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Merola I, Mills DS. Behavioural Signs of Pain in Cats: An Expert Consensus.  PLoS One. 2016 Feb 24;11(2):e0150040.  (Free PMC article)

Drs. Isabella Merola and Professor Daniel Mills from the University of Lincoln, UK recruited 19 veterinary pain experts to see if consensus could be reached regarding feline behaviors associated with pain.  Participants included veterinary internist, anesthesiologist, oncologist, dentist, behaviorist, dermatologist, ophthalmologist and neurologist.  They came from private practices or academia.

Behavioral signs of pain were classified as either ‘sufficient’ (sufficient to indicate pain when they occur, but not necessarily present in all painful conditions) and ‘necessary’ (necessary in the presence of pain, but not always indicative of pain).

An iterative method consisting of four rounds of questions and answers provided by the participants was performed over 5-months and the information provided assessed for consensus.  A particular behavior was considered an established pain marker if at least 80% consensus was obtained.  A total of 91 behavior signs were assessed in this study.

None of the 91 signs was considered ‘necessary’ to denote pain (i.e., if this sign is absent we cannot consider the cat to be in pain).  There were 23 signs considered sufficient to infer pain (i.e., if this sign is present the subject is in pain, but its absence does not exclude the presence of pain).   Two additional signs (“straining to urinate” and “tail flitching”) were also considered to infer pain, but a consensus was not reached on their frequency during either low or high level pain.

The list of behavioral signs could help veterinarians and cat owners to identify important signs that a cat is in pain and ultimately reduce suffering by leading to faster diagnosis of problems and illnesses. (GO)

Table 1: Behaviors considered sufficient (reliable) for pain their presence in high and/or low level pain:

Behavior sufficient for painPresence in low level painPresence in high level pain
Difficulty to jumpFrequentFrequent
Abnormal gaitFrequentFrequent
Reluctant to moveFrequentFrequent
Absence of groomingFrequentFrequent
Playing lessFrequentFrequent
Appetite decreaseFrequentFrequent
Overall activity decreaseFrequentFrequent
Less rubbing toward peopleFrequentFrequent
General mood changeFrequentFrequent
Temperament changeFrequentFrequent
Hunched up postureFrequentFrequent
Shifting of weightFrequentFrequent
Licking a particular body regionFrequentFrequent
Lower head postureFrequentFrequent
Blepharospasm (closed eye)FrequentFrequent
Change in form of feeding behaviorRareFrequent
Avoiding bright areasRareFrequent
Eyes closedRareFrequent

See also:
Merola I, Mills DS. Systematic review of the behavioural assessment of pain in cats.

J Feline Med Surg. 2016 Feb;18(2):60-76.