Loss of normal behaviors
The absence of normal behaviors in a specific patient (e.g. grooming or playing with string) should prompt you to assess that patient for pain. Many cats that are fearful or stressed
will stay at the back of their cages and hunch themselves up, but if you observe these cats before and after surgery, you
can detect subtle changes. For example, if pain relief is inadequate, a cat may be even more hunched than before. And instead
of just being at the back of the cage, it may actively try to hide under things (Figure 3), and its facial expression will be different from that before surgery.
3. A friendly cat that played at the front of its cage before surgery hides afterward.
It is important to assess patients before and after surgery. Each cat is unique, and some will have altered behavior due to
stress. The trick is to pick up small changes for that specific cat that can be attributed to pain. However, stress and fear
are aversive emotions that can worsen pain, so they should not be dismissed. Instead, give some thought as to how to also
relieve stress and fear, such as by providing a cat-only area, boxes for cats to hide in, and favorite toys and blankets from
home or by using a synthetic feline pheromone (Feliway—Ceva Santé Animale).
Response to palpation
Wound palpation is an important component of pain assessment; you should be able to apply gentle pressure to a surgical wound
without a cat's flinching or turning to bite (Figure 4). One of the many commonly reported problems after onychectomy is excessive licking and chewing of the feet.3 Cats will often shake their paws and try to bite at their feet if bandages are placed on onychectomy wounds. These behaviors
could indicate postoperative pain, pain from an incorrectly placed bandage, or a dislike of the bandage, so it is important
to differentiate among these.
4. Palpating a bone graft site to assess for pain.
HOW OFTEN SHOULD PAIN BE ASSESSED?
The patient's health status, the extent of the surgery or injuries, and the anticipated duration of effect of the analgesic
drugs administered determine the frequency and interval of evaluations. If a cat, for example, is resting comfortably (normal
posture and facial expression) after postoperative buprenorphine administration, it may not need to be reevaluated for two
to four hours. Allow animals to sleep after analgesic therapy. Vital signs can often be checked without unduly disturbing
a sleeping animal. In general, do not wake an animal to check its pain status; however, the patient should still receive scheduled
Continuous, undisturbed observations coupled with periodic interactive observations (e.g. palpating the wound) are likely to provide more information than occasionally observing the animal through the cage door.
Unfortunately, continuous observations are not practical for most clinical situations. But the more frequent the observations,
the more likely that subtle signs of pain will be detected.
Sheilah A. Robertson, BVMS (Hons), PhD, DACVA, DECVA, CVA, MRCVS
Section of Anesthesia and Pain Management
Department of Large Animal Clinical Sciences
College of Veterinary Medicine
University of Florida
Gainesville, FL 32610
This highlight was selected from a lecture Dr. Robertson gave as part of the International Veterinary Academy of Pain Management
tract at the 2008 CVC Central.
1. Lascelles B, Capner C, Waterman-Pearson AE. A survey of current British veterinary attitudes to peri-operative analgesia
for cats and small mammals. Vet Rec 1999;145:601-604.
2. Waran N, Best L, Williams V, et al. A preliminary study of behaviour-based indicators of pain in cats. Anim Welfare 2007; 16(S):105-108.
3. Patronek GJ, Assessment of claims of short- and long-term complications associated with onychectomy in cats. J Am Vet Med Assoc 2001;219(7):932-937.