Chronic feline pain from all perspectives

Elizabeth Colleran, DVM, DABVP (Feline) with Adam Christman, DVM, MBA, after her keynote address

Cats are most comfortable at home which is nothing new to anyone who owns a companion feline or treats them. However, this can make it tricky to diagnose when they are in pain because they do not act the same in the clinic and cats are prone to hiding illness.

Elizabeth Colleran, DVM, DABVP (Feline), shared her tips and tricks on how to make identifying chronic pain in feline patients less painful for the patient, client, and veterinary professional, during her keynote address at the 2023 Fetch dvm360 Conference in Charlotte, North Carolina. “When we assess pain, we're not talking about how the cat is in pain, but how much pain...But they do have very rich emotional lives and we know from humans, who can tell us about how it feels to be in pain, how important it is to consider the emotional needs of these animals, as well as everything else. Then how do we cope with it? Part of that is how helpful you are, and part of it is the environment that you live in,” she said.

Osteoarthritis and chronic pain

One of the most common diseases in cats is osteoarthritis (OA), with 40% of these felines showing clinical signs of the condition, especially those over age 12 years. Colleran informed attendees that because the clinical signs can present in both old and young cats, it is important to create a baseline and begin screening feline patients as early as ages 7-10 years. When setting this baseline, it can be easier for veterinary teams and clients to uncover OA at an early age, which can then improve the quality of life for cats with this disease.

“We know, for example, that osteoarthritis is ubiquitous, far more common in cats than anyone ever thought. One in 5 cats now is over the age of 11 years. I used to think...that 16 [years of age] was an old cat. Now there are 20-somethings, and we might have lots of them. So, they're living a lot longer, said Colleran. She also noted that the conditions of older cats need to be taken more seriously because many of those over the age of 12 years have evidence of degenerative changes.

"There's a huge, huge cadre of cats out there who really need our help and I want to make sure that you also know that if you're looking for osteoarthritis and has a very large part, you may not see anything, any changes radiograph,” she continued.

Because a radiograph might not pick up on anything, Colleran stressed to Fetch attendees this is why the physical exam and educating pet owners on the signs of OA are important. For example, using cartoon images of cats with OA can be a powerful tool for your clinic. Veterinary clinics can leave them in lobbies or exam rooms so when they are talking to clients they can use that as a reference point or even a chance for clients to look at the image and identify if it is how their cat is acting at home. At Colleran’s clinic, she said, there are moving graphics displaying different things to look out for cats with OA or pain in general.

Colleran also cautioned that owners tend to believe that as their cat gets older, it will sleep more and move less, causing them to only notice more severe OA symptoms. Veterinary professionals should train their teams to hear these signs that owners might not recognize like if a cat cannot jump high anymore and the owner is just associating it with old age when the pet could be suffering from chronic OA pain. Colleran explained that cat owners want to help their pets and they need their veterinarian to point them in the right direction. She offered a scenario as an example:

“In my practice, when I tell my client ‘I think your cat has some significant chronic pain,’ the client says to me, ‘He's just getting old and slowing down.’ Because the signs of pain are so difficult for caregivers to see, they don't believe me. So what do I do about that? Pick your drug of choice…make sure you get an effective dose, put them on that drug for 5 days, and say ‘call me on day 4.’ I've had people call me on day 3 in tears because they didn't see it until we put them on some paper,” Colleran said.

Action items for veterinary teams and clients

It can be difficult for pet parents to understand the amount of pain their pet is in if they cannot see it. To help them understand, Colleran shared a checklist veterinary teams can share with clients and also use in practice to identify changes in the cat’s movements. The checklist includes the following:

• Going up and/or down sitars
• Jumping or climbing into/onto the cat’s favorite spot
• Using scratching posts
• Playing
• A change in behavior
• Limping
• Vocalizing or hissing in response to moving around or being stroked over joints

Along with the checklist, Colleran informed the attendees about another resource: the Feline Grimace Scale app. This is a quick and easy tool to assess acute pain in cats based on changes in facial expressions, she noted. The app educates users about the tool and facilitates real-time pain scoring for feline patients.

Takeaways

Pet owners want to be proactive. No one wants to see their beloved family cat suffering, especially if they were in pain and the owner did not realize it. Providing clients with resources and ways to help their pet or being on the lookout for signs can help ease the stress of the situation while getting cats the treatments they need.

Colleran also shared how helpful recording cats at home can be. If a client notices a weird way their cat is walking or climbing up steps, tell them to take a video of it. This way, the veterinary team can get a closer look at the issues that are presenting at home that cannot be created in the clinic.

As veterinary professionals, what other ways can you help? In closing her presentation, Colleran offered advice to attendees:

“The first thing we want to do is onboard your team. We recruited cats for trials. Everybody in my practice, just about, has old and young cats, so we got the group to try and take some videos and see what their experience was at home and the cats getting an injection. Try to do before and after videos.... Find ways to think about educating your clients to get the kind of videos you really need,” explained Colleran.

“The other part of it is make [clinic visits] as peaceful and quiet of an experience as you can...There's cat-friendly certification now for individuals, there are ways that you can learn how to interact with cats in a way that reduces the amount of stress that they experience,” concluded Colleran.

Reference

Colleran E. A Tail of Two Kitties: Recognizing Chronic Pain from The Cat's Perspective and Yours. Presented at Fetch dvm360® conference; Charlotte, North Carolina. March 24-26, 2023.