My Cat Hurts?
March 11, 2016 (published)
EveryCat Health Foundation

A summary of:

Behavioral Signs of Pain in Cats: An Expert Consensus
PLoS One. 2016 Feb 24;11(2):e0150040
DOI: 10.1371/journal.pone.0150040

Drs. Isabella Merola and Professor Daniel Mills from the University of Lincoln, UK recruited 19 veterinary pain experts to see if a consensus could be reached regarding feline behaviors associated with pain. Participants included veterinary internists, anesthesiologists, oncologists, dentists, behaviorists, dermatologists, ophthalmologists, and neurologists. They came from private practices or academia.

Behavioral signs of pain were classified as either ‘sufficient’ (sufficient to indicate pain when they occur, but not necessarily present in all painful conditions) and ‘necessary’ (necessary in the presence of pain, but not always indicative of pain).

An iterative method consisting of four rounds of questions and answers provided by the participants was performed over 5 months and the information provided assessed for consensus. A particular behavior was considered an established pain marker if at least 80% consensus was obtained. A total of 91 behavior signs were assessed in this study.

None of the 91 signs was considered ‘necessary’ to denote pain (i.e., if this sign is absent we cannot consider the cat to be in pain). There were 23 signs considered sufficient to infer pain (i.e., if this sign is present the subject is in pain, but its absence does not exclude the presence of pain). Two additional signs (“straining to urinate” and “tail flitching”) were also considered to infer pain, but a consensus was not reached on their frequency during either low or high-level pain.

The list of behavioral signs could help veterinarians and cat owners to identify important signs that a cat is in pain and ultimately reduce suffering by leading to faster diagnosis of problems and illnesses. (GO)

Table 1: Behaviors considered sufficient (reliable) for pain, and their presence in high and/or low-level pain:

Behavior sufficient for pain Presence in low-level pain Presence in high-level pain
Lameness Frequent Frequent
Difficulty to jump Frequent Frequent
Abnormal gait Frequent Frequent
Reluctant to move Frequent Frequent
Withdraw/hiding Frequent Frequent
Absence of grooming Frequent Frequent
Playing less Frequent Frequent
Appetite decrease Frequent Frequent
Overall activity decrease Frequent Frequent
Less rubbing toward people Frequent Frequent
General mood change Frequent Frequent
Temperament change Frequent Frequent
Hunched up posture Frequent Frequent
Shifting of weight Frequent Frequent
Licking a particular body region Frequent Frequent
Lower head posture Frequent Frequent
Blepharospasm (closed eye) Frequent Frequent
Change in form of feeding behavior Rare Frequent
Avoiding bright areas Rare Frequent
Growling Rare Frequent
Groaning Rare Frequent
Eyes closed Rare Frequent