Chronic Pain of Declawing

June 6, 2012
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Declawing is an extremely painful procedure. According to the American Association of Feline Practitioners (AAFP), “Physically, regardless of the method used, onychectomy causes a higher level of pain than spays and neuters. Patients may experience both adaptive and maladaptive pain; in addition to inflammatory pain, there is the potential to develop long-term neuropathic or central pain if the pain is inadequately managed during the perioperative and healing periods.”  (Emphasis added; please note that veterinarians who claim that using a laser decreases pain are just plain wrong.) You will see in this article that “adequate” pain management is very rarely achieved, meaning that nearly all declawed cats are at risk of developing chronic pain.

Scientific research shows that veterinarians are extremely variable in their pain management protocols. A survey published in 2000(1) found that 30% percent of veterinarians used no pain meds at all; of the others, 70% used primarily or only butorphanol–a drug since proven to be largely ineffective in cats. (I recently spoke with the lead author of this study; she believes that the situation has improved in the last decade as vets have become more aware of, and more willing to treat, pain in animals; but there are no data to prove it.) Of those few veterinarians that do provide adequate pain meds, they’re usually given only for 3 days, despite a study(2) finding  that cats remained painful for at least 12 days (the end of the study period.)

Signs of pain in a declawed cat: holding up paw, positioning toes over edge, squinting, whiskers pulled back

Cats hide pain extremely well; in fact, their reputation for stoicism is legend. I believe that virtually all declawed cats experience pain in one or more toes, some or all of the time. Evidence for this is the fact that 100% of human amputees experience phantom sensations (40% of them painful) for the rest of their lives, no matter how or when the amputation occurred–even as an infant, even with perfect surgical technique, and even with abundant post-op pain meds. (There’s an interesting clip from The Doctors TV show that mentions this in reference to human toe amputations.)

Despite their stoicism, some cats may eventually show overt signs of declaw pain, including:

  • Lameness (note that if both paws hurt, the cat will not limp)
  • Holding up one paw or shifting weight from side to side
  • Grimacing (squinted eyes, whiskers pulled back close to the head)
  • Shifting weight backward away from the toes
  • Dropped carpus (hyperflexion of the wrist resulting from weight shift)
  • Sitting so that the toes overhang the edge of the seat
  • Walking gingerly, as if on nails or glass
  • Reluctance to have feet handled
  • Decreased activity
  • Decreased appetite
  • Increased aggression

The most stunning aspect of these signs is that they may not be noticed for days, months, or even years after declawing surgery. Dr. James S. Gaynor, a pain management specialist (and one of my favorite professors in vet school!), says:

“Feline patients who have had onychectomy (declaw) may experience chronic pain. Owners of such cats usually report one of several concerns, the most common of which is fear that the cat is still in pain, especially in the fore paws, because it seems to walk very lightly on those feet, as if walking on nails or glass. Another common concern is behavioral changes, which may include decreased activity, decreased appetite, or increased aggression. The inciting cause for these presentations within days to months to years is usually the lack of adequate acute pain control in the immediate postoperative period.While owners may not bring their cats in for the problem early, it becomes apparent from the history that the pain, which the cat is manifesting as some problem, began sometime soon after the declaw procedure.”(3)

Dr. Gaynor believes that this type of chronic pain is due to a phenomenon called “wind-up” (as in “wind-up toy”). This is an increase in pain intensity over time that, in the case of declawing, can develop during a surgical procedure, or in the days to weeks afterward. Ordinary painkillers have little or no effect on wind-up pain. Dr. Gaynor states, “Treatment for this type of declaw pain involves simultaneously treating the wind-up phenomenon and providing analgesia. Treatment of wind-up basically involves resetting the receptors so that the spinal cord can process nociceptive [painful] input in an appropriate manner, allowing analgesics [painkillers] to work more effectively.”

This TED Talk discusses the phenomenon of allodynia, or “wind-up pain.”

Prevention of wind-up pain is obviously preferable to treating it. Dr. Gaynor recommends what he calls an “aggressive” multi-modal pain management formula for declaw surgery. It is unlikely that many vets actually do this much. This information is provided in case you want to ask the veterinarian who did the declaw (or any vet who continues to declaw) if this is the protocol used in their clinic:

  • Premedicate with medetomidine 20 μg/kg (or other alpha-2-agonist for sedation and analgesia) PLUS hydromorphone 0.1 mg/kg (or some other effective opioid in cats, such as buprenorphine) PLUS  atropine 0.02–0.04 mg/kg (or glycopyrrolate 0.01 mg/kg). Combine in one syringe and administer SC.
  • Induce anesthesia with diazepam/ketamine, propofol, or thiopental IV.
  • Perform a declaw nerve block with lidocaine 1.5 mg/kg combined with bupivacaine 1.5 mg/kg as a total dose
  • Give meloxicam 0.2 mg/kg SC during recovery from declaw, followed by 0.05 mg/kg PO daily for 4 days; then 0.05 mg/2 kg PO daily for 4 days.
  • Give buprenorphine 0.02 mg/kg SC 4 hours after hydromorphone administration; then 0.01 to 0.02 mg/kg buccally Q 12 H for 2 days.

Yet even this comprehensive protocol misses the boat by only giving post-op pain relief for eight days (though it’s much better than what most vets do). Pain relief should be provided for at least two weeks post-op, and even that might not be enough for some cats.

Dr. Gaynor has also developed a medical protocol for relieving this type of chronic pain. Feel free to give this information to your veterinarian if you think your cat may be experiencing chronic pain from declawing:

Veterinary Protocol for Alleviating Chronic Declaw Pain

  • Confirm pain is from paw.
  • Radiograph paw to rule out bone fragments.
  • Give amantadine 3 mg/kg PO daily for 21 days.
  • Give buprenorphine 0.01–0.02 mg/kg buccally Q 12 H for 2–3 days.
  • Give meloxicam 0.05 mg/kg PO daily for 4 days; then 0.05 mg/2 kg PO daily for 4 days; then 0.05 mg/cat PO daily for 4 days; then 0.05 mg/cat every other day for 5 days. [Note: The units for meloxicam administration are based on 0.05 mg, which is approximately 1 drop of meloxicam from the bottle, thus making dosing easy.

It’s great that there is a way to diminish the pain that declawed cats experience. However, no pain protocol can replace the amputated bones or undo the damage to severed tissues. Nevertheless, there are things we can do to help declawed cats: see Relief for Declawed Cats).


(1) Wagner AE, Hellyer PW. Survey of anesthesia techniques and concerns in private veterinary practice. J Am Vet Med Assoc. 2000 Dec 1;217(11):1652-1657.

(2) Romans CW, Gordon WJ, Robinson DA, et al. Effect of postoperative analgesic protocol on limb function following onychectomy in cats. J Am Vet Med Assoc. 2005 Jul 1;227(1):89-93. Comment by Hornstein SE, et al. in J Am Vet Med Assoc. 2005 Sep 1;227(5):707.

(3)  Gaynor JS. Chronic pain syndrome of feline onychectomy. NAVC Clinician’s Brief. April 2005.


 

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