Figure 4.

(a) A cat with abdominal pain following ovariohysterectomy. The cat is depressed, immobile and silent. The patient has squinted eyes and is in a hunched-up position with head down. (b) A cat with abdominal pain secondary to constipation. The eyes are partially closed (‘feigned sleep’), the ears are pulled apart (ie, distance between the tips of the ears is increased when compared with a non-painful cat), and the muzzle is retracted backwards (whiskers are straight, not loose and curved). (c) Periodontal disease, such as gingivitis and periodontitis, causes pain, inflammation, dysphagia, chronic haemorrhage and weight loss. Painful cats with severe oral disease (eg, requiring multiple dental extractions) have decreased food intake, increased pain scores and present distinct behaviours such as reduced attention to surroundings and spending more time lying down, compared with pain-free cats with minimal periodontal disease. Following dental extractions, this cat scores 9/10 using the Feline Grimace Scale and requires the administration of opioids for pain relief. (d) A cat with abdominal pain can contract or extend its pelvic limbs and/or contracts its abdominal muscles (flank) spontaneously. These cats may be in dorsolateral recumbency with facial expressions of pain. (e) A tense and depressed cat in severe pain after sternotomy. This patient is sitting up due to intense discomfort, reluctant to move and not attentive to the surroundings. The cat received a score of 8/10 using the Feline Grimace Scale, indicating the need for analgesia. The cat remained uncomfortable and bothered by all bandages, catheters and nursing needs, despite infusions of opioids, ketamine and lidocaine, and the administration of NSAIDs and intercostal nerve blocks. This demonstrates that pain can be challenging to treat in some cases. The cat finally improved and analgesic infusions were tapered down before patient discharge. Images (a), (c), (d) and (e) courtesy of Paulo Steagall. Image (b) reproduced from Steagall and Monteiro (2019) ⁵