New tools help identify and manage acute pain in cats

Illness, trauma and surgery cause acute pain, and effective management of that pain is a condition of feline welfare, understood as physical health and mental well-being. The consensus guidelines of the International Society of Feline Medicine (ISFM), published in 2022 in the Journal of Feline Medicine and Surgery by an expert panel, start from a known problem: pain has traditionally been under-recognised in cats, assessment tools are not widely implemented, and signs in this species may be subtle. The unique challenges of feline metabolism and comorbidities may lead to undertreatment and to the development of peripheral and central sensitisation.

The document's principles are preventive and multimodal analgesia, including local anaesthesia, with drug choices that take into account the type, severity and duration of pain, comorbidities and avoidance of adverse effects. Nursing care, environmental modifications and cat-friendly handling are described as pillars of the plan, as is a team approach that involves the cat carer. The pain management guidelines of the American Animal Hospital Association (AAHA), also from 2022, take the same direction for dogs and cats: diagnostic guides and algorithms for acute and chronic pain, owner instruments for chronic pain, an expert consensus emphasising proactive, pre-emptive management rather than a reactive approach, and a tiered decision tree that prioritises the most effective modalities.

Assessment requires an instrument. The UNESP-Botucatu multidimensional feline pain assessment scale (UFEPS) is valid and reliable for acute pain, but had been validated only for ovariohysterectomy and can be time-consuming. A study published in 2021 in PeerJ, by researchers at Unesp and collaborators, evaluated the scale and its new short form (UFEPS-SF) in 10 healthy control cats and 40 cats requiring pain management for clinical (20) or surgical (20, of which 12 orthopaedic and 8 soft tissue) conditions. Three evaluators applied, in real time, visual analogue, numerical rating and simple descriptive scales, followed by the UFEPS-SF, the UFEPS and the Glasgow CMPS-Feline in random order; rescue analgesia in surgical cases was given when the UFEPS-SF scored 4 or more.

Inter-rater reliability was moderate to good for the UFEPS and the UFEPS-SF (confidence intervals of intraclass correlation coefficients 0.73 to 0.86 and 0.63 to 0.82). The correlation between the two forms was 0.85, and of each with the feline Glasgow scale strong (0.79 and 0.78), confirming criterion validity. All scales distinguished cats in pain from controls and responded to rescue analgesia. Sensitivity and specificity were moderate: 83.25% and 72.00% for the UFEPS, 78.60% and 84.67% for the short form, 74.28% and 70.00% for the Glasgow. The authors conclude that both forms show appropriate validity, responsiveness, reliability, sensitivity and specificity for acute pain in varied clinical and surgical conditions.

Scales describe behaviours, but recognising them takes training. A paper published in 2024 in the Journal of Feline Medicine and Surgery used a database of 60 hours of recordings of cats with different types of acute pain, medical, surgical, trauma and orofacial, and different degrees, from none to severe, before and after surgery or analgesia, recorded with ethical approval and owner consent. Selection was based on a published ethogram of acute pain behaviours; 24 videos, averaging 33 seconds, each showing one behaviour from the ethogram, were uploaded to an open video channel (youtube.com/@Steagalllaboratory) with a short description for the public. The authors hope the compilation will improve professional training and understanding of cat behaviour.

Taken together, the four papers form a learning path: see the behaviours, score them with a validated scale, and treat pre-emptively and multimodally. This summary names no drugs or doses; the full guidelines and the assessment of each patient rest with the veterinarian, and publication of this text is conditional on technical review in veterinary anaesthesiology and analgesia.