Plain-English summary
Cats are famously hard to read, and the assumption that owners simply cannot tell when a cat hurts is widespread. A 2023 study put that assumption to the test on a large scale: it asked more than a thousand cat caregivers around the world to score photographs of cats' faces using a structured five-part scale, then compared their scores with those of veterinarians looking at the same images.
The caregivers held up well. Their total scores were, statistically speaking, not different from the veterinarians'. The reliability of those totals was rated good. What varied was which part of the face people were reading — some features turned out to be much steadier signals than others.
What the study found
The survey ran in English and Spanish between March and May 2021, distributed through International Cat Care and other platforms using convenience sampling. Eligible participants were caregivers over 18 who were not veterinary health professionals. Of 3,039 responses received, 1,262 were complete, spanning 66 countries.
Each participant scored 10 images of cats showing different levels of pain, using the Feline Grimace Scale's five action units: ear position, orbital tightening, muzzle tension, whiskers change, and head position. A group of eight veterinarians scored the same images.
Scores for each action unit and for their sum were not significantly different between caregivers and veterinarians, with one exception — muzzle tension, where caregivers scored slightly higher than veterinarians.
Reliability differed sharply between features. For caregivers, the single-rater intraclass correlation was 0.65 for ear position and 0.69 for orbital tightening, both in the study's "good" band. Muzzle tension came in at 0.58, moderate. Whiskers change (0.37) and head position (0.38) fell into the "reasonable" band — the weakest of the five. The sum of scores was 0.65: good.
Demographic variables did not significantly affect the scores participants gave.
What this study cannot tell you
The participants were self-selected, recruited largely through a cat-welfare organization. People who answer a survey advertised by International Cat Care are, almost by definition, unusually engaged with cat welfare. This is not a random sample of cat owners, and the results should not be read as describing owners in general.
The task was also easier than real life. Scoring a still photograph, chosen and framed by researchers, is not the same as reading your own cat across a dim room while it moves, hides, or reacts to your presence. Ten images is a short test.
Most importantly: this measured agreement, not clinical outcome. It shows people can apply a scale consistently. It does not show that home scoring leads to better decisions, earlier care, or better welfare — none of that was measured. And the scale itself is for acute pain. Applying it to slow, chronic discomfort takes it outside what has been studied.
What pet owners should track
The practical value here is knowing where to look, and describing what you see in terms a veterinarian can use:
- Ear position — held normally, or rotated outward and flattened
- The eyes — open and relaxed, or tightened and squinted
- Muzzle tension — the shape around the mouth and nose, relaxed versus drawn tight
- Head position — carried level with the shoulders, or held low
- Note when you first saw the change, and whether it comes and goes or stays
A short video is often worth more than a description, because facial signs are easy to miss in a still moment and easy to doubt afterwards. Note whiskers and head position too, but weigh them less — those were the least reliable features even among people trained on the scale.
What PAWai can help organize
PAWai can hold these observations with their dates, so a pattern you noticed on a Tuesday is still there, in your own words, when you reach the appointment two weeks later. PAWai does not score your cat's pain, does not tell you whether your cat needs pain relief, and does not administer the Feline Grimace Scale. Pain assessment and any treatment decision belong to your veterinarian. What PAWai contributes is that your observations arrive intact and dated rather than half-remembered.
If you believe your cat is in pain, contact your veterinarian. Nothing on this page is a reason to observe and wait.
Disclaimer
PAWai organizes information and educates pet owners. PAWai does not diagnose conditions or recommend treatment. Always consult a licensed veterinarian for medical decisions about your pet.
Citation
Monteiro, B. P., Lee, N. H. Y., & Steagall, P. V. (2023). Can cat caregivers reliably assess acute pain in cats using the Feline Grimace Scale? A large bilingual global survey. Journal of Feline Medicine and Surgery, 25(1). https://doi.org/10.1177/1098612X221145499