We’ve come a long way in our understanding of pain, and that’s true in veterinary medicine as well as human medicine. We know that chronic pain can suppress the immune system, making animals more susceptible to viruses and bacteria they otherwise might have no problem fighting. And, of course, pain just plain hurts, reducing the quality of life dramatically. While we veterinarians have advanced alongside our physician colleagues when it comes to managing pain, many pet owners have not. That’s not because they don’t care, but because they don’t know enough to recognize the problem and get help. The problem is especially disturbing in cats, and that’s what had me turning to my colleague and longtime friend Dr. Robin Downing for her expert read on the subject. Dr. Downing is an internationally recognized expert on the subject of pain and how to treat it; her work at the Downing Center for Animal Pain Management in Windsor, Colo., is both compassionate and ground-breaking, and her advocacy for those who can’t speak for themselves is passionate.

“There was a study at Texas A&M that looked at cats who presented for other things — none were brought in for pain,” Dr. Downing says. “And they found that 90 percent of cats over the age of 10 had X-ray evidence of painful arthritis. They were in pain, and their owners didn’t know. We now know that the statistics for cat arthritis are the same as for dogs — 20 percent across all age categories. That means one in five cats has osteoarthritis, and one in five cats is in pain, and owners aren’t aware of it.”

Is Your Cat in Pain?

The signs of chronic pain in cats are easy to overlook, Dr. Downing says. There are a couple of reasons for that, including cats’ instinctive attempts to hide outward signs of pain. In the wild, animals who appear vulnerable are exactly that: To predators on the prowl, unusual behaviors such as those that come with injury or pain are like a sign saying “Eat Here” with an arrow pointing to the unfortunate animal.

We’re nowhere near as observant as these predators, which is why when a cat finally starts showing signs of distress, we might not notice them or, more likely, may misread them. Cats prefer their routines and stick to their habits as much as they possibly can, especially when they’re in pain.

“It’s important for people to understand that cats are motivated to behave how they always behave,” Dr. Downing says. “That makes it easy for us as cat owners to miss pain in its early stages, when cats are doing their level best to compensate. They like routine, and they want to maintain their routine. That makes it harder for us to identify that moment of ‘Hey, wait a minute, there’s something that’s not quite right’ until a problem is a little more advanced.”

But Dr. Downing says that when you know what you’re looking for, it’s much easier to see.

“Signs of chronic pain in cats are almost exclusively behavioral in nature,” she says. “We can tell if they’re uncomfortable by monitoring their behavior.”

For example, she says, a cat who’s no longer jumping up to favorite high perches may be avoiding activities that are painful. Changes in appearance can also be pain-related if a cat is not grooming herself properly because it hurts. Changes in litterbox habits are also worth noting. A cat may have problems getting into or out of a box with high sides or may have a problem getting to a box that’s on another floor.

Changes in personality can be another sign of chronic pain. “It’s like they put on their crabby pants,” Dr. Downing says. “These are cats that are often painful, and they’re crabby because they’re uncomfortable.” Keep an eye out as well for the friendly cat who now hides from interactions, the snuggly cat who is now aloof — or even the aloof cat who is now snuggly.

How You Can Help

Dr. Downing and I agree that weight reduction is a priority for any overweight cat in chronic pain. Carrying excess weight puts pressure on already painful joints, and Dr. Downing says what researchers know now about fat makes getting a cat to a normal body weight even more imperative.

“Now we know that fat is a very biologically active tissue,” she says. “It secretes inflammatory hormones that contribute to the overall pain experience.” Concurrent with weight management — and your veterinarian can help with that — Dr. Downing recommends managing the cat’s environment to ease the strain of pain. And that starts by ending your cat’s days as a free-roaming pet.

“Don’t let these old cats just be outside on their own,” she says. “That sets them up for injury, and they’re going to try and get away if they get in trouble — you might lose them forever.”

Providing safe outdoor space like a catio is a good idea, Dr. Downing says, and she recommends creating an equally feline-friendly environment inside. She also recommends keeping one room of your home warmer than the rest, perhaps fashioning it as a feline hangout with access through a cat door. If that’s not possible, pet-safe heated beds in favorite places are another option — along with a little help for the cat trying to get to those spots. That can be as simple as putting an ottoman in a place where a cat can use it to get to a higher perch more easily or buying small stairs sold to help pets onto furniture or beds. And make sure your cat doesn’t have to travel to the bathroom: Put a litterbox on every level of your home.

Work With Your Veterinarian

One thing you can’t do? Give your pet pain medications. Over-the-counter medications can be deadly for cats, which is why you need to work with your veterinarian to get your pet on supplements that might help, as well as prescription pain medication that’s safe for most cats when used as directed.

No animal needs to suffer with chronic pain. Identifying it is the first step, and once that’s done, your veterinarian can help manage your cat’s condition. Your cat needs your help, and I know once you can see how much your pet is suffering, you’ll be making her life a lot easier.