Revealing pain points in cats

Assessing a cat in pain for orthopedic injury or chronic disease can be challenging for veterinarians. Although feline patients are not known for being cooperative, an organized approach to the medical exam will help in achieving successful completion, according to Michael H. Jaffe, DVM, MS, CCRP, DACVS, associate professor and service chief of small animal surgery at Mississippi State University College of Veterinary Medicine. In his lecture at the 2023 Fetch dvm360 conference in Long Beach, California, Jaffe walked attendees through some steps for assessing orthopedic-associated pain in cats and identifying potential causations, including osteoarthritis (OA).¹

Photo: Petra Richli/Adobe Stock

Gathering information

A patient’s health history is an important tool for veterinary professionals and can provide valuable clues leading to diagnosis. Jaffe said a health history can help the veterinarian ascertain whether the condition is acute or chronic and answer other important questions: How and when did the lameness begin? For example, an injury could signify a recent trauma.

Also, does the condition worsen or improve after rest? Can the patient bear weight on the limb? Does medication help improve the condition? Is the condition intermittent or persistent?

“If it’s something that’s persistent, then it’s oftentimes a little bit more severe, in some cases,” he said. Clicking or popping sounds, which can indicate a meniscal tear, and travel history, in the event the patient was at risk of infectious disease, should also be noted, according to Jaffe.

Physical exam

Jaffe noted that cats experiencing pain may not cooperate with veterinarians’ attempts to handle them. In some cases, sedating the patient may be necessary to allow them to be properly examined. Sedation can also help relieve the animal’s pain and reduce their anxiety.

Performing palpations on the patient’s bones and joints, veterinary professionals are looking for effusion, crepitus, pain, and asymmetric range of motion. Thickening around the joint and muscle atrophy should also be noted. The contralateral limb should be used as a reference for comparison in cases of unilateral injury, Jaffe said. Additionally, the examination should start distally on the patient and proceed proximally.

“When you do the exam, I really encourage you to isolate each bone and joint individually, rather than just grabbing the leg and doing the accordion thing, and saying, ‘Yup, that one’s fine.’ Look at each of these structures individually,” said Jaffe. “For one, it’s going to make the cat less freaked out. And, for two, I think you’re going to get a more accurate assessment of what’s going on because if you’re just, kind of, jerking the whole leg back and forth and you get pain, you don’t where that’s coming from” and the cat may not tolerate further examination.¹

Jaffe said a limb being examined should be as relaxed as possible to best assess its range of motion. He noted that Fear Free training and implementation can help a practitioner achieve this success. “We want these kitties as relaxed as possible,” he said. “Making a quiet room away from the barking dog kennel thing, there’s a lot of this exam that you can get done very efficiently.”

Incorporating feline-specific behaviors by increasing exploration and play, providing feeding strategies, and minimizing conflict can help reduce a cat’s perception of a threat, according to the American Animal Hospital Association. Practitioners can also appeal to cat senses by offering scents of catnip, silvervine, or pheromone; providing surfaces for scratching and optimal materials for bedding; and playing feline-friendly music to help reduce blood pressure.³

Examining gait

A gait exam requires patience, Jaffe said, and should be done prior to any sedation. Start by closing doors and windows for patient safety and use a feline-friendly space. Although cats often crouch and may refuse to move if they are afraid, other feline patients will move to a place where they will try to hide.

By placing a cat in a location that requires them to move to reach a hiding spot, the practitioner will get at least a short look at their gait. Another incentive to get the patient to move is using a motivational toy such as a laser or feather. Veterinary professionals can also try to have a cat jump up or down from an object to assess their ability to jump.

If needed, practitioners can have a client bring a video from home that shows their pet’s gait. “Allowing the cat to move around the room on their own may afford you your best opportunity to see how they walk, jump up on a chair, or jump down,” said Jaffe.

Osteoarthritis

Although clinical signs aren’t always obvious, OA is quite common in cats, as well as a common type of degenerative joint disease (DJD). In a retrospective study of 100 cats older than 12 years, radiographic evidence found DJD in 90% of these felines. However, only 4% of the studied cats exhibited clinical signs of arthritis.² In another study cited by Jaffe, investigators found 22% of cats older than 1 year had radiographic changes that suggested OA despite most of these felines showing no clinical signs.^1,3

Signs of OA and pain associated with the disease in cats include reluctance to jump, decreased activity, and lameness. Jaffe shared with his audience an example from a client conversation in which the pet owner told him that their cat “finally learned” not to jump up on the counter. However, Jaffe recognized the change in behavior as a sign of possible arthritic pain. “If [the cat] could get up on that counter, she would. Cats kind of adapt a little bit with their arthritis. Instead of jumping down things, they kind of slink down a little bit more,” he said.

Upon medical examination, there may also be pain on flexion and extension of the patient’s joints, along with crepitus and decreased range of motion. Jaffe noted that the hip, stifle, tarsus, and elbow joints are most commonly affected in felines, and older cats have higher incidence.¹

Takeaways

There are a variety of treatments for managing OA and associated pain in cats, according to Jaffe. Medicinal therapies include nonsteroidal anti-inflammatory drugs, adjunctive drug therapy, and supplements for joint health. Nonpharmacologic treatment options include weight management, environmental modifications, physical rehabilitation, and surgical techniques, he said.

In his talk, Jaffe addressed other causes of orthopedic pain in cats that may be considered during examination. These include hip dysplasia, patellar dislocation, feline knees and teeth syndrome, and various injuries such as bite wounds.

REFERENCES

1. Jaffe MH. How to do a purrfect feline orthopedic exam. Presented at: Fetch dvm360 Conference; December 1-3, 2023; Long Beach, CA. Accessed December 15, 2023. https://www.isvma.org/wp-content/uploads/2023/10/How_to_do_a_purrfect_Feline_Orthopedic_Exam.pdf
2. Hardie EM, Roe SC, Fonda RM. Radiographic evidence of degenerative joint disease in geriatric cats: 100 cases (1994-1997). J Am Vet Med Assoc. 2002;220(5):628-632. doi:10.2460/javma.2002.220.628
3. Feline specific factors in pain management. American Animal Hospital Association. Accessed December 15, 2023. https://www.aaha.org/aaha-guidelines/2022-aaha-pain-management-guidelines-for-dogs-and-cats/how-to-pain-assessment-toolbox/feline-specific-factors-in-pain-management/