Recognising pain in older cats: signs, scoring, and when to act

If you have noticed your older cat slowing down and you are not sure whether they are simply getting on, or quietly uncomfortable, you are asking the right question. Cats are extraordinarily good at hiding pain, and chronic discomfort in senior cats often goes unrecognised for months or years before anyone realises what they are looking at.

This article is written for families of cats roughly ten years old and upwards. It explains why pain in cats is so easy to miss, the behavioural signs to watch for, the validated scoring tools UK vets use to put numbers around what you are seeing, the conditions most often responsible at this stage of life, and how to recognise when pain is no longer just something to manage but a quality-of-life question. It is reviewed by an RCVS-qualified veterinary surgeon and reflects how UK first-opinion practices actually approach these cases.

Why pain in cats is so easy to miss

Cats are both predator and prey. In the wild, a cat that visibly limps, vocalises, or favours a limb broadcasts vulnerability to anything that might take advantage of it. Even after thousands of years of domestication, that instinct has not gone away. A pet cat sitting on a familiar sofa will still mask discomfort in ways a dog of similar age would not.

The result is that feline pain is overwhelmingly behavioural rather than overtly physical. A dog with hip pain often whimpers, hesitates at the car boot, or pins their ears back when stroked over the hindquarters. A cat with the equivalent problem usually does something much quieter: they simply stop jumping onto the windowsill they have used every morning for twelve years. The window stops being a window the cat goes to. That is often the entire signal.

Families adapt without realising they are adapting. The cat stops using the upstairs bedroom and someone in the family moves the bed downstairs. The cat eats less in one sitting and meals get smaller and more frequent. The rhythm of life changes without anyone formally acknowledging it has changed. Suffering, when it is present, is rarely dramatic.

A 2010 study by Lascelles and colleagues found radiographic evidence of degenerative joint disease in over 90% of cats over the age of twelve, even though their families had not reported lameness or pain. Most of those cats were almost certainly uncomfortable. Almost none of them had been recognised as such.

The two shapes of pain in older cats

Pain in older cats comes in two broad shapes. They look similar from the outside but matter very differently for what comes next.

Acute pain is a recent, identifiable problem. A fall from a height, a wound from an altercation, a urinary blockage, a sudden flare of pancreatitis. The signs tend to be more visible: hiding for longer than usual, refusal of food for more than a day, vocalisation at the litter tray, an abrupt change from yesterday. Acute pain is usually a same-day or next-day vet visit.

Chronic pain is the slow, persistent kind that develops over months. Osteoarthritis. Chronic dental disease. The discomfort of advanced chronic kidney disease, hyperthyroidism, or low-grade abdominal disease. This is the type of pain most commonly missed in older cats, because by the time it is established, the cat has been quietly adjusting for a long time and the family has been adjusting alongside them. Most of this article is about the chronic kind.

The behavioural signs worth watching for

There is no single sign that confirms a cat is in pain. There is a pattern that, taken together over weeks rather than days, almost always does.

Reduced grooming. A coat that was once smooth and well-kept becomes greasy, scurfy, or matted along the spine, hips, and base of the tail. Self-grooming requires twisting the spine; when it hurts, the cat does less of it. This is one of the earliest and most reliable signs of musculoskeletal pain in older cats, and one of the easiest to dismiss as "just old age".

Changes in how they move. Hesitating before a jump they used to do without thinking. Choosing a half-height stop on the way up. Falling more than they used to. Tail held lower than it once was. A subtle stiffness in the first few steps after lying down which improves as they warm up. That stiffening-then-loosening pattern is a classic sign of osteoarthritis.

Quieter at meals. Eating in shorter bursts and walking away. Leaving food they would once have finished. A slight head tilt or pawing at the mouth when chewing can signal dental or jaw pain. Cats with painful mouths often start preferring softer food without anyone realising the preference is new.

Different sleeping spots. Moving away from high places to the floor or a low chair. Sleeping with the body more bunched, head tucked in, paws curled under, rather than stretched out or lying on a side. This bunched, guarded posture is a recognised pain indicator.

A change in personality. Becoming less tolerant of being handled, particularly around the back end. Withdrawing from social interaction they used to enjoy. Some cats become more clingy with one person; others become more solitary. New or increased irritability, sometimes mistaken for "they are just getting grumpy in their old age", is often pain showing through.

Litter tray changes. Going outside the tray. Standing in the tray for longer than usual. Crying at the tray. Difficulty climbing into a high-sided tray. All worth attention. Litter tray problems in an older cat are pain problems until proven otherwise.

None of these on their own is conclusive. Together, and recognised as a trend rather than a single observation, they often are.

Scoring tools UK vets use

When you take an older cat to your usual vet with a vague concern that "something is different", the vet will often want to give that concern a structure. Two validated tools come up most often in UK first-opinion practice.

The Feline Musculoskeletal Pain Index (FMPI) is an owner-completed questionnaire developed at North Carolina State and validated for use in older cats with degenerative joint disease. It walks you through how easily your cat does everyday things: jumping up, jumping down, stair use, grooming, play. It then produces a score. Repeated every few weeks, it tracks whether things are getting worse, holding steady, or improving on treatment. It is freely available online and is often what a vet will ask you to fill in between appointments.

The Glasgow Composite Measure Pain Scale, Feline version (CMPS-F) is the in-clinic tool. The vet looks at posture, behaviour, facial expression, and response to gentle palpation of any suspected sore area, and assigns a composite pain score. The face component, sometimes called the Feline Grimace Scale, is unusually informative. Cats in pain show specific changes in ear position, eye narrowing, muzzle tension, whisker position, and head position that are reproducible enough to be scored reliably across different vets.

Neither tool replaces clinical judgement. Both turn a soft "I think something is different" into a number you can return to and compare against. Owners often find this reassuring because it stops the conversation feeling speculative.

The conditions most often responsible

In an older cat presenting with the behavioural pattern above, a small number of conditions account for most of what your vet will be considering.

Degenerative joint disease (osteoarthritis) is by far the most common. The figure of 90%+ of cats over twelve having radiographic changes is striking and reflects how under-recognised this is. The hip, elbow, and lower spine are the most commonly affected sites. There is no surgical fix at this age; treatment is about long-term comfort, and there is more that can be done about that than there used to be, including a newer monthly injection covered in the treatment section below.

Chronic dental disease, especially feline odontoclastic resorptive lesions (FORLs) and chronic gingivostomatitis, is widespread in older cats and often genuinely painful. The signs are subtle: changed eating habits, increased drooling, head shaking after eating, reluctance to be stroked around the head. A proper oral examination usually needs sedation or general anaesthesia because cats won't reliably tolerate the kind of inspection a dentist would do on a person.

Chronic kidney disease (CKD) affects roughly a third of cats over fifteen and brings its own discomfort: nausea, mouth ulceration, weight loss, and the general malaise of metabolic disease. CKD pain is not usually the kind that responds to pain relief; it responds to the underlying disease being managed.

Hyperthyroidism is common from about ten years onwards. Cats often present with weight loss despite a strong appetite, increased thirst, restlessness, and sometimes a thickened gland palpable in the neck. It can cause irritability and a poor coat that families often attribute to age rather than disease.

Inflammatory bowel disease and chronic pancreatitis can sit quietly for years. They show up as intermittent vomiting, weight loss, occasional reluctance to eat, and a cat who is "off" without anyone being able to pin down why.

Less common but worth knowing about: feline lower urinary tract disease, hypertension (often secondary to CKD or hyperthyroidism, and often missed without blood pressure measurement at a senior check), and intra-abdominal masses including lymphoma and other tumours. The chance of cancer rises noticeably from about ten years old.

What links these is that almost all of them are diagnosable with a senior-cat work-up, and almost all of them have something useful that can be done about them. The temptation to put behavioural changes down to "she is just getting old" is understandable. It is also one of the main reasons cats live with untreated pain for longer than they need to.

What a senior cat check usually involves

If the picture you are seeing fits more than one of the patterns above, the right next step is a senior-cat appointment with your regular vet. The work-up most UK practices will offer for a cat in this age group usually includes:

• A full physical examination, with particular attention to body condition, hydration status, gentle joint palpation, abdominal palpation, and an oral examination as far as the cat will allow.
• Blood pressure measurement. This is genuinely important and often missed; older cats with kidney disease or hyperthyroidism are at meaningful risk of hypertension, which is treatable but only if anyone looks for it.
• A senior blood profile including kidney values (creatinine, urea, SDMA), liver enzymes, electrolytes, total thyroxine for hyperthyroidism, and usually a haematology panel.
• A urine sample, ideally collected at home in a clean tray with non-absorbent litter. Urine specific gravity tells you a lot about how the kidneys are concentrating.
• A pain assessment using the CMPS-F or equivalent, and often a request for you to complete an FMPI between this appointment and the next.

Sedation or imaging may be discussed if the picture warrants it. Many things become clear from the bedside work-up alone.

What treatment looks like

What "treatment" means depends entirely on what is found. A cat with isolated osteoarthritis pain is in a very different conversation to a cat with concurrent CKD and dental disease. Some broad patterns are worth knowing about so the recommendations your vet makes feel less out of the blue.

For osteoarthritis specifically, the landscape changed in 2022 with the licensing of frunevetmab (Solensia), a monoclonal antibody given as a monthly subcutaneous injection at the vet practice. It targets nerve growth factor, a key driver of chronic joint pain. It is the first treatment of its kind for cats and has measurably improved comfort and mobility for many, particularly cats that did not tolerate or did not respond well to traditional NSAIDs. It is not right for every cat. The evidence base is still maturing, and a small number of reports, mostly in dogs on similar anti-NGF treatments and so far only anecdotal in cats, have raised questions about whether they can speed up joint deterioration in advanced disease. Your vet will weigh the likely benefit against that, and against kidney function and other factors, for your individual cat.

Traditional pain medications are used carefully in older cats. Meloxicam is licensed for long-term use in cats and remains a workhorse for chronic musculoskeletal pain, with kidney function monitored before starting and during treatment. Gabapentin is widely used for chronic pain, particularly where there is a neuropathic component, and as a calming agent before stressful trips to the vet. Buprenorphine has a role for shorter-term acute flares.

Environmental changes make a bigger difference than people expect. Ramps to favoured high spots. Steps onto the bed. Low-sided litter trays in more locations around the house. Warmer bedding. Food and water at a height that does not require crouching. Brushing out the scurf along the back the cat can no longer reach. These are not consolation; they are part of treatment.

Treating concurrent disease is often the single biggest comfort intervention. A cat with poorly managed hyperthyroidism, kidney disease, or chronic dental pain will not be comfortable no matter what is done about their joints.

When pain becomes a quality-of-life question

For most older cats, this is a long, manageable conversation. Years of additional good time are realistic with the right combination of diagnostics, medication, environmental change, and regular review.

For some cats, particularly very elderly cats with multiple concurrent conditions, there comes a point where comfort cannot reliably be restored. The signs that the conversation is shifting in that direction tend to be:

• Pain that is no longer responding to the combination of treatments that worked before, particularly when doses have been at the upper end of safe ranges.
• Loss of interest in the things that used to define the cat: a favourite person, a favourite spot, food, gentle play, looking out of the window.
• More bad days than good days, when measured over a fortnight rather than a single hard week.
• New problems stacking on top of long-managed ones in a way that makes any further intervention feel like prolonging discomfort rather than restoring it.
• A clear sense, often felt before it can be articulated, that the cat is enduring their days rather than enjoying them.

If you are at that point, or worried you might be, the question to take to your vet is not whether you have done enough. You almost certainly have. The question is whether comfort is still achievable, and if not, what comes next.

Our Quality of Life Assessment is a structured way to put the question to yourself in the quiet before a conversation with the vet. It does not give you an answer. It helps you see what you are already seeing.

A short note on home euthanasia

If end-of-life care does become the conversation, home euthanasia is one of the options worth knowing about. For most cats, the carrier and the car are themselves a source of significant stress. A peaceful passing at home, on a familiar blanket, with the people they know, is often the kinder option for everyone in the room. Our home euthanasia service is set up around exactly this. If you want to talk it through, the line is open seven days a week.

There is no right way to do any of this. There is only the way that fits your cat and your family. The most important thing, almost always, is not to wait for an emergency to make the decision for you.

References worth reading

• Lascelles BDX et al. Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats, Veterinary Surgery, 2010.
• Slingerland LI et al. Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats, Veterinary Journal, 2011.
• Bellows J et al. Common physical and functional changes associated with aging in dogs and cats, JAVMA, 2015.
• ISFM Consensus Guidelines on the Long-Term Use of NSAIDs in Cats, Journal of Feline Medicine and Surgery, 2010 (updated 2024).
• Reid J et al. Validation of the Glasgow Feline Composite Measure Pain Scale, Veterinary Record, 2017.
• Evangelista MC et al. Facial expressions of pain in cats: the development and validation of a Feline Grimace Scale, Scientific Reports, 2019.