How to Tell If Your Cat Is in Pain — and When Their Quality of Life Is Slipping

Your cat can't tell you when something hurts, and cats are very good at not showing it. A cat in treatable pain can still jump onto the sofa, finish their bowl and curl up like nothing's wrong. So the hardest part of loving an aging or unwell cat isn't the big, obvious crisis. It's the quiet, gradual slide that is almost impossible to see from the inside.

This guide covers the signs of pain that veterinary guidelines list, what the two end-of-life quality of life scales behind our calculator measure and where they stop, and how to track the trend at home. None of this replaces your vet. It helps you walk in with something better than a gut feeling.

How can you tell if your cat is in pain?

Look for changes in what your cat does, compared with what is normal for them. For acute pain, WSAVA's guidelines list a change in posture or body position, reduced activity and play, less interest in the surroundings, less willingness to interact, reduced appetite, an abnormal gait or shifting weight, hiding, hissing or growling from fear, attention to one body part, protective behavior, and stopping grooming or over-grooming one spot.⁴

Chronic pain, such as arthritis, tends to look slower and more gradual. WSAVA's checklist for chronic pain in cats covers general mobility, activities (play, hunting, jumping and litter-box use), eating and drinking, grooming, rest and relaxation, social interaction with people and other pets, and temperament.⁴ WSAVA adds that these changes can build gradually and be quite subtle, which makes them easiest to spot for someone who knows the cat well, often the owner.⁴

None of these is proof on its own. Two or three together, or a familiar habit quietly disappearing, is worth raising with your vet. WSAVA also notes that a cat resting calmly may not be comfortable: cats in pain can stay very still, and some appear to sleep when they are not resting. A comfortably sleeping cat is usually in a relaxed or normally curled position.⁴ VCA adds that cats will become very still if breathing is a problem.¹

WSAVA notes that arthritis in cats can be regarded as an age-related condition.⁴ That is part of why it goes unnoticed: owners expect a limp and get a cat who "sleeps more" and "isn't as playful." For how to catch and monitor that specific pattern, see our guide on spotting and tracking arthritis in dogs and cats.

Do cats hide their pain?

For cats, the main sources agree. VCA says cats hide their pain extremely well and are already very adept at disguising illness, so the signs of chronic conditions can be quite subtle even for owners who are tuned in to their cat's routine.¹ WSAVA says cats, as both predator and prey, are particularly good at concealing pain by reducing the behavioral signs, and that they don't generally move or engage with clinic staff the way other animals do, which makes pain harder to assess in an exam room.⁴

One Lap of Love hospice veterinarian argues that dogs and cats, as carnivores, don't "hide" pain the way prey animals such as rabbits must.³ The wording is debated. The practical point isn't: a cat who isn't crying out can still be in pain, which is why home observation matters.

What quietly signals that a cat's quality of life is slipping?

Quality of life isn't a single thing. It's the balance of several. Dr. Alice Villalobos, a veterinary oncologist, developed the HHHHHMM scale to help owners and veterinarians assess it, and VCA publishes a cat version with seven categories scored from 1 to 10, with 10 the best.¹ Villalobos herself noted in 2011 that there were no clinical studies of end-of-life quality of life assessment in pets, which is why a score belongs in a conversation with your vet and not in place of one.⁷ Reframed as everyday questions, the categories are:

• Hurt. Is pain controlled, and can your cat breathe easily? VCA calls adequate pain control, including the ability to breathe properly, an absolute necessity.¹
• Hunger. Is your cat eating willingly? VCA says to try hand-feeding first; if that doesn't work, a feeding tube may be an option to discuss with your vet.¹
• Hydration. Is your cat drinking enough? VCA notes that fluid given under the skin is generally an easy, well-tolerated way to supplement what an ailing cat drinks.¹
• Hygiene. Can your cat be brushed, combed and kept clean, and is the coat matted? VCA says cats are very sensitive about keeping themselves clean, and with an oral tumor or back pain they may not be able to groom and may need help.¹
• Happiness. Is your cat still interacting with family and their surroundings? VCA notes that cats communicate with their eyes as well as by purring.¹
• Mobility. Can they get around on their own? VCA says it may be time to consider a mobility device if not, and that cats are surprisingly accepting of wheeled carts when pain is well managed.¹
• More good days than bad. VCA says quality of life is compromised when there are too many bad days in a row, or when the cat seems "turned off" to life. Bad days may mean nausea, vomiting, diarrhea, seizures, frustration, pain or discomfort, or an inability to breathe.¹

Read together, these turn a vague worry into something specific. A cat can score well on mobility but poorly on appetite, or the reverse — and knowing which category is slipping tells you what to raise with your vet, who can often improve it. If your cat is also a senior, our senior pet care checklist pairs well with this as a daily routine.

HHHHHMM category	The question to ask at home	What VCA lists when it is slipping
Hurt	Is pain controlled and is breathing easy?	Pain not controlled; becoming very still because breathing is a problem
Hunger	Is your cat eating willingly?	Can't eat properly or willingly; needs hand-feeding
Hydration	Is your cat drinking enough?	Needs extra fluid, such as fluid under the skin from your vet
Hygiene	Can they be kept clean?	Matted coat; can't groom and needs help
Happiness	Do they still interact with family and surroundings?	Little interaction; seems "turned off" to life
Mobility	Can they get around on their own?	Can't move around on their own; may need a mobility device
More good days than bad	Are there too many bad days in a row?	Nausea, vomiting, diarrhea, seizures, frustration, pain or discomfort

Cats also have a validated pain tool of their own, for sudden pain: the Feline Grimace Scale. Researchers at the Université de Montréal recorded 35 client-owned cats with naturally occurring acute pain and 20 control cats, and identified five facial action units: ear position, orbital tightening, muzzle tension, whisker position and head position.⁶ Their definitions of the action units describe ear tips pulled apart and rotated outward, narrowed or squinted eyes, a flattened and stretched muzzle, whiskers moved forward as if on end, and the head held below the shoulder line.⁶ The study tested acute pain, so treat it as a lens for a sudden change, not for a slow decline. Like any single reading, one grimace check is still a snapshot.

Why one bad day isn't the answer — track the trend

Here's the trap: changes in cats can be gradual and subtle, and a cat can have a rough morning and a bright evening. You can catch them on their worst hour or their best. Judged one day at a time, decline hides in the noise. That's why the most important word in this whole subject is trend.

Score the same categories on a set schedule. Lap of Love suggests having several family members use its tools daily or weekly.³ A total that drifts from 48 to 44 to 39 over three weeks, say, tells you a story you'd never notice day to day. The point isn't the individual score. It's the direction of travel, caught early enough to do something about it with your vet.

Doing this on paper works, but it's easy to let slip. Logging comfort, appetite, and mobility in one place — where the whole household can add what they see and the trend draws itself — makes a slow slide visible instead of invisible.

How do vets actually measure a cat's quality of life?

Vets use several kinds of tool, and they answer different questions. For arthritis pain in cats, WSAVA's guidelines list several owner-completed questionnaires. The most widely studied is the Feline Musculoskeletal Pain Index, whose short form has nine items about mobility and daily activities, each rated from "normal" to "not at all."⁴ AAHA's 2022 guidelines likewise say capturing the owner's evaluation is particularly important for chronic pain.⁵

HHHHHMM and JOURNEYS do a different job: they help families talk through end-of-life decisions. VCA says Villalobos designed HHHHHMM to measure the success of a palliative or hospice plan for a cat with a life-limiting disease.¹ Neither scale appears in WSAVA's lists of instruments for cats.⁴ The one validation study of HHHHHMM we found in PubMed, of 314 guardians of pets in Italy, reported that the model's fit was "partially adequate."⁸ That doesn't make the scales useless. It means a score is something to discuss with your vet, not a result.

The second scale, JOURNEYS, was written in 2013 by Dr. Katie Hilst, a veterinarian who provides in-home euthanasia.² It scores eight areas out of 10 each, for a total out of 80: Jumping or mobility, Ouch or pain, Uncertainty and understanding, Respiration, Neatness or hygiene, Eating and drinking, You, and Social ability. The "You" area asks whether you feel overwhelmed, or unable to meet your pet's needs physically, emotionally or financially, and whether there is tension in the family. For cats, the author notes that a nauseous cat may hang out at the water bowl or with their head hanging over it.²

JOURNEYS says there are no hard and fast rules, although a higher score is better. It describes 80 as a happy, healthy pet and 8 as a pet that is suffering, and says a low score on any single measure may be a reason to consider euthanasia and to talk with your veterinarian.² Our cat quality of life calculator is built on both scales, so you can pick whichever fits your situation — or run both and compare.

When is it time to talk to your veterinarian?

No score decides this, and no article should. But some signs shouldn't wait. JOURNEYS says severe episodes of difficulty breathing, coughing or open-mouth breathing call for immediate medical attention.² Merck says a urinary blockage in a male cat is a medical emergency needing immediate veterinary attention, with signs including repeated unsuccessful attempts to urinate, crying out in the litter box, lethargy, loss of appetite and reluctance to move.⁹ Straining or distress while urinating, blood in the urine, or urinating outside the box also warrants a call.⁹

A cat who stops eating needs a call too. Merck notes that anorexia or food deprivation can set the stage for hepatic lipidosis, a potentially lethal liver disease, in overweight cats, and that the outlook is best when cats are seen early.¹⁰ Beyond emergencies, take VCA's warning sign seriously: too many bad days in a row, or a cat who seems "turned off" to life.¹

Having that conversation early isn't giving up. VCA says many medical problems owners assume can't be managed can be, with a vet's help and supportive care, sometimes at minimal expense, and it urges owners to involve their vet and the vet's support staff early.¹ Its list of supportive options for cats includes oral or injectable pain medication, hand-feeding or a feeding tube, fluid under the skin, and mobility aids such as carts.¹ Lap of Love, a veterinary hospice service, describes the right moment for euthanasia as a subjective window of hours, days, weeks or months rather than one point, and reminds owners that they know their pet better than anyone, including their vet.³

Walking in with a few weeks of scores turns a painful, abstract decision into a grounded, shared one. If your cat has a chronic condition like kidney disease, our guide on what to log for a cat with chronic kidney disease shows exactly what to track, and our vet visit preparation checklist covers what to bring.

Important medical disclaimer: SteadyTails is a logging and coordination tool. This guide is for general reference and does not provide veterinary advice, diagnosis, or treatment. Quality-of-life scales support your decisions — they don't make them. Always talk with your veterinarian, who can weigh any score against your cat's specific diagnosis and comfort options.