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Cat Pain Scale: How to Assess Feline Pain

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Cats are masters of hiding their pain and discomfort. As a cat parent, I can confirm it’s often hard to tell whether my cats are in pain or just feeling antisocial. Fortunately, there’s a helpful tool pet parents can use to decode cat pain called a cat pain scale.

Learning how to use a cat pain scale can help you take better care of your favorite feline. Signs of pain in cats can be all too easy to miss. And misjudging cat pain can delay potential pain relief and even life-saving treatment.

Here’s what you need to know about how to use a cat pain scale and what to do if you suspect your cat is experiencing pain.

Why Cat Pain Is So Hard to Measure

Cats are notorious for concealing signs of pain, even from the most attentive cat parents. But they’re not trying to be sneaky or secretive. The behavior is more of a survival instinct. In the wild, overt displays of pain or weakness could make cats easy targets for larger predators.

Today’s cats may not face the same risks as their ancient ancestors, but they still hide their pain. That can make it hard to diagnose and treat the source of the pain, especially chronic cat pain.

Acute vs. Chronic Pain in Cats

Veterinarians classify cat pain as either acute or chronic.

Acute pain comes on suddenly, typically from an injury, medical procedure, or illness. Cats with acute pain often experience reduced appetite, lethargy, or aggression. These behavioral changes may make acute pain easier to recognize

Chronic pain, on the other hand, develops gradually over time. Cats may learn to tolerate the pain and show fewer outward signs of discomfort. This can make chronic pain difficult to detect.  

Whether acute or chronic, pet parents and vets need a way to measure a cat’s pain level accurately so they can treat it effectively. A cat pain scale makes it easier to detect your cat’s pain, despite any attempts to disguise it.

What is a Cat Pain Scale?

A cat pain scale is a simple tool vets and cat parents can use to measure a cat’s pain or discomfort level.

Over the years, several different types of cat pain scales have evolved. Though each one is slightly different, they’re all based on the same principle. Observing and scoring your cat’s behavior and physical appearance can tell you if your cat is in pain and how severe the pain is.

The most widely recognized scales include:

No single feline pain scale is universally considered “the best.” However, most vets tend to adopt one or another, depending on their preference.

For example, Dr. Amber Carter, DVM, DABVP, prefers the Feline Grimace Scale. She says it’s a simple, reliable, and easy-to-use metric for cat parents and vets alike.

Dr. Carter, who founded CatVetLife, says she uses that scale most frequently at her Cat Care Clinic in Ormond Beach.

“The other two scales would be more popular in a university setting,” she adds. “For example, a cat being evaluated in a study on pain.”

How to Use the Pain Scale for Cats

So, how exactly do you use a cat pain scale to tell if your cat is in pain? Each type of scale has different directions. We’ll focus on the Feline Grimace Scale since it’s a user-friendly option that’s easy for cat parents to master. 

To start, it’s important to have a good sense of what your cat looks like and how they stand when they’re not in pain, says Dr. Carter. This will give you a good baseline for comparison when you suspect your cat is in pain.

Secondly, Dr. Carter recommends using the scale to assess your cat’s pain as soon as you notice something amiss.

“You should evaluate your cat any time you suspect they are in pain,” Dr. Carter says. It doesn’t matter whether they are at rest, eating their food, or using the litterbox. “Taking a video can be extremely helpful,” Dr. Carter adds. “That can show how the cat looks in their natural environment.

What You’ll Need to Assess Your Cat’s Pain

How It Works

The Feline Grimace Scale evaluates five specific areas of your cat’s face. You’ll score each area on a scale of 0 (no change) to 2 (obvious change).  Then you’ll combine these scores to give you a total feline pain score. The higher the score, the more significant your cat’s pain is, explains Dr. Robert Gonzalez, Regional Medical Director for Small Door Veterinary.

Let’s review each area, what to look for, and how each is scored.

Ear position

  • Ears facing forward (0)
  • Ears slightly flattened and rotating outwards (1)
  • Ears flattened and rotating outwards (2)

Orbital tightening (squinting)

  • Eyes opened (0)
  • Eyes partially closed (1)
  • Squinted eyes (2)

Muzzle tension

  • Relaxed; round shape (0)
  • Slightly elongated horizontally; mild tension (1)
  • Tense; oval shape (2)

Whiskers change

  • Loose, relaxed, and curved toward the ground (0)
  • Slightly curved or straight (1)
  • Straight and moving forward, away from the face (2)

Head positions

  • Head above the shoulder line (0)
  • Head aligned with the shoulder line (1)
  • Head below the shoulder line or tilted down; chin toward the chest (2)

Add up the total of all scores. Your cat is likely in pain if their total score is greater than or equal to 4/10.

Note that some of the feline facial expressions associated with pain occur for other reasons as well. For instance, flattened ears can also indicate a cat is anxious or scared. However, the presence of all five changes simultaneously and consistently is a strong indicator of pain.

Next Steps After Scoring

“If there is any concern whatsoever that a cat is in pain, a visit to the veterinarian is in order,” says Dr. Carter.

“True, potentially life-threatening emergency situations would be pain associated with urination or known injuries,” she says. She adds that if a cat vocalizes or winces when touched, they should also be evaluated right away. When in doubt, it’s always best to have your vet examine your cat — better safe than sorry! 

Be prepared to share the following information with your vet:

  • Your cat’s grimace scale score
  • Any behavioral changes like reduced appetite or mobility issues
  • Videos or photos showing behaviors or areas of concern
  • Potential sources of pain/distress

Your vet will examine your cat, assess the findings, and determine if pain medication, treatment, or further diagnosis is recommended based on the pain score and clinical signs.

Pain Relief for Cats and Recovery Tips

“Effective pain management in cats involves a multimodal approach, combining various strategies to address pain comprehensively,” says Dr. Gonzalez.

Though treatments vary according to a cat’s needs, Dr. Gonzales says pain management typically includes some combination of:

  • Medications: Pain medications, such as NSAIDs, opioids, and local anesthetics.
  • Environmental modification: Ensuring a comfortable, stress-free environment with easy access to food, water, and litter boxes.
  • Physical therapy: Gentle exercises and physical rehabilitation techniques to aid recovery.
  • Nutritional support: Feeding a diet that supports overall health and may include supplements that help relieve inflammation and pain.
  • Monitoring and adjustment: Regularly assessing cat pain levels and adjusting the treatment plan as needed to provide optimal pain and quality of life.
  • Addressing underlying causes: Identifying and treating the root causes of the pain to provide long-term relief.

During treatment, continue scoring your cat using the Feline Grimace Scale. Lower scores indicate pain control measures are working. However, if your cat’s score remains the same or increases, it’s a sign that the treatment isn’t relieving their pain. If that’s the case, talk to your vet about additional or alternative interventions.

To show how the cat pain scale works in real life, Dr. Gonzales shares this example.

“We had a cat that came in who was very upset with being handled. This was the first time we had ever seen him. His eyes were squinting and he had his head down. However, he was fine with his face and front limbs being examined,” Gonzales says.

“We found he had lumbar back pain, which was why he was so upset,” Gonzales continues. “We treated him with pain medication and anti-inflammatories. At the next visit, he was a perfect patient, head up, wide-eyed, and playful with the team.”

How to Know If Pain Becomes Unbearable

In some cases, a cat’s pain may plateau at severe levels despite pain treatment. This can indicate their medical condition is too advanced or painful to manage effectively with available therapies.

When a good quality of life seems unattainable, you may need to have an honest discussion with your vet about your next steps. Deciding when it’s time to say goodbye to your beloved cat is never easy. But a cat pain scale can help reveal when your cat is enduring persistent, unrelenting pain. This insight can be helpful when making the difficult but humane decision to end a cat’s suffering through euthanasia.

Shedding Light on Hidden Cat Pain Signs

Cats have been hiding signs of pain for millennia. Though scientists haven’t cracked the feline pain code yet, tools like the cat pain scale can help us improve cat welfare. Assessing your pet’s pain in real time can lead to early diagnosis, timely treatment, and effective pain relief. 

So keep a keen eye on those whiskers and expressive eyes. A grimace may speak volumes about your cat’s hidden hurts — and provide a path toward compassionate, tailored care.