Recognizing Their Pain

Veterinarians and the industry at large seek to better understand and develop effective modalities of care for feline pain.

Understanding and diagnosing feline pain has lagged behind canine pain “probably because cats don’t show when they hurt so we didn’t realize they were in pain,” says Joyce Login, DVM, veterinary medical lead, pain, oncology and specialty at Zoetis. “They are a predator/prey species, so for them, it’s essential to their survival that they don’t draw attention to themselves. That’s why they’re really good at hiding when they are in pain.”

There are an estimated 80 million cats in the United States, and almost half suffer from chronic and debilitating pain, according to Painfreecats.org, a product of the North Carolina State University (NCSU) College of Veterinary Medicine’s Comparative Pain Research and Education Centre. “Only a small percentage of these 40 million affected cats have been properly diagnosed and are under a vet’s care,” according to the website. “The barrier to delivering needed professional care: the inherent difficulty in diagnosing chronic pain in a species that has successfully evolved because of its ability to mask such pain as a form of protection against predators.”

The pain is shown behaviorally, rather than some of the more traditional signs, such as limping or crying out. “Cats will show us they’re in pain by their behaviors – their body postures, and even facial expressions,” Login says. “We just need to understand what they’re saying.”

Chronic pain is very insidious, and harder to detect. Clients may think their cat is just slowing down or it’s all due to old age, but chronic pain in cats is more common than most people think. “Studies have shown that 38% of all cats have clinical signs of osteoarthritis, and other research found evidence of osteoarthritis in more than 90% of cats over 12 years. So there are a lot of cats out there that are probably hurting and not getting a lot of help.”

Treatment options are also limited when compared to dogs. As far as non-medical management, choices such as joint protection, acupuncture, laser, and rehab exist. “When we finally do recognize that the cat hurts, there aren’t a ton of medicinal options for them that are approved,” says Login. For instance, in the United States, Login says there’s nothing approved for cats with chronic pain. There are NSAIDs for cats that are approved for acute pain, and one opioid, Zoetis’ SIMBADOL™ (buprenorphine injection).

“It’s more difficult to design studies that quantify feline pain, and that slows down drug development,” she says. “You can get a dog to walk across a force plate, and a lot of times that’s how we’d measure the NSAIDs for dogs. But cats don’t do that, and even if they did I don’t think it would measure well.”

That said, there’s a lot of optimism moving forward. People are understanding cat pain better. More developments and options for cat pain are coming in the future. Login says Zoetis is working on monoclonal antibodies to manage pain in dogs and cats. “We’re very positive about the benefits these treatments are going to have in terms of compliance and efficacy.”

Developing programs

In the interim, distributor reps can partner with their veterinary practice customers to develop programs. Veterinary practices need guidance on “what resources are available, and what they can look at in terms of educational resources for clients before they start implementing things,” says Login (see sidebar for a list of resources).

Also, distributor reps can share best practices that they’re seeing in other clinics. Have your customers considered cat-exclusive exam rooms or waiting room areas? Pheromones for the veterinary visit or recommendations for clients when traveling with their cats? Do the practices employ gentle-handling techniques developed from Fear Free or AAFP’s Cat-Friendly Practice program?

Also, does the veterinary practice utilize validated pain scales that measure all cats for pain? “That helps to catch a lot of cases where the cat is in pain that we may have missed in the past,” Login says.

Signs of Feline Pain

Common signs of pain in cats, according to the International Veterinary Academy of Pain Management (IVAPM):

• Reduced activity
• Loss of appetite
• Quiet/loss of curiosity
• Changes in urinary/defecation habits
• Hiding
• Hissing or spitting
• Lack of agility/jumping
• Excessive licking/grooming
• Stiff posture/gait
• Guarding behavior
• Stops grooming/matted fur
• Tail flicking
• Weight loss