Pain and pain management in cats: an ever-evolving field

If you have read any of the papers in this special collection and are reading this Editorial, then you are among those rarified veterinarians very aware that pain is the most ubiquitous experience of all sentient – and even non-sentient – beings. You accept that all animals will encounter pain and that pain is a complex, multidimensional experience beyond its mere perception, and that it also includes physiologic and emotional affective components; to borrow the words of Dr M Lesley Wiseman-Orr and others, ‘Pain is not just about how it feels, but how it makes you feel.’ ¹ And that in contradistinction to humans, whereby pain is what the patient says it is, you well understand that for other animals pain is what we say it is and thus a grave medical and ethical responsibility we undertake for our patients. And finally, you are aware that the only constant in the pain and pain management sphere of study is that it is an ever-evolving and rapidly progressing field.

This special collection brings together key research-, thought- and practice-leaders in the recognition, assessment, prevention and management of feline pain. The information you find here will be immediately applicable in any clinical setting and have implications long into the future.

Several articles reflect the expansion of knowledge in familiar territory, while others explore new ground. Several are narrative reviews summarizing current best understandings and practices.

Two studies in the collection specifically look at the use of liposome-encapsulated bupivacaine in cats – in limb amputation (Shrock et al ² ) and gastrointestinal (GI) surgery (Andrews et al ³ ). Additional light is shed on the seemingly constantly vexing question of the highest, wisest use of non-steroidal anti-inflammatory drugs (NSAIDs) in cats, with one study investigating the use of robenacoxib in feline GI surgery (Rogers et al ⁴ ) and the ‘2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats’ (Taylor et al ⁵ ) supporting veterinarians in the decision-making around NSAIDs in managing chronic pain and how to minimize adverse effects and optimize pain management. Cats and cannabinoids are reviewed by Niño Cital et al, ⁶ while Mulder et al ⁷ look at the safety and efficacy of a cannabidiol/cannabidiolic acid-rich hemp paste in cats with osteoarthritic pain.

Ovariohysterectomy is the specific focus of four studies: Goich and colleagues ⁸ compare opioid options, Pisack and colleagues ⁹ compare NSAID options, Martins and colleagues ¹⁰ explore a non-pharmacologic component of postoperative pain, comparing the midline vs flank laparotomy approaches, while Alegre and colleagues ¹¹ look at the efficacy of combined grapiprant and tapentadol in cats undergoing elective ovariohysterectomy. Meanwhile, osteoarthritis is discussed in two articles: Lefort-Holguin et al ¹² review what we know and do not yet know, and Gober ¹³ assesses the recognition of osteoarthritic pain in cats using a validated feline checklist.

Pain recognition and assessment is rightfully the focus of a further six articles in the collection: specifically the Feline Grimace Scale (Robinson and Steagall ¹⁴ , Cheng et al, ¹⁵ Marangoni et al ¹⁶ ), a video collection of acute-pain related behaviors in cats (Marangoni and Steagall ¹⁷ ), owner perceptions of their cats’ pain as it pertains to veterinarian decision-making (Kogan et al ¹⁸ ) and assessment by veterinarians following elective sterilization procedures (Basra et al ¹⁹ ).

Three International Cat Care Veterinary Society/Feline Veterinary Medical Association-commissioned Clinical Spotlight reviews are included in the collection: Professor Clare Rusbridge ²⁰ continues her industry-transforming expositions on neuropathic pain in cats, and Mary Ellen Goldberg’s^21,22 two review articles look at common conditions for physical rehabilitation in cats and treatment therapies and exercises that can be used to manage pain in cats.

The collection also includes the expansive ‘2022 ISFM consensus guidelines on the management of acute pain in cats’ by Steagall et al. ²³ And finally, Monteiro et al ²⁴ look at the importance of a team approach when managing cats with chronic pain.

I would like to extend my most profound thanks to each of the authors for their energy, expertise, time and passion in producing their contributions to this important special collection. And I would like to convey on behalf of all veterinarians and cats everywhere for all time, our collective and immense gratitude to International Cat Care Veterinary Society and the Feline Veterinary Medical Association and their leadership, as well as the editorial team, without whom this special collection would not have been even conceived, much less completed with such devotion and excellence: Kelly St Denis, Andy Sparkes, Abi Strickland, Hannah Godwin and Emma Longmore. We are all better for having this collection in our ever-eager claws.

With deepest appreciation,

Mark E Epstein DVM, Dipl ABVP (C/F), Founding Fellow Companion Animal Pain Management, CVPP TotalBond Veterinary Hospitals, USA