Pain management

Long term (chronic) pain is as debilitating in animals as it is in people. Constant pain significantly reduces pleasure in life and can lead to sleeplessness and a poor appetite. Simple measures to control even mild pain can result in a happier healthier cat.

Animals, like people, are prone to many different forms of pain. All types of injury including surgery can cause pain. There are times when pain can be anticipated such as immediately following surgical procedures. In these instances your veterinarian will probably give your cat something for pain relief before and during surgery and then ask you to continue this at home after. Studies have shown that relief of pain improves recovery after surgery.

In cats long term (or chronic) pain is often caused by arthritis (joint pain) or dental disease. When managing pets with conditions such as arthritis which cannot be cured, veterinarians are trying to give your pet the best quality of life and so pain control is an important part of management.

It can be very difficult to identify pain in cats as they will often try to hide signs of pain. Animals in pain can show a variety of signs some, like lameness, are obvious. Other well recognized signs are calling and restlessness, but poor appetite, reduced grooming, hiding away and altered sleeping patterns are also common effects of chronic pain in cats. Cats with arthritis are less willing to jump up or down off things and often can’t jump as high as they used to. Animals with a painful focus may continually lick the sore area. Some animals in pain become reserved and unresponsive but others may become aggressive if they are scared of being touched.

Often owners notice very subtle changes in their pet’s behavior or appearance that allow them to identify that their pet is experiencing pain more quickly than veterinarians can. If you are concerned that your pet may be in discomfort you should discuss your concerns with your veterinarian. However, sometimes owners attribute signs of pain, eg poor appetite and reluctance to exercise as signs of old-age rather than pain. They can be very surprised at how much their cat improves when pain is relieved.

Pain is much more difficult to control once it is well established so it is far better to treat it as soon as it is recognized. There are many different types of drugs used in the management of pain each has different benefits and side effects. Your veterinarian will initially prescribe what they think is the best drug for your pet but it is quite common to have to try a number of different drugs for the treatment of chronic pain before the best treatment is found. Cats are not good at handling many of the commonly used pain relief drugs. Never give your cat a pain relief medication not prescribed by your veterinarian, some common household remedies like paracetamol can be fatal to cats even at low doses. If you are worried about your pet, or it develops signs such as vomiting, diarrhea or bleeding when it is receiving pain relief always contact your veterinarian and do not give any more tablets until you have done so.

NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) is a difficult name but one that simply means drugs that reduce inflammation but are not steroids. These drugs block the action of some of the messengers of pain and inflammation in the body (prostaglandins). NSAIDs (as they are commonly known) may be familiar to you as the common human drug aspirin, but there are many different types. Cats are particularly sensitive to the effects of some NSAIDs and these should all be used with caution in cats.

Commonly used NSAIDs in cats include carprofen (Rimadyl), ketoprofen (Ketofen), meloxicam (Metacam), and robenacoxib (Onsior). Although cats are much less tolerant of these drugs than dogs or people, when used carefully NSAIDs are relatively safe. One common side effect in people is stomach upsets caused by damage to the lining of the stomach, although this is perhaps less of a problem in animals and the newer forms of NSAIDs have fewer side effects. If your pet has these side effects then your veterinarian can prescribe some additional drugs to help protect the stomach or it may be necessary to change the type of pain relief your pet receives. Many of the newer NSAIDs do not share the side effects of the older drugs.

NSAIDs can be given as tablets or liquids (and sometimes your veterinarian will give these drugs by injection). These drugs are removed from the body by the liver or kidneys and therefore should not be used in animals with damage to these organs. Liver and kidney function should be checked in animals receiving long term NSAIDs.

Opioids
Opioids are drugs with similar action to morphine. They are some of the most powerful forms of pain relief available. Morphine is commonly used in veterinary hospitals to control severe pain after surgery but there are now new types of opioids such as fentanyl. Most of these drugs can only be given by injection which has previously made them unsuitable for managing long term pain in the home. Fentanyl patches are a sticky patch impregnated with fentanyl that is applied to the skin. The drug is absorbed through the skin in a steady fashion and provides long term (several days) relief from severe pain. These patches are most often used for control of pain in cancer patients or after significant surgery.

Cats receiving opioids do not appear to suffer as many side effects as people do although some cats may experience hallucinations (highs) on this drug. One of the annoying side effects in pets is that these drugs can cause constipation. Fentanyl patches pose a significant risk to patients if the patch is removed and eaten by your pet so care must be taken to prevent access to the patches.

Tramadol
Tramadol has become very popular with veterinarians for managing chronic pain in pets. There are few serious side effects with this drug although it has been reported to cause vomiting and sleepiness in some patients. Since it works in completely different ways from the existing pain relief drugs it can be used alongside all of them. This allows for a much greater reduction in pain with fewer side effects.

There is no doubt that some cats do not like taking medication! Pills and capsules can be tricky to give but may be disguised in strong flavored food and many of the medications come in a liquid form for adding to food. If you are having problems treating your cat, discuss your concerns with your veterinarian. There may be another way to give the medication and your veterinarian will want to find a way to be sure your cat is getting all its treatment. For further advice read the factsheet on how to give medication to a cat.

Some lifestyle changes can help to reduce pain experienced by pets. If your pet has joint pain your veterinarian will advise that its weight should be kept to a minimum healthy level (to reduce the strain on the joints). Providing your cat with a soft warm bed in an accessible place can be beneficial if she/he has back or joint pain. Massaging or applying warm compresses to arthritic joints may help relieve discomfort. Some people find acupuncture to be of benefit in managing pain in their pets.

Nutraceuticals such as glucosamine and chondroitin may help to reduce inflammation in joints in people but there is not the corresponding evidence for cats, although some do seem to respond well. Omega 3 fatty acids may help animals with arthritis.

It is important that pets are not allowed to suffer with chronic pain when there are so many options for pain control today. If you have any queries about pain or how to manage it for your pet you should discuss your concerns with your veterinarian who will be happy to help you.