Provision of analgesia in cats: are we doing enough?
Pain has traditionally been under-recognised in cats. Pain assessment tools are not widely implemented in veterinary practice, and signs of pain in this species may be subtle.
International Cat Care’s veterinary division, the International Society of Feline Medicine (ISFM), encourages the routine assessment and treatment of pain in cats. However, recognition of pain is not always straightforward and the perception that cats experience less pain than dogs may largely reflect different behavioural responses to pain between the two species rather than genuine differences in the experience of pain. This campaign highlights the reasons many cats are not receiving adequate analgesia and aims to encourage clinics to review their policies on prescribing analgesics to cats.
Do cats feel less pain?
Neutering is a surgical procedure and therefore associated with pain. However, in a UK-based study published in 2013, while perioperative analgesia was widely used in both dogs and cats, only 33% of cats received post-operative analgesia following neutering compared with 75% of dogs, and neutering was considered more painful in dogs than in cats.1 For some vets, there may be a perception that undergoing routine surgical procedures, such as neutering, is less painful for cats than for dogs, but it makes physiological sense that both species are likely to feel pain for several days after a surgical procedure. Studies have shown that cats do show behavioural changes indicative of pain for 3 days or more after neutering,2 but we know that this species is less demonstrative and less likely to show overt signs of pain, such as vocalization.
Additional reasons why cats receive less analgesia post-operatively than dogs may include the following:
- Owners may be unaware of the subtle signs of pain cats demonstrate, such as lethargy and decreased social interaction, or may consider such behaviour ‘normal’ post-surgery, injury, or illness and not seek further veterinary treatment. International Cat Care’s Acute Pain Cat Carer Guide is an excellent resource to help owners recognise and manage acute pain in cats.
- Vets may have a misconception that owners are unwilling to pay for, or administer, analgesic drugs to cats, however, a survey indicated that 78% of owners expected analgesia to be provided routinely for surgery (including neutering), and 61% would expect animals to be discharged with with analgesics.3
- Cats may be discharged relatively rapidly after surgery, often before pain scoring is carried out, and when they are still benefiting from peri-operative analgesic injections. This means they may remain comfortable while under veterinary care but may become more painful when in the home where assessments such as wound palpation are not carried out.
Increases in cat ownership worldwide mean more cats are requiring veterinary care. Illness, trauma and surgery can all result in acute pain, and effective management of pain is required for optimal feline welfare (ie physical health and mental wellbeing).
Building an analgesic plan
The 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats strongly recommends the use of preventative and multimodal analgesia, along with good nursing care and optimisation of both the clinical and home environments as part of a successful pain management plan.4
The analgesic plan used will be determined by the type, location, severity and expected duration of stimulus, as well as whether the cat is being managed as an inpatient or an outpatient. For example, analgesia following castration or ovariohysterectomy/ovariectomy may be required for at least 1 and up to 3 days after surgery using non-steroidal anti-inflammatory drugs, depending on the peri-operative analgesia protocol used. Local analgesia such as testicular blocks and local application to the ovarian pedicle can also improve post-neutering comfort as part of a multimodal pain management plan, as described in the guidelines.4
Want to learn more?
Watch our free to view webinar ‘Building optimal analgesic protocols with the ISFM acute pain management guidelines’ presented by Dr Paulo Steagall (DVM, MS, PhD, DACVAA) Associate professor of Veterinary Anesthesiology and Pain Management at the Université de Montréal, Canada.
- Hunt JR, Knowles TG, Lascelles BD and Murrell JC. Prescription of perioperative analgesics by UK small animal veterinary surgeons in 2013. Vet Rec 2015; 176:493.
- Vaisanen MAM, Tuomikoski SK, Vainio OM. Behavioural alterations and severity of pain in cats recovering at home following elective ovariohysterectomy or castration. J AM Vet Med Assoc 2007; 231: 236-242.
- Demetriou JL, Geddes, RF and Jeffery ND. Survey of pet owners’ expectations of surgical practice within first opinion veterinary clinics in Great Britain. J Small Anim Pract 2009; 50: 478-487.
- Steagall P, Robertson S, Simon B et al. 2022 ISFM Consensus Guidelines on the Management of Acute Pain in Cats. JFMS 2022, 24: 4-13.