Cat Health

Pain Relief in Cats: What to Know About

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Have you ever witnessed your cat in distress and reached for your bottle of ibuprofen? Fortunately, you probably second-guessed yourself.

A cat in pain can seem exceptionally vulnerable and heart-wrenching because most felines are ordinarily so stoic.

Pain relief for cats requires expertise and finesse. Cats have nothing in common with dogs or humans when it comes to safe amounts of pain medications.

They usually require significantly lower doses and suffer much more serious effects from poisoning than canines.

Nevertheless, cats require pain intervention for a wide range of ailments from infections to organ failure to surgical recovery to trauma. You can accomplish safe pain control for your cat through solid communication with your veterinarian.

This article covers how to recognize pain in your cat, frequent causes of feline pain, and the various safe and effective analgesics.

You will also learn about some all-too-common poisonings caused by people intending to help their cats.

Cats show their pain in various ways

How can you tell if your cat is in pain? Some symptoms of pain are obvious while others are either subtle or nonspecific.

Moreover, since domesticated cats are not apex predators even in an urban environment, they tend to hide their distress until their condition is advanced.

  • Crying – Wailing, whimpering, meowing, growling, or hissing
  • Trembling
  • Posturing – Guarding abdomen, hunching back, curling body
  • Expression – Face tightens, ears back
  • Panting
  • Agitation – Your cat acts exceedingly restless, paces
  • Lameness
  • Unusually aggressive behavior
  • Fearful
  • Avoids you – Does not want you to pet or pick her up
  • Lethargy, excessive sleeping
  • Purring
  • Inappropriate elimination – Too painful to venture to the litter box or climb in; Urinary disorders such as UTI or a blocked feline also commonly cause this
  • Focusses grooming or licking on a particular area
  • Hiding
  • Unkempt from lack of grooming
  • Less affectionate, less playful
  • Acts sensitive to light
  • Does not want to move, trouble to get up from a lying position, or difficulty jumping

What are some important causes of pain in cats?

Pain can affect a few systems in cats.

Pain can come from the abdomen.

Intestinal obstruction

Intestinal obstructions in cats originate from most frequently a foreign body they ingested, a tumor, or constipation. Impacted feces can be resolved often without surgery, but rumors and foreign bodies such as string usually require surgical intervention.

Bacterial Infection

Peritonitis

Peritonitis refers to inflammation of the abdominal lining or organ tissues, and it will cause abdominal pain. If there is a buildup of fluid, you will also notice abdominal swelling.

Fluid leaking into the abdomen not only causes pain and rigidity but also dehydration from an electrolyte shift. Your cat may have symptoms other than pain such as lethargy, vomiting, and diarrhea.

Peritonitis has many possible causes.

  • Viruses – FIP (feline infectious peritonitis), stomach flu
  • Pyometra – Bacterial infection of the uterus
  • Intestinal parasites
  • Tear or rupture of fluid-filled organ – Intestines, urinary bladder, uterus in pyometra or dystocia
  • Tumors
  • Abdominal abscesses

Urinary or Kidney Stones

  • Feline urinary obstruction – Male cat with a stone that blocks the urethra; Both pelvic and urethral pain
  • Urinary tract infection

GDV

Although rare, bloat can occur in cats and present as abdominal pain. The stomach will swell with gas from excess fluid or food and can rotate. Sometimes the spleen will also twist although it can spontaneously do so on its own.

Cats, unlike dogs, usually have a preexisting gastrointestinal disease or motility disorder that predisposes them to GDV.

In addition, cats are more likely to present with respiratory distress rather than abdominal pain. They have a much better prognosis for survival with protracted clinical signs than do dogs.

Organ Disease

Occasionally, the disease of certain organs can cause abdominal pain. This is particularly true of the pancreas with pancreatitis but can also occur in the liver and kidneys. Moreover, tissue death can cause severe and acute pain such as in the small intestine or stomach.

Orthopedic issues can pose the most intense pain

Fractures and hip dysplasia are a couple of obvious sources of orthopedic pain. Cats can also suffer from cracked toes or metacarpal or metatarsal bones, a cranial cruciate ligament (CCL or ACL) tear, a dislocated hip or pelvic fractures.

Broken ribs are not common but can occur with a hit by a car or a fall. Back pain can stem from injury or a slipped disc.

Skin blemishes and injuries are painful

Lacerations are often overlooked as a source of pain for cats. Cats also experience pain from itching, ear infections, bruising, punctures, hematomas (blood-filled pockets under the skin), and abscesses.

Your veterinarian will try to eliminate the inciting cause, but concurrent treatment for pain may be necessary.

A painful chest impedes breathing

Conditions such as pleuritis (inflammation of the tissue around the lungs) can be extremely painful.

Other painful conditions include a fluid buildup such as from chyle or FIP. Relief of chest pain is urgent because it can inhibit breathing.

Painful eye symptoms are localized

The eyes are difficult to reach with traditional oral analgesics and may require supplementary pain treatment with localized eye drops.

Cats may indicate eye pain with excessive blinking (blepharospasm), redness, rubbing the face, tearing, and light sensitivity. Common causes are injury, infection, a corneal ulcer, or secondary glaucoma.

Poisoning cats with pain medications is more common than you think

With advances on the internet and informational overload, self-medication has become an all-too-common practice.

However, treating your cat for pain without professional medical advice can prove life-threatening. There are several prevalent drugs for pain relief that you should never give your cat.

Never give these medications without a veterinarian’s explicit instruction

Aspirin, a common over-the-counter human medication, is toxic to cats

Aspirin works in cats much as it does in dogs and people. It blocks inflammation but has minimal discrimination. Therefore, it also inhibits other pathways that provide necessary benefits to the body.

Too much aspirin or long-term use can lead to stomach and small intestinal ulcers which will sometimes bleed or perforate the digestive tract lining.

Aspirin, like many other NSAIDs, can cause detrimental effects to the liver and kidneys and disrupt normal clotting functions.

Cats often experience low dose toxicity which manifests as GI signs such as vomiting, inappetence, and diarrhea.

Ironically, you may give aspirin to relieve pain in your pet and inadvertently cause abdominal discomfort.

A dose of 50 mg/kg (22.7 mg/lb) every 12 hours for a cat can lead to upper gastrointestinal bleeding which will translate into black tarry stools.

Perforating ulcers can occur with bacteria from the intestinal tract spilling directly into the abdomen. Shock and septicemia will follow quickly behind.

Acute poisoning can occur at a dose as low as 100 mg/kg (45.5 mg/lb) a day which can prove fatal within five to seven days.

Treatment for aspirin toxicity aims towards support and drug elimination as there is no antidote.

If you catch accidental ingestion within a couple of hours, your veterinarian may induce vomiting and administer activated charcoal. Activated charcoal slows drug absorption and can have benefits hours into the poisoning.

Intravenous fluids hydrate your pet, support the kidneys, and may hasten the elimination of the drug.

Finally, your cat will also need antacids and GI protectants during treatment and well after recovery. Damage to the liver or kidneys can be permanent and, if present will require lifelong management.

Ibuprofen (Advil, others)

Ibuprofen, like other NSAIDs, causes toxicity in cats at low levels.

Many veterinarian experts such as Veterinary Partner do not consider any dose of ibuprofen to be safe for cats.

The consumption of less than 11 mg is toxic to a typical cat that weighs eight to ten pounds. Even large cats weighing over 20 pounds cannot tolerate more than 120 mg of ibuprofen.

Cats are unable to process ibuprofen effectively and thus recycle it continually through the liver. The drug’s long half-life in the bloodstream means a prolonged potential for repeated poisoning.

Ibuprofen causes typical GI damage such as bleeding and ulceration, but it is particularly damaging to the kidneys. Kittens and senior cats are the most susceptible to the adverse effects of ibuprofen.

As with aspirin, treatment begins with gastrointestinal decontamination if the poisoning is detected early enough. Your veterinarian will induce vomiting and give your cat repeated administrations of activated charcoal.

Support for the kidneys is via IV fluids. Once your medical professional has finished making your cat vomit, he or she will administer drugs to relieve nausea as well as antacids and medications to protect the gut lining.

Permanent kidney damage is possible and will require further management for the life of your pet. Gut support with GI protectants generally continues for one to two weeks beyond recovery.

Naproxen

A toxic dose for Naproxen is not well-established. Dogs suffer signs of poisoning at doses of 5 mg/kg (2.27 mg/lb) and cats will be much lower.

Never ever give acetaminophen to your dog or cat

Acetaminophen (Tylenol, others)

Acetaminophen is neither an NSAID nor a steroid. Experts are still trying to ascertain the drug’s mode of operation. It is one pain medication you must never administer to your cat under any circumstances.

Do you know how there are always emphatic warnings about the possibility of liver failure if you take too much Tylenol? That applies over ten-fold to your cat who, in addition, can never hope to break the drug down.

Even more critical than liver damage are the changes to the red blood cells known as methemoglobinemia.

Hemoglobin, necessary to carry oxygen in the red cells, transforms into methemoglobin. Much like the effects observed in onion toxicity, the mucus membranes become muddy and pale, and the animal goes into respiratory distress.

Treatment involves gastric decontamination, intravenous fluids, and an antidote in the presence of high blood levels. The antidote for acetaminophen is N-acetylcysteine.

Your veterinarian will likely also start liver protectants immediately as organ effects are often delayed for a week or more.

On the other hand, methemoglobinemia typically occurs within four to twelve hours of poisoning.

Acetaminophen is toxic to cats at 50 to 100 mg/kg (22.7 to 45.5 mg/lb). Twice that dose is likely to prove fatal.

On top of respiratory signs, acetaminophen poisoning can cause vomiting, diarrhea, facial swelling, a rapid heart rate, and hypothermia. Depression of the central nervous system can lead to a coma and death.

Signs of liver disease include icterus (yellow color of whites of eyes and the mucus membranes), lethargy, and ascites (fluid in the abdomen).

What can you give your cat for pain relief?

NSAIDS

AS of 2021, there are only two NSAIDs that are approved for use in cats. Others have limited extra-label uses, whereby a medically trained professional can prescribe certain drugs outside the scope of their FDA-approved purpose.

Such uses still fall under the guidelines set forth by the Animal Medicinal Drug Use Clarification Act of 1994.

NSAID stands for nonsteroidal anti-inflammatory drug, and the class is exactly as it sounds. NSAIDs have anti-inflammatory effects but are not in the steroid family of pharmaceuticals.

NSAIDs can be effective against pain and fever as well as inflammation. They act on certain enzymes called prostaglandins.

Meloxicam (Metacam and other brands)

Meloxicam is one of the FDA-approved NSAIDs for cats, but its labeled use is limited to one 24-hour subcutaneous injection specifically for postoperative pain.

In 2010, the FDA issued a caution against the use of oral meloxicam in cats, implicating it in kidney failure.

However, according to Today’s Veterinary Practice, veterinarians continue to use Meloxicam extra-label to offer chronic pain relief for cats.

Meloxicam comes as an oral suspension as well as an injectable. The dosage is about 0.3mg/kg (0.136 mg/lb) for the injectable and 0.1mg/kg (045 mg/b) as the initial oral treatment followed by half that amount daily.

Some veterinarians use an alternative dosing schedule of 0.05 mg/kg (0.023 mg/lb) every other day or 0.025mg/kg (0.011 mg/lb) daily as possibly easier on the kidneys.

Robenacoxib

Robenacoxib is another FDA-approved NSAID for cats. Its primary advantages are its action on specific tissues and its long-acting ant-inflammatory effects despite a relatively short life in the blood.

Its approved purpose is for postoperative pain associated with spays and neuters and orthopedic surgeries.

The manufacturer’s dosing regimen is 1 mg/kg (0.45 mg/lb) every 24 hours for three days, although practitioners may go as high as 2.4mg/kg (1.09 mg/lb).

A major disadvantage is that the medication comes in 6-mg tablets which makes it difficult to administer to cats.

Aspirin

Aspirin is not often your veterinarian’s first choice of pain relief for cats. More commonly, aspirin is prescribed to treat another ailment such as excessive clotting or certain heart problems.

Aspirin dosing and monitoring are very strict for cats. A common regimen is 6 to 10 kg/mg (2.73 to 4.55 mg/lb) every 48 to 72 hours.

Your vet may also recommend an aspirin dosage for emergency at-home use for pain relief in your cat, but always get advice before you give it.

Your practitioner will know how aspirin may affect your cat’s changing health needs and will adjust the dose accordingly. Always follow your veterinarian’s advice to the letter regarding any pain medication.

Steroids

Steroids do not directly address pain. However, they are powerful anti-inflammatories. Medications such as prednisolone can be paramount in relieving pain if it is associated with inflammation.

  • Back pain
  • Joint pain – Arthritis, and OCD
  • Allergies – Steroids relieve swelling and discomfort

Unfortunately, steroids can cause the same GI problems as NSAIDs, and the risk is far greater if you combine the two.

More common side effects of short-term steroid use are excessive drinking and urination and an increase in appetite. Long-term use is necessary for some cats, but the side effects become more troublesome.

  • Calcium deposits in the skin – calcinosis cutis
  • Thin skin, skin infections, blackheads, and poor coat
  • Obesity
  • Increased risk of diabetes
  • Urinary tract infections
  • Increased susceptibility to bacterial and fungal infections

Steroids most used in cats are methylprednisolone, prednisolone, and triamcinolone.

Opioids

Opioids are potent analgesics with sedative rather than anti-inflammatory effects. You will not find them except through your veterinarian.

Their indication is short-term for severe acute pain from surgery or trauma and potentially long-term for cancer treatment and arthritis.

One example of a commonly used opioid is buprenorphine which has the disadvantage of being extremely short-acting.

Other opioids used in cats are hydromorphone, morphine, sufentanil, fentanyl, and remifentanil. Some of these drugs have specific uses during anesthesia.

Opioids require extreme caution as they suppress the respiratory system.

Miscellaneous

Ketamine, lidocaine, and propofol are useful only in a clinical setting and generally for pain management during prolonged surgical procedures such as orthopedics.

Propofol is an anesthetic agent but works effectively with other drugs because of its great effects on slowing the heart and depressing blood pressure.

Many times, ketamine and lidocaine are part of a cocktail that may include an opioid. Such mixtures go into intravenous bags, and the medical staff will utilize a constant rate infusion.

Some medications are finding advanced uses in pain control

  • Gabapentin (Neurontin) – Traditional antiseizure medication, Gabapentin has use for nerve pain in back cases and some neuropathies; The drug also addresses bone and muscle pain in some patients
  • Maropitant Citrate (Cerenia) – An antiemetic, Cerenia can treat mild pain with extra-label use in cats
  • Amitriptyline – An antidepressant, this drug has been shown to treat nerve pain in felines

Examples

This video reiterates how difficult it can be to determine if your cat is in pain. The medical professional discusses a couple of specific signs that are easier to spot than others. We can readily identify and relate to a cat’s facial expression and link it to signs of pain.

The cats illustrate happy healthy cats free of pain. Their ears are upright and forward, and their facial expressions are relaxed. Pain will cause a worsening grimace like ourselves.

The ears will start moving back as they will also do with aggression. The muscles of the face will tighten with a corresponding narrowing of the eyes, pulling back of the lips, and flattening the whiskers.

This video shows another healthy, young cat but the medical professional again has extremely helpful tips on how to watch for signs of pain in cats.

He also emphasizes again the danger of giving in to the temptation of self-medicating your cat with your pain killers.

I have worked in the veterinary field with dogs and cats for several years.

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