Pain management in cats is one of the most challenging aspects of feline medicine. Cats are masters at hiding pain — an evolutionary survival trait — making it difficult for owners and even veterinarians to recognize when a cat is suffering. Additionally, cats lack key liver enzymes (specifically UDP-glucuronosyltransferase) involved in metabolizing many common analgesic drugs, which means medications safe for dogs and humans can be toxic or fatal in cats. Despite these challenges, significant advances in feline pain management have been made, and cats today have access to safer, more effective pain control than ever before.

Overview

Pain in cats may be acute (post-surgical, traumatic) or chronic (osteoarthritis, cancer-related, neuropathic). Osteoarthritis (OA) is dramatically underdiagnosed in cats — radiographic studies suggest that over 90% of cats older than 12 years have evidence of degenerative joint disease, yet most are never treated. The approval of Solensia (frunevetmab), an anti-nerve growth factor (anti-NGF) monoclonal antibody specifically designed for cats, has transformed chronic pain management in feline practice.

Causes & Risk Factors

Common sources of pain in cats include:

  • Osteoarthritis / degenerative joint disease — The most common cause of chronic pain, particularly in older cats. Commonly affected joints include the elbows, hips, stifles, and spine.
  • Dental disease — Tooth resorption, periodontal disease, and stomatitis cause significant oral pain
  • Post-surgical pain — Spay/neuter, orthopedic surgery, soft tissue procedures
  • Urinary tract disease — FLUTD, urinary obstruction, cystitis
  • Trauma — Fractures, bite wounds, falls
  • Cancer — Neoplastic pain from tumors or treatment
  • Neuropathic pain — Diabetes-related neuropathy, nerve damage
  • Pancreatitis — Abdominal pain from acute or chronic inflammation

Symptoms

Cats rarely vocalize when in pain. Instead, look for behavioral changes:

  • Decreased jumping height or frequency (jumping to lower surfaces or using intermediate steps)
  • Reluctance to use stairs
  • Decreased grooming (matted or unkempt coat) or overgrooming a painful area
  • Decreased activity and increased sleeping
  • Hiding or social withdrawal
  • Reduced appetite
  • Aggression when handled or touched in a specific area
  • Changes in litter box habits (difficulty posturing, eliminating outside the box)
  • Stiff gait or limping
  • Facial expression changes (squinted eyes, flattened ears, tense muzzle) — the Feline Grimace Scale is a validated tool for assessing acute pain

A cat that has stopped jumping onto the bed or counter may not be “slowing down with age” — they may be in pain. Discuss any changes in mobility or behavior with your veterinarian.

Diagnosis

  • Physical and orthopedic examination — Joint palpation, range of motion assessment, gait evaluation
  • Feline Grimace Scale — A validated facial expression tool for acute pain scoring
  • Owner questionnaire — Client-Specific Outcome Measures (CSOM) and other tools to track behavioral changes at home
  • Radiographs — To identify arthritis, fractures, dental disease, or neoplasia
  • Advanced imaging — CT or MRI for spinal, neurological, or complex orthopedic pain
  • Response to therapy trial — Improvement after starting pain medication supports a pain diagnosis

Treatment & Medications

Chronic Pain (Osteoarthritis)

  • Solensia (frunevetmab) — A feline-specific anti-NGF monoclonal antibody given as a monthly subcutaneous injection by your veterinarian. The first FDA-approved treatment specifically for feline OA pain. Works by targeting nerve growth factor, a key mediator of pain signaling. Well tolerated with a favorable safety profile. This has become the cornerstone of chronic feline pain management.
  • Gabapentin — Used for neuropathic and chronic pain at doses of 5-10 mg/kg two to three times daily. Also provides mild sedation and anxiolysis. One of the most versatile pain medications available for cats.
  • Meloxicam — An NSAID that may be used at very low doses for short periods under strict veterinary supervision. Long-term NSAID use in cats carries significant risk of kidney injury. Not FDA-approved for chronic use in cats in the United States.
  • Robenacoxib (Onsior) — A COX-2 selective NSAID approved for short-term use (up to 6 days) in cats for post-surgical pain. Used off-label for longer courses in some countries under close monitoring.
  • Environmental modification — Ramps, heated beds, raised food and water dishes, low-sided litter boxes, and soft bedding to reduce joint stress
  • Weight management — Maintaining a healthy weight is critical for reducing joint load
  • Physical rehabilitation — Gentle range-of-motion exercises, massage, and laser therapy may benefit some cats
  • Adequan (polysulfated glycosaminoglycan) — Injectable joint-protective agent used off-label in cats

Acute Pain (Post-Surgical, Trauma)

  • Buprenorphine (Simbadol) — A partial mu-opioid agonist and the most commonly used opioid in feline medicine. Can be administered transmucosally (absorbed through the oral mucous membranes), subcutaneously, or intravenously. Simbadol is a sustained-release formulation providing up to 72 hours of pain relief from a single injection.
  • Robenacoxib (Onsior) — For short-term perioperative pain control
  • Methadone — A full mu-opioid agonist used in hospital settings for severe acute pain
  • Local and regional anesthesia — Nerve blocks, epidurals, and local anesthetic infusions are increasingly used in feline surgery

Medications NEVER Safe for Cats

  • Acetaminophen (Tylenol) — FATAL to cats even in small doses. Causes methemoglobinemia and hepatic necrosis.
  • Ibuprofen (Advil) and naproxen (Aleve) — Extremely toxic. Cause acute kidney failure and GI ulceration.
  • Aspirin — Cats metabolize aspirin extremely slowly (half-life of approximately 40 hours versus approximately 6 hours in dogs). Toxicity occurs readily at standard doses.

Prognosis

  • Cats with osteoarthritis managed with Solensia and environmental modifications often show marked improvement in mobility and quality of life
  • Multimodal pain management (combining pharmacological and non-pharmacological approaches) provides the best outcomes
  • Regular reassessment is important, as pain conditions may progress over time
  • Quality of life assessment tools help owners and veterinarians make informed decisions about ongoing care

Frequently Asked Questions

Can I give my cat any over-the-counter pain medication? No. Acetaminophen, ibuprofen, naproxen, and aspirin are all dangerous or fatal to cats. Never give human pain medications to your cat without explicit veterinary instruction.

How do I know if my cat is in pain? Watch for changes in behavior: decreased jumping, reduced activity, hiding, changes in grooming habits, reluctance to be touched, or changes in litter box use. The Feline Grimace Scale can help assess acute pain based on facial expression.

Is Solensia safe for long-term use? Clinical trials and post-market surveillance have shown Solensia to be well tolerated for ongoing monthly use. The most common side effects are mild injection-site reactions. Your veterinarian will monitor your cat’s health at regular intervals.

My cat has kidney disease. Can they still receive pain medication? Yes, but options are more limited. Solensia is generally considered safe in cats with stable kidney disease. NSAIDs should be avoided. Gabapentin may be used with dose adjustment. Your veterinarian will tailor the pain management plan to your cat’s kidney status.

This information is for educational purposes only and does not replace professional veterinary advice. Never administer human medications to your cat. Consult your veterinarian for appropriate pain management.