Cats are spectacular at hiding pain. In the wild, a cat showing weakness is a cat that becomes prey, so even severe pain often presents as "a little off." By the time most parents notice obvious limping or crying, the underlying issue has usually been going on for weeks.
Here's what vets and feline behaviorists look for.
The behavioral changes
Pain in cats almost always shows up as a behavioral shift before it shows as visible injury.
Changes in routine
- Not greeting you at the door anymore
- Sleeping in new, hidden places (under beds, in closets)
- Less interested in favorite toys or treats
- Withdrawing from people they used to seek out
- Waking up less for meals
Changes in grooming
- Over-grooming a specific spot, a front leg, the belly, or a flank, is a classic sign of localized pain
- Under-grooming, a once-sleek coat becoming dull, matted, or dandruffy often points to mouth, back, or joint pain that makes grooming hurt
Changes at the litter box
- Hesitation before jumping in or out
- Going right next to the box but not in it
- Urinating or defecating in unusual spots
- Straining, small frequent attempts, this is an emergency in male cats
Changes with food
- Walking up to food, sniffing, and walking away
- Eating only from one side of the mouth (dental pain)
- Dropping kibble while chewing
- Only eating wet food suddenly (hard to chew dry)
The body-language cues
Pain vocalizations in cats are uncommon and usually late-stage. Look for the silent signals instead.
The "pain face"
Veterinary researchers have developed the Feline Grimace Scale, five subtle facial cues that together indicate pain:
- Ears flattened or rotated outward
- Eyes squinting or partially closed
- Muzzle tension (tight, pulled down)
- Whiskers pulled forward or straight
- Head held low, below shoulder line
Any two of these together in a cat who's supposed to be resting comfortably is worth a vet call.
Posture
- Hunched over with elbows tucked in (classic belly pain)
- Reluctance to jump to favorite perches
- Landing short of jumps they used to clear easily
- Stiff walking, especially after sleeping
- Tail held tight against the body instead of upright
Reactions to touch
- Flinching when you pet a specific area
- Suddenly not wanting to be picked up
- Biting or swatting when an area is touched, especially if they never did before
The senior cat trap
The #1 cause of missed pain in cats is attributing it to age. "He's slowing down, he's just old", in a 12-year-old cat, is usually arthritis, dental disease, or kidney pain, not just aging. All three are treatable.
Some numbers: studies using X-rays have found over 90% of cats over age 12 have osteoarthritis. Most of them have never been diagnosed.
What to do
- Document what you're seeing. A short phone video of how your cat walks, jumps, or eats is worth a thousand words at the vet.
- Note the timeline. When did it start? Is it getting worse? Worse at certain times of day?
- Don't give human painkillers. Ibuprofen, acetaminophen, and aspirin are all toxic to cats. Acetaminophen can kill a cat with a single adult dose.
- Call your vet. Feline pain management has improved enormously in the last decade. Safe options exist.
The cats I've met who were "just old and slow" and became bouncy again on proper pain management are a long list. If something feels off, trust the gut feeling. You know your cat better than anyone.