Is My Cat Scowling at Me or Are They in Pain?

Cat facial expressions may be subtle and hard to spot by the untrained eye. But armed with a little information, you can use your cat’s ears, eyes, muzzle, whiskers, and head position to better understand when your cat might be experiencing pain (and to what degree).  

Because cats are masters at hiding their pain, we need to look beyond obvious indicators when trying to figure out what and how they're feeling. We don't want our feline companions to suffer. And considering the arsenal of pain management tools available, they don't have to. 

Decoding and Scoring Facial Expressions of Cat Pain

There are many indicators of how your cat is feeling if you know what to look for. Pain may be reflected in some physical changes, like difficulty jumping up onto or down from higher surfaces, decreased appetite, and trouble chasing moving objects. There may also be behavioral changes, like a decrease in activity level, less interaction with family members, and becoming more irritable or withdrawn. But cat facial expressions can also be valuable clues in assessing your cat’s pain level in acute states when they are experiencing medical, surgical or oral pain. In fact, veterinary professionals are learning how to add this assessment into their diagnosis and treatment protocols. 

In 2019, a study was conducted by researchers at the University of Montreal to develop a Feline Grimace Scale^[1]. Cats with naturally-occurring pain were closely observed, and by evaluating the cat’s ear position, amount the eyes were closed, muzzle tension, whisker direction or change, and head position — all defined as “action units” — a total score can be calculated. This tool, along with other indicators of pain, can be used to quickly and easily assess the level of pain your cat may be experiencing. 

Using the Feline Grimace Scale is generally simple and straightforward, and something you might be able to learn yourself. But remember, your veterinarian is the expert and will work with you decode your cat’s facial expressions and other pain indicators. No one action item, physical expression, or behavior alone is an indicator of pain. Your cat needs to be evaluated as a whole and in context to fully determine if your cat could be hurting. 

To use the Feline Grimace Scale, you will first need to download the simple training manual and follow the instructions. In it, you will see pictures and drawings of cats such as are shown below, and you then need to compare your cat’s face to those examples and rate each element of your cat’s facial expression from 0 to 2. It might help to take photos or video of your cat so that you can match their facial expressions against the examples. These can then be shared with your veterinarian to determine what the scores mean. This assessment may be an indicator of pain, but these changes may be also be due to something other than pain. You should consult with your veterinarian to see if the assessment is needed.

Here’s how you would score your cat’s possible pain level:

• 0 = Action unit is absent. In other words, you don’t see any change or signs of tension in the ears, eyes, muzzle, whiskers, or head position that would indicate pain.
• 1 = Moderate appearance of the action unit, or you’re not sure. If you see (or think you see) slight changes to the ear position, tightening of the eyes, straightening of the whiskers, or tension in the nose and mouth, your cat may be experiencing some pain, and a veterinarian should be consulted. 
• 2 = Obvious appearance of the action unit. You see significant changes to the position of the ears and head, and tension in the eyes, muzzle, and whiskers indicating your cat is in pain. You should make an appointment to see a veterinarian right away.

If the final total score is 4 or greater, your veterinarian may recommend further diagnostic testing and/or pain management.