Cat in litterbox
If you’ve ever awoken to the soft pitter-patter of paws on your face, thrilled to the grace of a glorious sofa-to-loveseat leap or felt the telltale squish of a hairball beneath your bare feet, you’ll know that cats are special. So special, in fact, that they manage to bring their feline singularity to their expression of discomfort, too.

Yes, cats are every bit as likely to occult any signs of pain, illness or discomfort as they are to demonstrate feline uniqueness in the above- mentioned ways. They are oddballs, indeed.

Signs of injury like hiding, eating less and, when seriously afflicted, perhaps favoring a limb or failing to make their leaps as graciously as before, can be so subtle that most owners are liable to miss them.

Now, that’s not to say that cat owners are clueless. In most cases they’ll observe a difference in their pet’s behavior.

Nonetheless, they may misread the signs and fail to consider that what their pet is feeling is related to outright pain. Pain, some may assume, comes with yowling or growling, not with the more subtle changes I’ve described above.

Easy-to-Miss Sources of Pain

With those very human limitations in mind, here’s my list of the 10 most overlooked or misunderstood painful maladies in cats:

1. Cat bite abscesses. When a cat starts to limp, most owners tend to think about strains and sprains as a result of all that feline athleticism. What most cat owners don’t realize is that cats rarely injure themselves in this way. Cars, dogs, coyotes and other cats tend to be more common sources of serious injuries.

Of these, cat bites are the most typical among my younger, outdoor-venturing patients. Indeed, I’d venture to say that about 75 percent of my feline limpers are ultimately diagnosed as having received a cat bite. And a teensy-weensy bite wound is by far the most common finding — apart from the often too-subtle evidence of pain. Some owners may even notice a swollen area near the bite wound that can be warm to the touch or have some discharge.

These cases often call for the area to be clipped and cleaned so the abscess can be drained, if needed. Some cats may also need antibiotics and pain medications.

2. Ingrown toenails. In my experience, older indoor-only cats who limp visibly in one or more paws are more likely to suffer from an oft-overlooked issue: ingrown toenails. That’s because owners aren’t always aware that geriatric cats’ toenails tend to overgrow, sometimes curling painfully into their paw pads.

But really, it can happen to cats of any age if you don’t stay on top of nail trimming.

3. Urinary tract obstruction. This life-threatening condition is especially common in male cats. Affected pets can’t pee, their bladder fills up with urine and the pain becomes excruciating! Cats will often strain in the litterbox to no avail. Anything that makes a normally placid kitty screech when you touch their belly is a really big deal. This is considered a serious emergency.

Most cats will require anesthesia so the blockage can be relieved, as well as catheterization and hospitalization until the problem is resolved.

4. Feline idiopathic cystitis. On a related note, inflammation of the urinary bladder is considered highly painful.

Many cats demonstrate their discomfort by urinating frequently about the house (often straining to produce urine, which may have a bloody tinge to it). Unfortunately, plenty of cat owners assume their cats are merely “angry” at them and fail to do something about it. Most probably have no idea how painful this condition is. Otherwise, we’d see more patients within hours of showing these signs.

5. Pancreatitis. Hard to diagnose and considerably painful, inflammation of the pancreas is the bane of many a veterinarian’s work life. That’s because these kitties are usually displaying the most non-specific of signs, from a simple loss of appetite to transient (or short-lived( vomiting or diarrhea, rendering diagnosis difficult. What’s worse is that pancreatitis is often hard to treat, too!

6. Stomatitis. This condition is among the most painful I can think of. Although the condition is poorly understood, it has been associated with calicivirus, feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV). Stomatitis is characterized by severe inflammation of the oral tissues, especially those surrounding a cat’s molars.

Cats with this condition will often have bad breath, lose weight, fail to groom properly and sometimes even drool (among other signs). Opening their mouths will sometimes elicit a yowl of pain. Long-term treatment is typically required, including a thorough dental cleaning, often with extractions to help bring relief. Controlling pain and inflammation is the mainstay of treatment for many of these patients.

7. Feline resorptive lesions. Everyone knows that dental fractures (i.e., broken teeth) and periodontal disease can be painful, but many cats will suffer these painful lesions, too. Like deep cavities that occur at or below the gumline, these lesions are uncomfortable. Cats may not show obvious signs, but when the lesion is probed, they’ll react, often by "chattering" their jaws. Dental X-rays are especially important to evaluate the extent of the problem and, unfortunately, affected teeth usually require extraction.

8. Osteoarthritis. Yes, cats get this too. And it’s every bit as painful as it is for you or your dog! “Slowing down” is the most common sign, but cats may also stop jumping or grooming, have trouble getting into the litterbox and resent being petted, among other possibilities.

In addition to a physical exam, diagnosis may require X-rays or a short trial to see if signs subside when the cat is given a pain medication. For chubby cats, weight loss can go a long way toward reducing stress on arthritic joints. Providing soft, comfortable beds, litterboxes with lower sides and ramps to help cats get on the couch or bed without jumping can help, too.

9. Corneal ulceration. Ever seen your cat squint at you with one eye? If so, you can be pretty sure she wasn’t trying to be cute. More than likely she was experiencing some degree of ocular discomfort.

If she has a corneal lesion –– or a corneal ulcer in particular –– it can be very painful. That’s because the cornea, the clear outer layer of the eye, is loaded with nerves –– presumably so you’ll never ever risk hurting such a delicate and irreplaceable anatomical structure. Often, the cat also has discharge from the eye. These lesions need immediate veterinary attention, not just to relieve pain, but because they can progress quickly and may require surgical repair.

10. Saddle thrombus. I don’t believe there’s a feline disease more painful than this one. Indeed, none will send me running for the pain meds faster than a patient with a saddle thrombus.

When owners find their middle-aged to older cats unable to use their back legs, breathing strangely and sometimes vocalizing loudly, one possible explanation is a saddle thrombus. This condition occurs when a blood clot gets stuck at the base of the aorta, thereby interfering with circulation to the hind limbs and eliciting extreme pain. Compared to the front legs, the back limbs may often feel cooler to the touch, and the skin and nail beds may appear white or blue.

Pain management is the first priority for these cats, and those having trouble breathing may need oxygen therapy until a treatment plan is in place.

Though not all of the above ailments are specific to cats, I’m sure you’ll agree that their uniquely feline reactions are, at the very least, very much in keeping with their adorably feline natures — hairball hurl-ups and all.