Older Cat Pain Management: Signs Your Cat Hurts and What Helps

Your Cat Is Not 'Just Getting Old' -- That Slowdown Has a Name

An estimated 90% of cats over age 12 show radiographic evidence of arthritis, according to research published in veterinary literature. Yet most of those cats never receive a diagnosis because they don't cry or limp the way a dog with arthritis would. Cats sit still when they hurt. They groom less because reaching certain spots hurts. They stop jumping to the cat tree because landing hurts. They choose the floor over the couch because getting down from the couch hurts.

Every behavioral change in a senior cat is pain until a veterinary exam proves otherwise. The cat that used to greet you at the door and now stays in the back bedroom is not being aloof -- it may be in significant chronic pain that has never been identified or treated.

How to Read a Cat's Pain Face

The Feline Grimace Scale (FGS), validated by researchers at the University of Montreal, identifies five pain indicators in a cat's facial expression: orbital tightening (squinting eyes), ear position (flattened or rotated back), muzzle tension (tightened), whisker change (fanned forward or back), and head position (below shoulders). A cat showing three or more of these signs consistently is likely experiencing pain.

Test your cat against these criteria when it's resting and relaxed -- that's the baseline. Then observe during movement, grooming, and when touched around the back, hips, and legs. A cat that flinches, turns to look at an area being touched, or stops grooming when touched on a specific spot is giving you a pain location map. Document these observations to share with your vet.

What Actually Works for Feline Pain

Feline pain management is complicated by the cat's unique liver metabolism, which makes many human and dog medications toxic in cats. Standard ibuprofen and most NSAIDs safe for dogs cannot be given to cats. The approved options are more limited but effective when used correctly.

Meloxicam (Metacam) in a feline-specific oral formulation is currently the most widely used NSAID for cats in many countries and is approved for multi-day use in the US after FDA approval of injectable meloxicam for cats. Long-term oral meloxicam requires baseline kidney function testing and monitoring every 6 months -- kidney disease is common in older cats and NSAIDs can worsen kidney function. Gabapentin (5-10 mg/kg twice daily) is increasingly used for neuropathic and chronic musculoskeletal pain and is well-tolerated in most cats. Robenacoxib (Onsior) is another approved option.

Environmental Modifications That Reduce Pain Every Day

Pain management is not only pharmacological. A cat with arthritis benefits from ramps or steps to reach favored high spots (removing the need to jump), low-sided litter boxes that don't require stepping over a high entry (a 4-inch entry vs. a 6-inch wall makes a measurable difference in litter box use for arthritic cats), heated beds or orthopedic foam beds that reduce joint stiffness, and food and water bowls at a height that doesn't require the cat to bend its neck downward painfully.

These modifications reduce pain stimulus throughout the day -- environmental pain reduction is cumulative and works alongside medication, not instead of it. A cat that hurts less from its daily environment may need less medication to maintain quality of life.