A cat pain plan that works has 3 layers, not 1 drug used harder. An NSAID covers inflammation, an opioid covers the sharp post-surgical hours, and an adjunct such as gabapentin or a local block covers nerve wind-up. The plan runs hardest for 72 hours, gets scored every 12 hours, and every drug in it is prescription-only, because the margin between relief and kidney injury is narrow.
3 layers, not 3 alternatives
Each layer hits a different target, which is the point: 2 or 3 drugs at modest amounts usually control pain better than 1 drug pushed to its ceiling, and the ceiling is where side effects live. The failure mode is the opposite: 1 drug, a dose that was right on day 1, and no reassessment by day 3.
Layers also let you subtract. Once the incision is 72 hours old and the score is 2 or lower at 2 checks in a row, the opioid comes off first, then the adjunct, and the NSAID stops last.
Layer 1: the NSAID that holds the base
An NSAID is the standard base for soft-tissue surgery, dental extraction and arthritis. Before it is prescribed, 3 things belong on the record: kidney values, blood pressure, and whether the cat is on a steroid. An NSAID plus a steroid is a combination to avoid, and 2 NSAIDs at once never make sense.
For routine surgery the course is commonly 3 days, sometimes 5, and it is not extended because the cat seems quiet. A cat that needs a second week needs a recheck, not a refill. Never use a dog formulation or a human tablet.
Layer 2: the opioid for the first 24 to 48 hours
The opioid layer covers the sharp, movement-related pain of the first day and night, when a cat is most likely to stop eating and hide. Buprenorphine is the common choice because it can be given into the cheek pouch at home. Expect 6 to 12 hours per dose, some sedation, and a cat quieter than usual.
Ask about this layer before discharge. A spay or an amputation sent home with an NSAID only has a gap at hour 12, exactly when the local block wears off.
Layer 3: adjuncts and the local block
Gabapentin is the workhorse adjunct for nerve-related and chronic pain, and it helps a cat too tense to eat after surgery. Low-rate ketamine in hospital, an incisional bupivacaine block before the skin closes, and cold therapy for 10 to 15 minutes 3 times a day in the first 48 hours all belong here, with a warm bed, food within 1 m and a low-entry litter box.
This is the layer owners can add to without touching a drug label. Warmth, quiet, a covered bed and lifting with 1 hand under the chest and 1 under the hindquarters instead of scruffing lower the score by a point or 2.
The 72-hour plan, scored every 12 hours
Score at 0, 12, 24, 36, 48, 60 and 72 hours: 7 checks in 3 days, same scale, same person where possible, scored at rest before you open the cage, because a just-handled cat scores higher for 20 minutes.
| Hours after surgery | Feline Grimace score (0 to 10) | What it means | Action |
|---|---|---|---|
| 0 to 6 | 4 to 6 | Expected with a block still working | Keep the plan, score at 12 |
| 12 | 4 or more | Block has worn off | Call: opioid layer may be missing |
| 24 | 3 to 5 | Moderate, movement-related | Adjust the plan, score in 12 hours |
| 36 to 48 | 2 to 4 | Improving | Continue, start tapering the opioid |
| 60 | 2 or less | Well controlled | Plan the stop date |
| 72 | 1 to 2 | Expected end point | Recheck at 7 days |
| Any time | 6 or more | Uncontrolled | Same-day recheck, not a refill |
One high score after a car ride is noise. Two scores of 4 or more 12 hours apart is a pattern, and a pattern is what changes a plan.
How to score without a vet in the room
The Feline Grimace Scale has 5 items, each scored 0 to 2: ear position, orbital tightening, muzzle tension, whisker position and head position. The total runs 0 to 10 and 4 or more is the usual treatment threshold. Score before feeding and before the next dose, or you measure the drug rather than the cat.
Three behaviours beat any number: no food by 24 hours, hiding where the cat never hid before, and refusing to lie on the operated side. Any 1 of those with a score of 3 is a call. The full scale is at /health/pain-scales-for-cats/.
What not to do
Never give ibuprofen, naproxen or acetaminophen. Acetaminophen destroys cat red cells at amounts a human would call trivial, and ibuprofen damages the kidney within days. Do not split a dog tablet or double a missed dose. Do not add a second drug from the same class because the first seems weak: 2 NSAIDs block the same pathway, double the risk and add nothing.
Tapering after day 3 and the 7-day recheck
Taper in the reverse order of addition: opioid first, then the adjunct, then the NSAID. Drop 1 layer at a time and score 12 hours later; if the score rises by 2 points, put that layer back for 24 hours. The 7-day recheck is not optional after an amputation or a major abdominal surgery, because day-7 wound pain is the pain most often missed.
Ask for the written plan at discharge: drug, layer, days, and the score that means call. Four lines on 1 page get followed.
When to call the clinic
- A grimace score of 6 or more at any check, or 4 or more at 2 checks 12 hours apart.
- No food for 24 hours, or no urine for 12 hours after surgery.
- Vomiting 2 or more times, or black stool, on an NSAID.
- A wound that is swollen, hot or discharging at 48 hours.
- Panting, a heart rate over 200 beats per minute, or a cat that will not settle.
Keep the drug boxes and the score sheet together. For a cat scratching around the wound, the itch plan at /health/health-cat-flea-allergy-plan/ covers the 30-day version and the 14-day check. If a human painkiller was given by mistake, call the clinic and check the ingredient at /tools/toxic/ on the way.
For the next 3 days: score every 12 hours and write the number down, keep the opioid layer for 24 to 48 hours, taper 1 layer at a time, and book the 7-day recheck before you leave.
Frequently asked
Is 3 pain drugs at once too much for a cat?
Not when each one has a different target and the cat is being scored every 12 hours. An NSAID, an opioid and an adjunct such as gabapentin usually control post-surgical pain better at modest amounts than a single drug pushed to its ceiling, and the ceiling is where side effects appear. The over-medication risk is a plan that is never reviewed after day 1.
How do I know the pain is not controlled at home?
Use the 5-item grimace scale and score before feeding and before the next dose: 4 out of 10 or more is the usual threshold. Two scores of 4 or more 12 hours apart is a pattern worth a call, and 6 or more at any check is a same-day recheck. Not eating for 24 hours, hiding somewhere new, or refusing to lie on the operated side also count.
Can I stop the painkillers once the cat seems normal?
Taper in the reverse order of addition rather than stopping at once: opioid first, then the adjunct, then the NSAID. Drop 1 layer, score 12 hours later, and put that layer back for another 24 hours if the score rises by 2. Inflammation peaks around 48 to 72 hours, which is why the NSAID is the last to go and why the 7-day recheck matters.