Hiding is the most common pain behavior in cats and the easiest to misread as personality. A cat that spends more than 6 hours a day out of sight, eats 50 to 75 percent of its normal ration, and stopped jumping onto the bed 10 days ago is describing pain in numbers, not mood. Score 5 facial features, measure activity for 2 weeks, and let the totals decide.
5 facial features, 0 to 2 each
The Feline Grimace Scale scores 5 features, each from 0 (absent) to 2 (obvious), for a total of 0 to 10. A score of 4 or higher is the usual cut-off for pain worth treating. The 5 features:
- Ear position: ears rotated outward and flattened, rather than forward and upright.
- Orbital tightening: squinting, with the eye opening narrowed by a third or more.
- Muzzle tension: lips drawn back and nose pad flattened rather than round.
- Whisker change: whiskers stiff, clustered, and angled away from the face instead of fanned out in a curve.
- Head position: head held below the shoulder line, or pressed against a wall or the back of a chair.
Score from a photo, not from memory. Take 3 pictures at 1 metre, from the same height, in daylight, and score each one twice 10 minutes apart. Cats that score 2 or more on any single feature, or 4 or more in total, need a vet visit within 24 hours rather than a wait-and-see week.
The 20 percent activity drop
Activity falls before appetite does. A collar tracker that logs steps and active minutes gives you a baseline in 14 days; after that, a 20 percent drop held for 3 consecutive days is the signal, roughly 1,900 steps a day instead of 2,400 in a 4 kg indoor cat. No tracker means 3 cheap proxies: hours out of hiding, height of the highest surface the cat still jumps to (a drop from 120 cm to 40 cm is meaningful), and time to reach the food bowl after the tin opens, which stretches from under 30 seconds to over 2 minutes.
Write the 3 proxies down for 14 days. Owners who guess tend to be wrong in both directions, and the trend line is what turns a vague complaint into a treatable problem.
Log 6 fields for 2 weeks
Record hours hidden per 24, percentage of the normal ration eaten, the highest jump height in cm, the facial score out of 10, litter box visits per 24 hours, and whether the cat sleeps in a new place. Six fields, 30 seconds a day. Two weeks is the minimum because pain fluctuates with weather and routine, and because a 14-day curve shows the vet whether a 3-day dip was noise or the start of a slide.
The 5 things that hurt most
The differential list for a hiding cat is short and testable:
- Mouth pain: tooth resorption and periodontal disease, present in roughly 1 in 3 cats over 10 years, often with drooling and one-sided chewing.
- Joint pain: osteoarthritis of the spine, hips, and elbows, visible as a stiff jump, a missed landing, or refusing stairs.
- Abdominal pain: pancreatitis and inflammatory bowel disease, with a hunched posture and a tense belly.
- Neck pain: reluctance to lower the head to the bowl, which owners report as sudden aggression when picked up, or as neck pain that never gets mentioned at the clinic.
- Bladder or urethral pain: frequent trips to the box with little or no urine, which is an emergency within 6 hours in a male cat.
Each of those 5 has a different test, which is why the exam starts with the mouth and the spine rather than with a full blood panel.
Hours, not days: the visit clock
The table combines the facial score, hours hidden, and food intake. Use the first row that matches; when 2 rows apply, follow the shorter time.
| Facial score (0 to 10) | Hours hidden per 24 | Food eaten | Action window |
|---|---|---|---|
| 0 to 1 | Under 2 | 100 percent | No action, normal cat |
| 2 to 3 | 2 to 4 | 75 to 100 percent | Log 48 hours, recheck score |
| 4 to 5 | 4 to 8 | 50 to 75 percent | Vet within 24 hours |
| 6 to 7 | 8 to 12 | 25 to 50 percent | Vet within 6 hours |
| 8 to 10 | Over 12 | Under 25 percent | Emergency now |
| Any score | Any | Any, with no urine for 12 hours | Emergency now |
What the exam adds
Expect a weight and body condition score, a full oral exam, and hands on the spine from neck to tail base before any blood is drawn. Blood work matters for the second layer: creatinine above 2.4 mg/dL (reference 0.8 to 2.4 mg/dL) or SDMA above 14 µg/dL for kidney pain risk, glucose above 250 mg/dL for diabetes, total T4 above 4.0 µg/dL (reference 1.0 to 4.0 µg/dL) for hyperthyroidism, and potassium outside 3.5 to 5.5 mmol/L. Blood pressure above 160 mmHg is common in older cats and is treated separately. Reference intervals vary with the analyzer, so read the range printed on that report.
Imaging is the next 30 minutes of value: 2 radiographs of the spine and hips, or ultrasound for the abdomen. A cat with a normal exam, a normal panel, and a score of 5 out of 10 still has pain, and the score is the evidence that gets it treated.
Exposure history belongs in the same visit. Lily pollen, permethrin drops sold for dogs, and 500 mg of paracetamol all produce hiding, drooling, and a flat posture within 6 to 12 hours, so run anything the cat touched in the past 72 hours past the toxin list before the appointment.
4 steps this week
- Take 3 daylight photos at 1 metre and score them twice today.
- Start the 6-field log tonight and keep it for 14 days.
- Measure the highest surface the cat still jumps to, in cm, and write it down.
- Book the visit if the total reaches 4 out of 10, and bring the 14-day log and the photos.
Terms mentioned in this article
Frequently asked
Is my cat hiding because it is in pain or just because it is shy?
Time and food separate the two. A shy cat hides under 2 to 3 hours a day, comes out for food within 30 seconds of the tin opening, and holds the same jump height for months. A painful cat hides 6 or more hours, eats 50 to 75 percent of its ration, and drops its jump height by 20 cm or more within 2 weeks. Score 5 facial features out of 10 for 3 days and the answer is usually clear.
Can I use the facial scale on a cat that is asleep or being held?
No. Score only a cat that is awake, unrestrained, and not being petted, because restraint and sleep change ear position, eye opening, and whisker angle and will inflate the score by 2 or 3 points. Take photos in daylight at 1 metre, wait 10 minutes, score again, and use the higher of the 2 totals when deciding whether to call the vet.
How long can a hiding cat wait before the visit?
Use the numbers, not the calendar. A total of 4 to 5 out of 10 with 4 to 8 hours hidden and 50 to 75 percent of the ration eaten gets a visit within 24 hours. A total of 6 or more, under 25 percent eaten, or no urine for 12 hours moves the visit to 6 hours or to an emergency clinic tonight, because urethral obstruction can kill a male cat in 24 to 48 hours.