Is Your Cat Hiding Pain? Learn About the Feline Grimace Scale

While you may not have heard of the Feline Grimace Scale (FGS), it is a handy tool that all cat owners and veterinary professionals should know. Think of it as a cat pain scale, a more objective way of measuring your furry friend's discomfort. This article discusses the more common signs of pain in cats, why a pain scale is helpful, and when to call a vet.

Why recognizing pain in cats is crucial

Did you know cats are experts at hiding their pain? Those with significant oral pain and tooth abscesses often keep eating, and it is not unheard of for a cat with a broken back or pelvis to run away after being hit by a car. Cats have evolved to cope with pain as best they can. It is a survival mechanism, so non-domesticated animals can fare better when injured or unwell in the wild. A cat that can continue to eat despite a sore tooth and run away after being injured is much more likely to survive.

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While the ability to mask pain is advantageous for wild animals, it often results in a pet with pain not detected by its owner. This can mean the cat is dealing with severe pain without its owner realizing it. Not only does this negatively impact their quality of life, but it also leads to a delay in interventions and treatments, which can have serious consequences. Many diseases, including cancers, periodontal disease, and pancreatitis, carry a better prognosis when identified early on.

Common causes of pain in cats

Some of the most frequently seen issues in veterinary practice would include:

  • Gingivitis and oral resorptive lesions of the teeth
  • Osteoarthritis
  • Cystitis
  • Ingrowing claws
  • Eye ulcers
  • Pancreatitis, gastrointestinal, or bile duct disease
  • Post-operative pain
  • Injuries, such as cat bites or trauma

When experiencing pain or discomfort, cats exhibit specific behavioral changes. These can include a reduced appetite, purring (as a way of self-soothing), stiffness, reluctance to jump or run, hiding away, faster breathing, and licking at the source of pain.

What is the Feline Grimace Scale (FGS)?

If you've ever wondered how to tell if your cat is in pain, you are not alone. The cat grimace scale was developed by Dr. Paolo Steagall at the Université de Montréal and first presented in the U.S. in 2019 at the American Veterinary Medical Association convention. This fast and simple way to assess feline pain has proven to be a great contribution to feline health.

This research-based tool evaluates cat facial expressions and enables both owners and vets to pick up on early and subtle signs of pain. Importantly, it is most accurate for evaluating acute pain and is less effective for assessing those with chronic painful conditions, such as arthritis.

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The 5 facial expressions to watch for

This pain scale tool assesses five separate areas. Let's take a look at each in more detail, noting the 'normal' for a cat not in pain:

  • Ear position. Ears should be relaxed, facing forward and moving toward the direction of any sound.
  • Eye closure (orbital tightening). Eyes should be wide open and not squinted or semi-closed.
  • Muzzle tension. The mouth should be nice and relaxed when at rest.
  • Whisker position. Whiskers are relaxed and curved down.
  • Head position. The head is held normally, right above the shoulders, and not with the chin toward the neck.

How to use the Feline Grimace Scale at home

Cat behavior should be monitored, and it can tell you a great deal about how a cat is feeling. Though pain signs are usually vague, they will be present. When using the FGS, you first want to observe your cat while it is calm and relaxed. Wait until it has woken and is not grooming or eating.

Feline Grimace Scale

Assess each of the five actions listed above and note whether they are absent (0), moderately present, or you're not sure (1) or present (2).

Example 1: A cat with ears facing forward, open eyes, a rounded muzzle, loose whiskers, and their head above their shoulders has a score of 0 and is likely in no pain.

Example 2: A cat with ears rotated outward, squinting eyes, an elliptical (stretched) muzzle, straight whiskers, and a tucked-down chin has a score of 10 and is in pain.

If a cat has a score of 4 or more, it usually requires pain relief. If its score is 3 or 4, recheck in 20 minutes to see if things have changed. Rechecking lets you get a better overview of how the cat feels and enables you to gauge whether pain may worsen or if your cat was just reacting to temporary discomfort.

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Other signs your cat may be in pain

As useful as the FGS is, it is just one piece in the puzzle. Keep in mind that it is really only helpful for acute pain. Let's take a look at some other indicators of pain in your cat.

Behavioral changes

Watch for signs that your cat is not acting normally. This can mean things like a reduced appetite, a lack of social desire, and stiff walking. Some cats may also act aggressively, wanting to keep people or other pets away from them.

Physical signs

Some cats will present with more obvious and discernible signs of pain. This can include things like tooth grinding, a limp, or grooming one area to excess. These physical signs can help pinpoint where the cat is feeling discomfort, so are very useful.

Vocalization changes

A very vocal cat may become quiet, while a quiet cat might suddenly find their tongue. Some of the vocalizations you hear can include hissing, meowing, groaning, and purring.

Note: It is a misconception that a purring cat is always happy, and purring often indicates stress or pain.

When to consult a veterinarian

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It might not be evident when you should contact your vet, mainly if your cat's signs are vague or coming and going. As a rule of thumb, seek immediate assistance if your cat is in obvious pain, has been injured, or seems distressed. If your cat is on pain relief already, but it does not seem to be helping, this would be another reason to contact your vet clinic. When in doubt, it is always best to contact your vet.

Vet visits can be costly, especially when out of hours. For this reason, it is worth considering pet insurance. Keep in mind that even indoor cats can get injured or become unwell, so it is not just outdoor kitties who require insurance.

How vets use the Feline Grimace Scale

Not every vet or vet tech knows this helpful cat pain chart, which isn't as widely used as it could be. Vet staff who know about it usually assess cats' comfort levels post-operatively, monitor those with possible pain during checkups, and help them decide when pain medicine is needed for inpatients.

How pain in cats is treated

Pain is hugely variable, and each patient will have individual needs and medical history so that pain will be managed in a range of ways. Each cat should have a tailored treatment plan. This plan should be reassessed frequently and will change as the cat's needs change.

Medications and pain relief options

For most, medicine is the cornerstone of treatment. This can include several types of medicine, including NSAIDs, steroids, opioids, and GABA analogs. In recent years, targeted pain medicine has started to emerge, with certain pain relief being issued for specific conditions, e.g., Solensia for feline osteoarthritis. This allows for an even better result for the cat.

Medications should be given as prescribed, and patients will be monitored to ensure the correct dose. Though some owners can be skeptical of vet-recommended pain relief, vets only prescribe this medicine after weighing the pros and cons. They will have determined it is in your pet's best interest if it has been prescribed. Please be aware that human pain relief can be very dangerous for cats and must never be given.

Natural pain relief methods

More natural pain relief is sometimes recommended with pharmaceutical options. A multi-modal approach to pain relief can help ensure a cat is as comfortable as possible. Some natural options include acupuncture, supplements (such as joint supplements for those with arthritis), and lifestyle changes (such as feeding soft food to those with oral pain). Another option that has been in the spotlight recently is CBD. Going forward, the use of CBD in the feline community is undecided, but it is a chemical with a lot of promise.

Importance of regular monitoring

Cats with ongoing medical issues need to be seen regularly for appointments. Ideally, your vet will use the FGS to assess for any acute pain, perform a complete physical exam, and take your history. A chronic condition such as arthritis will progress with time, and it is not uncommon for cats to require changes to their treatment plan to reflect this.

How to keep your cat comfortable at home

There is much you can do from your own home to support your cat when unwell or injured. They will appreciate having a predictable environment with plenty of creature comforts. This can include soft and padded bedding, litter trays that are easy for them to access and large enough for them to posture in with ease, and plenty of hiding spots and resting areas.

It is also helpful to reduce any stress factors. This can mean keeping the home calm and quiet, maintaining a routine, and not hosting guests while your cat recovers. If other pets or children are in the home, ensure they are kept away from a cat in pain, especially when it is resting or asleep.

The importance of being proactive about pain in cats

Using a tool such as the FGS empowers owners to better assess their pet's comfort levels from home and to better understand how they are feeling. Early signs of pain can be picked up, ensuring prompt evaluation and treatment. The scale also helps vet staff gauge when a cat requires pain relief and evaluate whether it is working as hoped.

Regularly monitoring your cat, particularly if it is elderly or unwell, can help you be better informed about how it is coping and when it needs some extra help. Early veterinary intervention allows for effective pain reduction and a happier and healthier cat.

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