 different properties: presence of the sign in acute and/or chronic conditions and/or nonpainful conditions; reliability of the sign as an indicator of pain; how likely the sign would be present when there is a low level of pain; and the likelihood that the sign would be present when there is a high level of pain. 

The panel judged 91 different signs of possible pain. None were considered necessary to denote pain, and none were specifically related to chronic conditions. Only panting, dilated pupils, and blepharospasm were reliably linked to acute pain. There were 23 signs considered sufficient to imply pain and 2 behaviors deemed reliable pain indicators. The importance of a cat’s mood and temperament and their impact on demonstration of pain was highlighted. The authors concluded that the findings provide a starting point for the development of a behavioral assessment tool for evaluating pain in cats, but further studies are needed.

Behavioral changes are commonly recognized as pain indicators. Using behavioral tools to measure these changes for pain assessment may minimize a cat’s distress. However, assessing pain only by behavioral signs is subjective, particularly in this species, as cats can exhibit signs of pain subtly and variably. Not surprisingly, in this study only 23 signs (out of 91) and 2 behaviors were considered sufficient—but not necessary—to suggest pain. I use composite measure pain scales, which evaluate behavioral changes. When possible, assessment includes interacting with the patient to observe responses to a provoked reaction. To refine these assessments, I always consider the clinical context of my feline patients and its potential impact over the evaluated responses. I also seek cooperation from the owners to detect if behavior is getting back to normal, as this can be a sign of a positive response to treatment, particularly once the cat is back in its own environment.—Francisco Laredo, VMD, PhD, Cet. VA, MRCVS (Anesthesia & Analgesia)