Feline Grimace Scale: Scoring Cat Pain 0 to 10

Cats do not limp into the clinic crying. They go quiet, stop grooming, sit hunched over the food bowl and eat half. That silence is why the Feline Grimace Scale exists: five facial features, scored 0 to 2 each, adding to a total out of 10, with 4 or above as the usual line for pain that needs an analgesic. It takes 30 seconds, needs no equipment, and works from a photograph if the cat is left alone for a minute.

The five features and their anchors

Each feature is scored on the same three-step ladder: 0 for the relaxed version, 1 for a partial change, 2 for the full expression. Score what you see in a still frame, not what you expect from the surgery.

Feature	0	1	2
Ear position	Ears forward and upright, facing the front	Slightly flattened or rotated outward	Flattened against the head, tips pointing sideways or back
Orbital tightening	Eyes fully open, round	Eyes partly closed, lid line visible	Squinting, eyes narrowed to slits
Muzzle tension	Relaxed and rounded, nose bridge smooth	Mild tension, slight flattening	Tense and drawn back, nose bridge flat and broad
Whisker position	Loose, curved, angled down and away	Slightly straightened, moving forward	Straight and bunched forward, away from the cheeks
Head position	Head held above the shoulder line	Head level with the shoulders	Head below the shoulders, chin lowered or resting

Scoring without fooling yourself

Watch the cat at rest, in its own cage or bed, with no hand on it and nobody talking. Thirty seconds of observation is enough; a two-minute video is better, because the ears move. Hold the camera at eye level so both eyes and both ear tips are in frame, and avoid backlight, which flattens the muzzle. Score before analgesia and again 30–60 minutes after it, using the same observer and the same lighting where possible. Two people scoring the same cat often differ by 1 point, so use one scorer per patient per day and let the trend speak.

What 4 out of 10 actually means

The published cutoff is 4 out of 10: at or above it, the cat is likely in pain and analgesia should be given or the current plan reconsidered. Below 4 does not prove comfort, and above 4 does not identify the cause. Treat the number as a trigger for action, then confirm with the rest of the picture: the invasiveness of the procedure, heart rate, respiratory rate, blood pressure, appetite and posture. After a rescue dose, rescore in 30 minutes. If the score stays at 4 or higher after two doses, the drug, the dose or the route is wrong, and the cat needs a vet rather than a third dose of the same thing.

Post-surgery: when to check and when to add

Soft tissue surgery such as ovariohysterectomy usually needs coverage for 24–72 hours; dental extractions and orthopedic repair often need 3–5 days. Score at 1, 2, 4, 8, 12 and 24 hours after recovery, then twice daily while the cat is on medication. A score that climbs between the 8-hour and 12-hour checks is the most common pattern, because the premedication wears off before the next scheduled dose. Multimodal plans — an opioid plus an NSAID plus a local block where possible — keep the score lower than doubling a single drug.

A version families can use at home

Photograph or film the cat for 10 seconds while it is lying down and unaware, then score the five features. Alongside the face, track six behaviours daily: eating less than half the usual ration for 24 hours, hiding more than usual for 12 hours, a hunched posture with front legs tucked under the chest, no grooming for 48 hours or licking one spot raw, missing the litter box, and flinching when lifted or touched. A resting breathing rate above 40 per minute, counted over 15 seconds and multiplied by four, is a reason to call the clinic the same day.

Chronic pain does not look like this

The grimace scale was built for acute pain, and it is weak at picking up long-standing joint disease. Most cats over 10 show some degenerative joint disease on X-ray, and the signs are behavioural: refusing to jump onto the counter it used for years, stiffness for the first ten steps after a nap, hesitating on stairs, over-grooming the lower back, urinating outside the box because the entry is too high, and irritability when the hind legs are handled. Weight loss of 5–10% takes load off the joints, a low-entry box and a ramp remove the two biggest daily obstacles, and long-term meloxicam helps when kidney values and blood pressure are checked first. Never give a cat ibuprofen, acetaminophen or aspirin; the safe margin is narrow to nonexistent.

Reading the face next to the eyes

Two eye conditions mimic a pain score and need a different plan. A cat with a feline herpesvirus flare and a corneal ulcer squints and holds its ears back for ocular reasons, so read the FHV long-term guide before treating the number as surgical pain. A cat with toxoplasmosis can present with fever, lethargy and neck or muscle soreness that reads as generalized pain, and the toxoplasmosis guide covers when a titer is worth sending. Either way, scoring twice on different days beats one high number.

For a cat that needs to lose weight before joint pain improves, the daily ration matters more than any supplement; the food calculator converts target weight and food energy into grams per day.

Five steps for the next painful week

1. Score before any painkiller, then 30 and 60 minutes after; write both numbers down.
2. Keep one scorer per day and use the same light, so the trend is comparable.
3. Add the behavioural checklist, since a cat can score 2 and still not eat.
4. Call the clinic if the score stays at 4 or above after two doses, or if breathing is over 40 per minute at rest.
5. For a cat older than 10, ask about joint pain at the next visit even if the face looks normal.

Frequently asked