Assessing Pain in Cats

Cats don’t often show obvious signs of pain (at least not obvious to people). Because cats don’t speak human, we have to learn to speak cat—that is, read their behavior cues and body language—to know when they’re hurting and need help.
 
September is Animal Pain Awareness Month, so this article highlights 2 tools used to evaluate pain in cats. Cat owners and veterinarians can use the Feline Musculoskeletal Pain Index (FMPI) to identify signs of joint pain in cats. The Feline Grimace Scale uses changes in cats’ facial expressions to help veterinarians assess the need for pain relief in hospitalized cats.
 
If you think your cat is in pain, contact your veterinarian. Never give a cat any pain medication unless your veterinarian has specifically recommended it. Many over-the-counter and prescription pain medications for humans and dogs are dangerous for cats.
 
Feline Musculoskeletal Pain Index
Arthritis is very common in senior cats and can also affect young cats. Other joint and tendon disorders also cause chronic (long-term) pain in cats. These conditions are notoriously difficult to diagnose in cats by physical examination alone; cats don’t tend to cooperate during orthopedic exams. However, chronic pain causes changes in behavior and mobility that we can observe and track over time.
 
Researchers at NCSU College of Veterinary Medicine developed the FMPI to help cat owners and veterinarians diagnose and monitor chronic pain caused by joint disorders. This tool has been clinically validated, meaning that it’s accurate and reliable.
 
The FMPI is a questionnaire for cat owners. In the questionnaire, owners rank their cat’s ability to perform normal activities like these:

• Walking
• Running
• Jumping on and off furniture
• Going up and down stairs
• Playing with toys
• Stretching
• Grooming
• Interacting with family members
• Tolerating being handled
• Eating
• Getting into and out of the litter box

 
Each item is scored, and the total score indicates the cat’s level of impairment. After a cat starts treatment, the FMPI can be used to evaluate whether the cat’s pain is decreasing over time.
 
You can find more information about the FMPI at its website: https://painfreecats.org/.
 
Feline Grimace Scale
Grimace scales are used to assess pain in a number of animal species. These scales evaluate changes in facial expression caused by tension in specific facial muscles in response to pain.
 
Researchers at the University of Montreal developed the Feline Grimace Scale to help veterinarians detect acute (short-term) medical, surgical, or dental pain in cats in the hospital. This scale, like the FMPI, has been clinically validated.
 
The Feline Grimace Scale includes 5 facial action units that reflect levels of pain:

• Ear position: facing forward, pulled slightly toward each side, or rotated outward and flattened
• Orbital tightening: eyes open, partly open, or squinted shut
• Muzzle tension: muzzle shape round (relaxed), intermediate, or elliptical (tense)
• Whisker position: curved and loose, slightly curved, or straight and directed forward
• Head position: above shoulders, in line with shoulders, or below shoulders

 
Each facial action unit is scored, and the total score indicates the cat’s level of pain. A score above a certain point suggests that a cat needs pain medication. The scale is also used to monitor response to pain medication.
 
More information, including illustrations of the different facial expressions, is available at the Feline Grimace Scale website: https://www.felinegrimacescale.com/.
 
Photo by Yerlin Matu

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