Cats Hide Pain: How to Tell if Your Cat Is Hurting

In the wild, showing weakness makes an animal vulnerable, so cats are masters at hiding pain. Many cats in pain don't cry or limp — they simply do less, or do things differently. Learning to spot subtle changes is one of the best skills you can develop as a cat owner.

Behavior changes

• Hiding more, or seeking out unusual places
• Less active, sleeping more, reluctant to play
• Not jumping onto furniture they used to reach, or hesitating before jumping
• Reduced appetite or eating more slowly, dropping food, chewing on one side
• Irritability — hissing, biting or swatting when touched, especially in one area
• Avoiding being picked up or stroked
• Less interaction with people or other pets
• Unusual vocalization, or unusually quiet

Grooming changes

• Less grooming, leading to an unkempt, greasy or matted coat — particularly along the back and rear (painful to reach with arthritis)
• Over-grooming one spot, sometimes to the point of bald patches, which can indicate pain in that area (for example, over-grooming the belly with bladder pain)

Litter box changes

• Urinating or defecating outside the box — especially next to it (climbing in may hurt)
• Straining, frequent trips or crying in the box
• Constipation

Posture and movement

• Sitting hunched with the head lowered and paws tucked under
• Lying in a tight, tense ball rather than stretched out
• Stiff or stilted walk, limping, reluctant to use stairs
• Tail held low or tucked
• Sitting or lying in unusual positions

The feline pain face

Researchers have developed the Feline Grimace Scale, a validated tool used by vets to assess acute pain from facial expression. Signs of pain include:

• Ears flattened or rotated outward and apart
• Eyes squinted or partially closed
• Muzzle tense and more elliptical
• Whiskers straight and pulled forward, or flattened
• Head held below the shoulders

A relaxed cat has forward ears, open eyes, a relaxed round muzzle and loose, curved whiskers.

Common sources of hidden pain

• Arthritis (osteoarthritis) — extremely common in older cats and frequently missed. Studies suggest a large majority of cats over about 12 have signs of arthritis on X-rays.
• Dental disease — especially tooth resorption, which is very painful. See common health problems.
• Bladder inflammation (cystitis) and urinary stones
• Injuries from falls or fights
• Constipation
• Pancreatitis and other abdominal problems

What to do

1. Note what's changed and since when. Video can be helpful — cats often behave differently at the clinic.
2. Book a vet appointment. Many causes of pain are very treatable, and there are safe cat-specific pain medications.
3. Never give human painkillers. Paracetamol/acetaminophen can kill a cat; ibuprofen, aspirin and naproxen are also dangerous.
4. Make life easier while you wait: low-sided litter box, food and water within easy reach, soft bedding, steps or ramps to favorite spots.

If your cat is in obvious severe pain, has breathing difficulty, or you suspect a urinary blockage, go to a vet immediately — see emergency symptoms.