Senior Cat Pain: 4-Level Scoring and Safe Drugs

Pain in a cat over 11 is usually under-treated, because old cats do not cry, limp or stop eating until pain is advanced. Four moves close most of that gap. Score the cat on a 4-level ladder, use the Feline Grimace Scale, get kidney values before any non-steroidal drug, and change the house. Every drug named below is by veterinary prescription only; there is no safe home dose of anything, including the painkillers in your own cupboard.

Why pain hides in an old cat

A cat sleeps 16-18 hours a day, so a sore hip only has to work for 6. Cats mask pain by design: a limping cat gets left behind, so the default is to move less. Degenerative joint disease turns up in most cats past 12, and the majority never limp. They stop jumping, stop grooming the lower back, and sleep 2-3 hours longer. Owners notice the routine, not the pain, so describe the routine rather than saying the cat seems fine.

Level 0 to 3: the four-level ladder

Score before you treat, and score the same way each time. Level 0 jumps, grooms and eats normally. Level 1 has changed 1-2 habits but still moves willingly. Level 2 hesitates, sits to eat, and resents handling. Level 3 is withdrawn, guards part of the body, and stops grooming or eating. Most senior cats sit at 1 or 2 for months, the window where treatment works best. Score weekly and write the number on a calendar, because 6 weeks of numbers beat any memory. The published scales are compared in pain scales for cats.

Reading the Feline Grimace Scale

The Grimace Scale scores 5 action units, ear position, orbital tightening, muzzle tension, whisker position and head position, at 0 to 2 each, for a total of 0-10. A score of 4 or more generally means pain that warrants analgesia, and 7 or more is moderate to severe. Photograph the face from 1 metre at eye level while the cat rests, before you touch it, since handling changes every unit. Two people scoring the same photo should land within 1 point. Details in the FGS guide.

All four levels on one page

The 6 signs counted below are: reduced jumping, reduced grooming, sitting to eat, hiding, guarding on touch, and a change in sleep position.

Level	FGS score	Signs of 6	Action	Recheck
0, none	0	0	No drug, keep the house adapted	30 days
1, mild	1-3	2-3	Environment first, add a prescription if no change	14 days
2, moderate	4-6	4-5	Vet visit, bloodwork, prescription, home changes	7-10 days
3, severe	7-10	6	Same-week vet, X-ray, 2-3 drug plan	48-72 hours

Kidney values before any NSAID

Non-steroidal anti-inflammatory drugs are the workhorse for arthritis and also the class most likely to injure a kidney already down to 40-50% function. No careful vet starts one without a chemistry panel, SDMA, urine specific gravity, urine protein ratio and blood pressure, usually $150-300. Creatinine alone misses a share of early loss, which is why SDMA is added. A cat in IRIS stage 1 may still get an NSAID on a normal schedule; stage 2 and beyond usually means a longer interval between doses, set by your vet, with rechecks at 7 days, 4 weeks, then every 3-6 months. More on arthritis in older cats.

Five house changes that work like analgesia

• A heated bed at 30-32 C surface temperature, on the floor in a draught-free corner; warmth cuts muscle guarding within 20-30 minutes.
• Steps or a ramp to the 2 places the cat still wants, the bed and the sofa, in 3 shallow steps rather than 1 jump of 60 cm.
• A litter box with an entry 10 cm or lower, 1.5 times body length, and 1 box per floor of the house.
• Non-slip runners along the 3 routes the cat uses; a cat that slips twice a day stops walking within a week.
• Bowls raised 3-5 cm so the neck does not drop, with food and water within 5 metres of the sleeping spot.

A warm damp cloth over the lower back 2-3 times a week covers the grooming a sore cat gives up first.

Prescription options a vet may layer

Multimodal means 2-3 drugs at lower exposure instead of 1 at maximum. Gabapentin is the usual first add-on for chronic and nerve-related pain, buprenorphine covers flare-ups, amantadine is sometimes added for wind-up pain, and a monthly antibody injection against nerve growth factor is now used for feline arthritis in many clinics. All are prescription-only, all are dosed by your vet from weight and kidney values, and none should be shared between cats or borrowed from a friend. Ask what to do in a bad week and get it in writing.

What never to give

Human painkillers are the most common poisoning in older cats. Ibuprofen and naproxen injure the kidney at a fraction of 1 human tablet. Paracetamol destroys red cells and the liver, and 1 human tablet can kill a 4 kg cat. Aspirin is not a safe substitute at any dose. Human anti-inflammatory gels, diclofenac included, are toxic when licked off the fur. If any of these went in, call a poisons service or an emergency clinic at once rather than waiting for signs, which can take 24-72 hours to show.

The recheck rhythm that catches drift

Weigh the cat monthly on the same scale, because 5% loss in 3 months changes the whole drug plan. Score the face twice a week at home and note the number. Keep a 72-hour note of activity, from a sitter or from your own camera. Book a clinic recheck 7-10 days after any change, then every 3-6 months, with bloodwork once a year and twice a year after 15. Lameness that swaps legs, a cat that stops using a box, or new reluctance to be picked up means the plan needs review, not a bigger dose.

When home management stops being enough

Same-day care for: no food for 24 hours, a leg that cannot bear weight, sudden hind-limb weakness, a joint that is hot and swollen, crying when lifted, or a cat that hides and will not come out for food. Resting breathing over 40 per minute alongside pain is an emergency, because that combination can be fluid or a clot rather than arthritis. If 2 prescription drugs at proper intervals have not moved the score in 4-6 weeks, the diagnosis needs revisiting.

Six steps for this week

1. Score the face once, at 1 metre, before touching the cat.
2. Write the level, 0 to 3, on a calendar and repeat weekly.
3. Book bloodwork with SDMA, urine and blood pressure before any NSAID.
4. Put a 30-32 C bed and 1 non-slip runner down today.
5. Lower the litter entry to 10 cm and raise the bowls 3-5 cm.
6. Photograph the drug labels and the dosing times your vet gives you, and keep them by the food bin.

Terms mentioned in this article

SDMAFGS

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