In episode #134 of Tripawd Talk Radio, we chat with Carl Bradbrook, a UK veterinarian specializing in pain management and co-founder of the Zero Pain Philosophy, a resource about pain in pets connecting veterinary pain specialists with pet parents.
In this episode, he explains why amputation pain in cats is so complex and how it’s often misunderstood.
Pain after amputation can look very different in cats
For felines, pain is often harder to recognize and manage than many pet parents expect.
As a veterinary anaesthesia and pain management specialist, Carl shares how amputation pain develops, why nerve pain and inflammation play such a big role, and how pain can begin even before surgery takes place.
What You Will Learn in This Tripawd Talk Episode
Tripawd cat parents will learn to ask better questions, recognize red flags sooner, and feel more confident advocating for their cat during recovery. We review topics like:
Amputation pain in cats often starts before surgery. It can involve both inflammation and nerve pain. This is why early and ongoing pain control matters.
Cats hide discomfort well. Changes in behavior, posture, appetite, and facial expression are often the best clues that pain is not well managed.
Pain management does not end when stitches come out. Many cats need continued support well beyond the first two weeks to heal comfortably.
Tripawd Talk #134: Cat Amputation Recovery and the Zero Pain Philosophy
Get up to speed on amputee cat pain management concerns like:
- pre-surgical pain control
- hospital pain management
- medications commonly used before and after surgery
- signs that pain is not well controlled at home
- and what phantom pain can look like in feline amputees.
You will also learn why healing takes longer than many people realize, and why pain management often needs to continue well beyond the first couple of weeks.
Tune in above, watch the video on YouTube below, or dive into the weeds with the full transcript that follows
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About Carl Bradbrook, BVSc CertVA DipECVAA FRCVS
Carl is a Diplomate of the European College of Veterinary Anaesthesia and Analgesia and is a co-founder of The Zero Pain Philosophy.
He worked for many years as an anaesthesia consultant, upskilling multiple vet practices on advanced treatments in anaesthesia and pain management.
Carl now works at Anderson Moores Veterinary Specialists in the UK as Clinical Director. He was President of the Association of Veterinary Anaesthetists from 2018-2022. His is a recipient of the Fellowship of the Royal College of Veterinary Surgeons Award for Meritorious Contribution to Clinical Practice.
Resources to Learn More
What is the Zero Pain Philosophy?
Tripawd Cat Pain Management Tools
TRANSCRIPT: Tripawd Talk #134 Cat Amputation Recovery and the Zero Pain Philosophy
TRIPAWDS: Carl, it is so nice to have you here today. Thank you for joining us. I can’t wait to talk to you.
BRADBROOK: Pleasure. No, thank you very much. Thanks for the invitation. I am really excited to talk about loads of stuff related to pain management and the work you guys are doing as well.
TRIPAWDS: You help pets with pain management in the veterinary world.
BRADBROOK: Perfect, thank you. I’ve been an anaesthetics and pain management specialist for about 12 years now. I graduated as a vet back in 2002, so we don’t deal with any other species on a regular basis.
As part of our work, then, we’re dealing with, obviously, the surgical, acute, traumatic-type pain, but a lot of those pets will present where they’ve got more chronic pain, for example, so we’ll be helping to manage that.
And as a part of that, we have a pain clinic for owners that want to bring their pets for more management of their chronic pain conditions as well. So, that’s really my day focus.
the work that I’m involved with is the team in the clinic. We’ve got a team of four specialists that work in the hospital. As a bit of interest, the pain stuff was really exciting. It is ever evolving.
There is so much information out there that we really, us, and myself, and Matt, we recognize that from a training point of view for, like a lot of things, COVID changed the way that we were practicing and working.
We had a bit more time on our hands, and we weren’t doing other stuff. That allowed us to expand the online presence that we have in a more accessible way, webinars, the pain updates, knowledge summaries.
Why Pain Management in Cats Is So Challenging
TRIPAWDS: Not only could we talk about amputation surgery pain in general, but also talk about cats, because felines get the short end of the stick when it comes to pain control. They deal with pain so much more stoically than dogs, and it’s so hard to tell when they’re hurting.
Pet parents are getting better at recognizing it, I think, because of the information that’s being provided, like the feline pain scale, and the Grimace Scale is another one. We have a link to that in our blog. I’ll share in this podcast.
BRADBROOK: For me, I think the focus is thinking that it’s not just what we’re doing from a surgical point of view, but these cats and other animals that will present with more chronic and long-standing pain.
Usually by the time we’ve reached the point of amputation, and in a lot of cases, not in traumatic injury, for example, the cat will have experienced pain for quite an extended period of time.
So, you’re reaching the point of making the decision for amputation, which you shared. It’s not always a straightforward or easy decision, and you touched on that there’s nerves involved, and that also means that those nerves, at some point, have got to be cut as part of the procedure.
And if we haven’t quite got on top of the pain management at that point, it’s very likely that those nerves are going to be sending signals as they are cut.
For example, that might have an impact on how that animal, that pet, that cat, experiences pain in the post-operative or post-surgical period.
But if you can imagine that if I’ve got a chronic injury, and then a decision is made months or weeks later for me to have an amputation, in that preceding period the nerves in that area will be continuously firing.
And it’s that plasticity within the nervous system that makes these changes and what we would call the concept of chronic.
TRIPAWDS: Maybe they look like they’re getting around okay, hopping around. A lot of people join us and say, well, my dog or my cat is already on three legs, so they should be okay, but during that time they adapted to three legs.
They’re probably experiencing some kind of pain related to whatever injury or illness they’re dealing with.
You’re saying that in that time, whether it’s a year or three months, those nerves are getting angrier and angrier over time?
BRADBROOK: Yeah, I suppose that’s a good way to think about it. Nerves are there to send a signal, and it’s individualized in terms of how the pet, or the person would experience it.
No two pets and no two people will experience pain in the same way, because it’s that conscious perception of what that pain is for the individual. That’s really the key part.
And I suppose one of the exciting things for the future is going to be around more individualized management of lots of diseases, but pain is one of them, where from a genetic perspective, there’ll be a better way to manage the individual’s experience of pain.
But you’re right, suppose they’re being irritated, there’s been an injury, then those nerves start firing, and because those nerves keep on firing, the other parts of the nervous system will adapt in a way that then means that pain processing within the nervous system is no longer what we would say is normal.
That’s when we get something that we call maladaptive pain, so all that processing is different. It means different parts are firing, and all of that together means the pain experience for that cat, that pet, will be different even before we decide to go ahead with amputation, which I like to think about as a different kind of pain, during and around surgery, and that is so helpful to think about it that way.
TRIPAWDS: As pet parents, we don’t really deal with the during part, like during the surgery. I’m not going to tell my veterinarian what I think they should be doing for that part. We know there are standards involved.
Preparing Cats for Surgery and Pre-Surgery Pain Control
TRIPAWDS: When it comes to surgery, pain treatment, and anesthesia, of course, but generally we experience the pre- and post- with our pets.
In the pre-surgery part, how much time do you think is needed to get an animal into surgery so that when they come out, that pain is better controlled?
In a week, would we be able to give our animal better pain control so that the recovery is better? Is it a day? I often see nowadays veterinarians starting gabapentin and maybe another medication a day or two ahead of surgery. Is that at all helpful?
BRADBROOK: The answer is yes, it will be. I think whatever we can do will have an impact in a positive way.
We do have information, for example, you mentioned some of the products that are there. Gabapentin is one of the medications that might be used.
We do have information to support that these drugs do act quite rapidly, and they will start to reverse some of the changes that have already happened in quite a short space of time.
That doesn’t mean they are going to reverse all of the stuff that’s happened, but they will start to help, to make a difference. You’re right, it’s interesting that you mentioned that there are veterinarians out there that are starting to do some pre-treatment.
And that is definitely going to benefit from both an intra and a post-op perspective.
TRIPAWDS: That’s really good to know. It’s funny because we’re here to talk about non-human animals, but when it comes to humans, is our pain experience in a situation like this similar to our cats and our dogs?
BRADBROOK: I think the honest answer is yes. The nervous system, in terms of how things are processed, is very similar. In fact, it’s the same. We will always be learning from our medical colleagues in terms of what they’re doing and what they’re thinking about.
But things don’t always completely translate through into veterinary medicine, just from a species difference.
In terms of the actual makeup of the nervous system and how it functions, absolute similarities, it’s then whether the products are the same and whether we use them in the same way. Those are the nuances.
But what you mentioned before, which I think is the fascinating part and that’s why we see pain looking different, cat versus dog versus person.
For example, stuff out there now, particularly in people, where they’re looking at the way that a different person responds to pain differently to someone else could be genetic, but it could be just the whole of their life experience for that time point.
So, there’s some really interesting stuff that’s coming out.
TRIPAWDS: Yeah, and I think what I’m hearing you say is that we all express pain differently, the consequences of pain, physical and mental, but pain is universal.
This thinking has just come so far, because when I was a child, it was like, “Dogs don’t feel pain, cats don’t feel pain,” why would we? It’s so hopeful to see that in my lifetime, this has come such a long way.
BRADBROOK: What drugs we can use is really important. I think it’s important that I mention this, particularly if this is going out in other areas, in terms of regions of the country.
Gabapentin for Cats and How Cats Take Medication
TRIPAWDS: Gabapentin in the form that it’s given, is it more effective in, let’s say, a capsule, or a tablet, or a transdermal in the ear for cats? What do you see?
BRADBROOK: Good question. So, we don’t have any evidence to suggest that the route of administration is going to impact on that, so we are generally giving it a lot of the time.
It’s around trying to medicate the cats and the challenges that can be associated with doing so, and particularly as most cats are pretty good.
Once you’ve given something once and you think, “Oh, I’ve won here, because they’ll take it,” the next time you try and do it in the same food or the same treat, they’re like, “Well, I’m not going to eat that now, so why do you think I would?”
And I think that’s where we see the challenges with cats, really, is around actually palatability, which we don’t see as a problem with gabapentin, so we’re really lucky in the UK they make some formulations that are flavored with things that cats supposedly like, chicken, for example.
Those kinds of things help, and the size of the tablet is obviously important. They’ll eat everything else or lick everything else before they take it.
Those would be the main, ways that the most common of the licensed medications across multiple countries will be the anti-inflammatory drugs, the non-steroidal anti-inflammatory drugs and maybe stock every single one of these drugs.
And again, how we might want to give that to our cats, there are some that are liquids in, like, a syrup-based, and there are others that are tablet-based, for example, as well.
It will be very much how to give medications, and in my experience, the liquid, the syrup-based ones are much easier. If I find trying to medicate one of our cats, that would be my preference.
But you know it yourself, don’t you? You might get some swelling, you might get some heat associated with that. These drugs are really effective at reducing inflammation, and we know that inflammation causes pain. That’s part of what’s happening.
It’s that kind of continuum of going from the initial injury onwards. If we can reduce inflammation, we’re likely to have a positive impact on pain as well. They’re really effective in the initial injury, pre-surgery.
If that’s a traumatic injury, or actually the cat arrives and you notice that something’s happened, but they’ll also be effective for the surgical part of the procedure, as well as post-operatively as well.
So, really super effective for is there underlying kidney disease, for example? That’s a really important thing. I always think about that as, Is there a reason for me not to use it? Because if there’s a reason for me not to use it, then I won’t pick it.
But if there’s not a reason for me not to use it, then I’m going to use that medication. It’s very much a, let’s kind of consider all of the points, and if it is a good drug, but for finding there’s not a reason for us not to want to include it in the pain management protocol, then I’m going to use that.
But you’re right, we should be really careful with using them in cats that are part of the aging cat disease profile that we see. It’s important to consider it in that context as well.
TRIPAWDS: What would be an alternative if I had a cat with kidney disease and they needed something to control that inflammation?
BRADBROOK: Yeah, that’s one we can consider.
We do have some data, interestingly, to support Gabapentin for use in musculoskeletal pain, where there might be trauma. In terms of effective pain control, there are some case reports out there supporting that.
But in terms of reducing the amount of inflammation per se, like the non-steroidals do, we don’t really have anything else that fits into that bracket. Unfortunately, that’s where we sit. We can manage pain in other ways if we can’t use them.
And the Gabapentinoids would be one example there. But compared to dogs, I’ll just mention very briefly, because I think it’s important to say that it just can’t be used in cats for chronic pain, as that starts to get what we call ‘wound up’ within the nervous system.
Using Opioids and Other Advanced Pain Relief Options for Amputee Cats
TRIPAWDS: I have heard of a lot more vets using Amantadine for dogs than cats. Is that something relatively new in the feline world?
BRADBROOK: I suppose it depends on the whole time frame, pre- and post-op.
TRIPAWDS: That is really good to hear. I love that there’s another to mention. What else is there we should be looking out for?
BRADBROOK: The other area to mention which are the opioids, or the opiates, and they’re an interesting class of drugs. They’re highly effective painkillers.
Now, whether they’re effective for the chronic types of pain that we’re discussing of the cat’s pain in those times, probably not using it much past the initial post-operative period. It’s not a long-term medication that we would be using.
TRIPAWDS: Because I have never done this personally, do they typically have the kind of side effects that you might see in a dog, like the dysphoria, the whining, the crying, a little bit of restlessness? Do cats exhibit that the same way?
BRADBROOK: Yeah, they do, and actually, cats have, you mentioned, some of the things that we see in dogs there. Cats will be the same. Usually salivation, maybe some sedation. They don’t quite look as we would expect them to look when they’re at home, for example.
They don’t normally vocalize like dogs do. You mentioned whining, and I’m sure for them that is also not great. We absolutely see some of those side effects when we’re using it.
TRIPAWDS: Now, do you think cats tend to get more nausea as a side effect than dogs?
BRADBROOK: Good, not necessarily pre- and post-, but I think something to mention that it will have an impact, particularly post, or it might be on the initial injury, or the use of the local anaesthetics, in terms of doing nerve block treatments, so we would be adding in.
Knowing Whether Your Cat’s Amputation Pain Medications Are Working at Home
TRIPAWDS: Okay. So, we have a cat who had a leg removed, we take our cat home, and one of the common scenarios that we as pet parents face is not knowing the difference between are the medications working, or are they not working? Is my cat acting a certain way, you know, lethargic, tired, doesn’t want to get up?
Is that good? Is that bad? How do we know that these medications are working? I think my first advice always to owners is that “You know your cat best, and you know what your cat was previously like. How did it respond to seeing you?”
BRADBROOK: You know, how food-orientated are they? Do they want to go outside normally? Are they an indoor cat versus an outdoor cat? Do they normally jump up somewhere? How do they sleep? What do you know, do they lie stretched out? Are they curled up? All of those things.
So, I think cat behaviour is really key to understanding whether they’re comfortable versus whether it’s the side effect of the medication, or whether they’re not comfortable at that point.
Now, I think we all know that it’s really interesting to look at those things when their pets are back at home.
And the other thing to mention is, if you imagine, once the surgery is completed, the tissue healing process is going to take quite a long time, so even though the stitches, the sutures, may come out after 10 or 14 days. The healing process is going to take a much longer period of time post- that as well.
So, stopping painkillers maybe at 10 or 14 days may not be appropriate, depending on how the recovery is going.
We talked about the non-steroidal drugs and kidney disease. But we also need to think about the fact that the tissue healing process could take weeks/months, to be complete. And I think that’s a real key here for not stopping medications too soon in the post-op period.
TRIPAWDS: That makes me so happy. So, it’ll depend on the drug, I suppose. That’s one thing just to make everyone aware of, these drugs, if they’ve been started pre-surgery, or started as part of the surgery, or immediately post-surgery.
BRADBROOK: The majority of the medications we’re using will be effective very quickly, so within hours of the majority of these products that we will be incorporating, they should be effective.
So, if you were to take your pet home, your cat home, for example, on, let’s say, the day or the day after surgery, then I would expect those medications to be effective.
If they’re not managing the pain effectively at that time point, then that, for me, would suggest that we need to revisit with our veterinarian and look to see whether maybe the cat needs to go back into the hospital and have medications that we can administer via other routes, injections, for example.
Or it may be that we can inject something and the cat is still able to go back home with the owner.
But really, we should be at the point for the majority of the cats, I think, that I certainly see, that we see in the hospital, they may be with us for two or three days post-surgery before we send them home so we can give them stronger painkillers that we can’t obviously give to the client to administer in the home setting. That’s really important as well.
And what I’d be wanting to see is that we start to wean down the medications they’re getting in the hospital and allow them to switch to the oral medications effectively.
Then once we know they’re comfortable on that, or as comfortable as we can get them, then we’re going to discharge them from the hospital at that point. With our vet, decide if this is okay, or we need to do something different.
Balancing Clinic Amputation Pain Control and Home Care
TRIPAWDS: Okay, now, a lot of people can’t afford to leave their animal in the hospital for more than even a day. And in those cases, how can they make their animal more comfortable?
BRADBROOK: I think the key there for me is what we can do when they’re in the hospital. So even if they’re only in the hospital for a day, for example, because there’s lots of limitations.
The concept that I like to think about is the better we can control the surgical pain and the acute pain that happens around the surgery, the less likely we are to develop further ongoing chronic pain in the post-op period.
So, the more that we can do in the clinic, the more effective our pain control is, the likely better outcome is for that pet to go home.
There will always be times where animals, cats, dogs, whatever, they have to go home sooner than perhaps we would want them to do in a different setting.
And that’s something we certainly experience as well, and it’s not to say that we always can keep them in. I’d love to do that, but that isn’t always possible.
But there’s definitely stuff that we can do. That means that when we do switch to oral medications and oral painkillers that the other bits we’ve done in the background before, will have a longer effect and will be there in the background for a period of time.
I would encourage everyone to speak to their veterinarian about what they’re going to do in the hospital setting that would allow them to get better control for when they are discharged from the hospital.
Phantom Pain in Cats After Amputation
TRIPAWDS: Oh, that is so good to know. It’s hard, it’s so hard on the pet parent, but it’s good to know that they can at least, you know, try to get the animal back to the clinic for some injectables that will make a real difference.
And this kind of points back to one thing we really advocate for ahead of surgery is to, like you said, talk to your vet about what kind of pain control they practice for a surgery like this.
Because not all vets practice pain management the same way. Not all vets know about the Zero Pain Philosophy Team.
And I think how their vet feels about pain control for something like this, because it is major, and like you’ve said, better pain control during the procedure does lead to better outcomes.
We see that a lot, and one of the outcomes that we tend to see for all animals, for a lot, I should say. I don’t want to make a blanket statement like that, but for a lot of them is phantom pain.
And phantom pain is something that, for a long time, was thought, “Oh, animals don’t feel it.” Even though on the human side, we knew that human amputees felt phantom pain and I would like to have a conversation with you about that now.
What is your understanding of phantom pain in the veterinary world, especially when it comes to cats?
BRADBROOK: The first thing to say is that we definitely see it, and they definitely can experience it. What we do understand is it’s related to what we were talking about before, in terms of having to cut the nerve, or cut nerves, as part of the procedure.
But it might be because those nerves were already damaged before the amputation, and that’s initiating the reason that then at the surgery we develop phantom limb pain, or amputation pain, or however you would describe it.
So, there will be a difference as to why one cat will experience it versus another one that may not, when they’ve had the same surgical procedure, effectively.
But perhaps their experience beforehand was different from the injury perspective. So yeah, definitely the cat might be experiencing it. And the key is gonna be cat behaviours here as well, the things that cats do when they’re not happy about something. They look around.
Recognizing Phantom Limb Behaviors and Nerve Pain in Cats
TRIPAWDS: Maybe they look at where their leg was, for example. Very common in people. Maybe they’re scratching the region.
BRADBROOK: And they’re biting at it. It’s another common thing that they may do. They start to overgroom themselves, as cats often do when they get stressed, for example. So, it’s the key to seeing those aspects.
It’s always going to be a diagnosis of excluding other reasons for them to be doing it. We’ll never necessarily be able to diagnose that they’ve got phantom limb pain as such.
It’s ruling out that they haven’t got skin disease, and other reasons for them to be particularly interested in licking the area, that sort of thing, that might be because of another reason, and not phantom pain.
I haven’t seen it in a cat that’s had an amputation, but what I have seen is they often become disorientated.
There’s something about the cats and the way they behave that makes me think that what you describe is they can’t really work out what’s going on, and they’re not comfortable, whatever the reason is for that. But you’re absolutely right, the behaviour changes like a bolt of lightning, for example.
That’s the strange thing about nerve pain. It’s very hard to treat it for that one time when it’s going to happen with some of the other medications that we use, and when it does happen, it’s very intense.
A lot of pain is kind of dull, aching pain that we will experience post a procedure, but in that initial period, and with nerve pain it’s very intense and very short-lived.
And that makes it really challenging to manage. I mean, What are the guidelines you would give to somebody?
In some cases, we may need to start to think about down-regulating some of the medications as well. We’re usually thinking about adding stuff in.
Long-Term Pain Medications and Behavior Changes In Amputee Cats
BRADBROOK: What we do know, particularly with chronic use of some medications, is that they might also impact behaviour. And we may get to the point, weeks, months past, where we want to perhaps try and withdraw some medications if we’re still using them, just to see whether that also has an impact.
But you’re right, once we know this is not okay, then we need to do something different.
TRIPAWDS: Okay, that’s really good to know, because it is a scary thing to happen to your pet and watch them. So don’t feel like you’re not being listened to. Get it if you need it.
Well said, well said. Thank you for your time today. I am so happy that you’re here, and we managed with the time difference and everything to get you here.
This is so helpful, and I would just like everybody to check out the website, the Zero Pain Philosophy.
There is a great section there for pet parents. It’s not just for veterinarians, and if you are lucky enough to be in the UK, there is a directory of veterinarians on the website that you can go to who are up on the latest pain management techniques and can help your cats and your dogs feel better after amputation surgery.
Thank you so much for being here, Carl!
BRADBROOK: Perfect. Thank you so much, Rene. It was amazing. It was a great conversation, so thanks for your time.
End of Conversation