These cats start
clawing at their mouths and cheeks, sometimes severely harming themselves. “It
looked like she was gagging or something was stuck in her teeth,” said one owner.
“Then I came home later to find blood everywhere.” It is incredibly distressing
both for cats and for their owners. Vets researching this behaviour call this
Feline Orofacial Pain Syndrome or FOPS.
I am studying this syndrome for my B Sc. Dissertation and would like to hear
from anybody whose cat has suffered from this. Contact me via this website.
I hope to send out an anonymous questionnaire later and I will publish the results
on this website in full. This will be a behaviour, not a veterinary, investigation.
Other research is also going on. There are three vets who are collecting cases
of FOPS for veterinary investigations -Clare Rusbridge of the Stone Lion Veterinary
Centre, 41 High St, Wimbledon village, London SW19 5AU (http://www.veterinary-neurologist.co.uk):
Sarah Heath of Behavioural Referrals, 11 Cotebrook Drive, Upton, Chester CH2
1RA: and Professor Danielle Gunn-Moore of the Easter Bush Veterinary Centre,
Roslin, Midlothian, Scotland, EH25 9RG. I recommend asking your vet to refer
the cat to these specialists as soon as possible. There is a information sheet
here
from Clare Rusbridge which would be useful for your vet.
Julia Giles, a final year veterinary student at Massey University in Palmerston
North, New Zealand,is studying the syndrome and has set up a website about oralfacial
pain syndrome – http://www.felineorofacialpain.com
This includes an excellent page on medical management at http://www.felineorofacialpain.com/medical-management/
FOPS may be similar to human orofacial pain and the cat’s behaviour is not unlike
that of rats and mice with orofacial pain. Headshaking in horses (which can’t
paw their muzzles) may also have some similarities. Some scientific references
are given at the end of this article.
IF YOUR CAT IS CLAWING ITS FACE
A diagnosis of "self mutilation" or "Feline Orofacial Pain Syndrome" does not
explain the cause: it merely describes the symptoms. Read this carefully if
you have a cat with this troubling problem.
Some cats lick in an exaggerated way or claw at their mouths or inside their
mouths till they bleed. Some will pull the skin and fur off the whole of the
side of the face or rip their tongues. Cats also sometimes chew their nails
right down to the quick (not ordinary chewing) producing bleeding paws --this
may or may not be connected with the face clawing.
When a cat starts clawing at its mouth, the most obvious explanation is oral
or dental pain. Therefore this is the first possibility, which must considered.
However, some cases repeated dental examinations and removal of some or many
teeth may not stop the behaviour and bad dental work may provoke it. So a specialist
dental vet is a must if dental work is to be done.
The syndrome was first recognised in l997 and I wrote about it in my then Daily
Telegraph column a couple of years later. It seems there are episodes of this
behaviour, separated in time sometimes by years; or the behaviour is continuous.
It may start in kittenhood at teething or vaccination time. Adult sufferers
are more common than kittens.
The mysterious face clawing behaviour seems to occur mostly in Burmese or crossbred
Burmese and may be an inherited disorder but it occasionally in other breeds
(particularly those related to Burmese) or moggies.
IF YOUR CAT HAS THIS PROBLEM
You will need to make sure the vet investigates thoroughly, particularly the
question of facial pain. Get Clare Rudbridge’s information sheet (see earlier)
and also download the one from www.fabcats.org
which is under Cat owners and Behaviour. The case of Pepper (below) shows that
vets, unfamiliar with the problem, may fail to give a proper dental and mouth
examination under anaesthesia. This is essential. A specialist dental vet should
be involved (see no 5).
The following possibilities may trigger FOPS and need careful consideration.
1. Dental problems.
2. Mouth ulceration (common during cat flu or after cat flu vaccination)
or gingivitis.
3. Teething in kittens.
4. Facial pain of some kind. (In humans facial pain can be caused by
muscle spasm sometimes set off by unconscious tooth clenching due to stress.
Trigeminal neuralgia is agonising stabs of pain often caused by a trigger spot
on the facial skin being touched and usually self limiting. Possibly these apply
to cats.) Even a facial infection or wound might start the clawing.
5. Dental work. Sometimes very minor dental work such as a scale and
polish may set off the syndrome. But too much or poorly done dental work is
more likely to start if off - this is why a specialist dental vet should be
involved from the start.
6. Stress
TREATMENT
Pain relief is essential while undergoing treatment. Indeed pain relief may
be the treatment. See lower down for vet’s opinions on treatment.
Failure to eat is a real danger. Make sure this is addressed from the start.
Ask about syringe or tube feeding -see the case of Pepper. Liquidise soft food
so that the cat does not have to chew. Feed kitten food (high in protein) or
a prescription diet if the cat has been anorexic.
Helpful measures may include bandaging the paws so that the cat cannot harm
itself or use of a buster or Elizabethan collar. Cats need to groom themselves
and cannot in a collar, so you must groom the cat at least twice a day while
it is wearing this. These should be short-term not long term measures.
Euthanasia should be considered if you think your cat is in unrelenting and
continual pain.
TREATMENT FOR STRESS
After examination and proper treatment of any medical or dental causes, it is
worth looking at stress as a contributing factor. Look at this FAQ also on this
page EIGHTEEN REASONS WHY YOUR CAT FEELS STRESSED AND
UNHAPPY -AND WHAT TO DO ABOUT THEM. While you are pursuing treatment get
a Feliway Diffuser (which lasts a month) that promotes calm in the household.
Reducing stress can do no harm. To diagnose stress factors properly you need
a cat behaviour expert. Remember that indoor cats need an enriched environment
and that multi cat households may be very stressful for some of the inmates.
HELP VETS RESEARCH THIS PROBLEM
DNA is being collected from affected cats. Ask your vet to send any left over
blood to the Medical school, Stopford Building, University of Manchester, Oxford
Rd, Manchester, M13 1BJ. Details of Clare Rusbridge’s research is here.
After reading Clare's research the forms required are as HERE:
FOPS
INSTRUCTIONS FOR DNA COLLECTION
FOPS
PHENOTYPE FORM
FOPS
INFORMED CONSENT
FOPS
INFORMATION SHEET FOR OWNERS
VETS' VIEWS
Sarah Heath, Clare Rusbridge, Professor Danielle Gunn-Moore and dental expert
Norman Johnston, vets who are studying this syndrome emphasize in a paper (FAB
Conference Proceedings 2006) that examination for oral or facial pain is essential
and proper pain relief is important. They use NSAIDs for mild attacks (these
must be prescribed by a vet; used wrongly they poison cats), opiods for hospital
cases, and phenobarbitone for severe cases. This can be injected for immediate
relief. A few severe cases may need lifelong drug treatment with regular liver
function tests.
Norman Johnston of Dentalvets in Scotland (www.dentalvets.co.uk)
likens this behaviour to trigeminal neuralgia in humans (agonising unexplained
facial pain). "I saw cases where there was undoubted pathology, particularly
those involving the lower jaw, which I could do something about. Causalgia is
a condition whereby injury to a sensory nerve, most commonly during a difficult
tooth extraction, appears to be the reason. Trigeminal neuralgia in adult humans
has similar features but the reasons for these attacks in humans have also been
a mystery for several centuries."
Sometimes cats show anxiety before an attack. This may give owners time to give
them drugs or bandage paws to stop claw damage.
CASES
• Derbyshire, an outdoor Burmese, had this disorder at the age of 2, 7, 11 and
12 -so there were long OK intervals. The clawing would only last for 48 hours,
then it would stop. Her owner would wrap gauze around her front paws, followed
by stocking plaster without lint --a difficult process. 'But by this time some
damage had always been done'.
• Sophie was an indoor brown Burmese. Had three or four episodes. Vet diagnosed
allergy and gave antihistamine which seemed to help (sedative effect?). Had
eaten spider plant. "Since Sophie has been allowed to go out and has a pot of
grass to eat when confined to the house, she has not had an episode. I do not
think stress was the problem -she has a laid back attitude to life."
• Some cats which have a perfectly good outdoor life also have the disorder.
So it cannot be wholly caused by the indoor life. Abby, a Burmese, was treated
unsuccessfully with steroids, had her paws bandaged (only she tore them off),
had an Elizabethan collar which was dangerous when unsupervised (she caught
her paw), and unsuccessful homeopathic treatment. BUT she has done less damage
to her face since her owner has kept her claws very short. Abby is not an indoor
cat and lives with a Siamese. Two other cats in the same house have separate
entrances/exits and lead separate lives!
• Nicky, a male Burmese, who started clawing at his face and throat was operated
on for a blockage in his throat -only to discover there wasn't one. He stopped
doing this when the stress (travel and a new home) was removed.
• Joey a Burmilla, a breed arising from a Burmese cross, would scratch his face
and try to put his paw in his mouth -often after a meal. Vets visits and dental
work did not relieve the situation until a retired vet decided he might have
'neck erosion' of the tooth. His owner insisted on having all his back teeth
taken out leaving only one front one and after that 'he was much happier".
• Archie, a rescue chocolate Burmese with cat flu in youth, had two episodes
and giving a sedative (second time) seemed to stop it. But since having builders
in the house he has been over-grooming and manic nail biting. Feliway Diffuser
did not help.
• Angel, his sister, a lilac female and flu survivor, had one episode of face
clawing which seemed directly connected to a rotten tooth and she was back to
normal as soon as the tooth was taken out.
• Pepper, was found clawing at her mouth, her paws and mouth covered with blood.
She was taken to the local Vets hospital where she was diagnosed as "self harming."
She was put in a buster collar, given pain relief, anti-inflammatories and antibiotics.
A day later she was sent home with amitriptyline as a sedative. She was eager
to eat, but stopped after a few mouthfuls apparently in pain. She was taken
back to the hospital for 3 days and kept in a buster collar. By now she was
apathetic and refused food and water. The owner removed the collar and Pepper
would claw if she tried to eat or drink. Two more days later she was seen again
at the hospital by a vet who proposed an exam under anaesthesia. This found
a depressed lesion in the mouth, possibly a tumour. But poor Pepper never came
round from the anaesthetic. The biopsy results showed a "necrotic ulcerated
glossitis' at the base of her tongue. The veterinary hospital interpreted this
to mean that the glossitis was caused by, rather than the cause of, the mouth
clawing.
• Burbage, a male Burmese with the same disorder had dental work and was prescribed
medication. Several teeth were removed. The tooth removal seemed to make no
difference. "Now at the warning signs --dilated eyes starting up to two days
before --I zap him with valium which seems to stop it happening. The behaviour
seems triggered by stress," reported his owner in l999. But by the following
year, she had moved to Hong Kong and Burbage seemed worse. A local vet diagnosed
an allergy -showed how Burbage's gums, muzzle and nostrils were swollen, itchy
and his airways were narrowed. The air pollution made this common in Hong Kong.
Burbage was given a low allergy diet. The owner got rid of scented products,
litter with deodorants, got rid of furniture polish, turpentine, cleaning fluids
etc. The clawing stopped. "Work out through careful observation what is triggering
the reaction. Buy fragrance free litter. Change the diet to low allergy food.
Stop using perfume. There is a strong chance that the cat will not suffer further
attacks," says Burbage's' owner. Also kept an eye out for an allergic reaction
to dry cleaned clothes.
• Muffin, the 16 year old lilac Burmese companion, started clawing at her mouth
about 2 weeks after Pepper's death. The diagnosis was gingivitis, gum disease,
with bleeding. The gum disease was treated with dental cleaning and antibiotics.
An opiate painkiller was administered and the clawing stopped. A cat with oral
pain.
REFERENCES
Eriksson, J., Jablonski, A., Persson A-K., Hao, J-X, Kouya, P. F., Wiesenfeld-Hallin,
Z., Xu, X-J., & Fried, K., (2005), ‘Behavioral changes and trigeminal ganglion
sodium channel regulation in an orofacial neuropathic pain model,’ Pain, 119,
82-94
Fleetwood, I. G., Innes, A., Hansen, S. R., & Steinnberg, G., K., ‘(2001), ‘Familial
trigeminal neuralgia’, Journal of Neurosurgery, 95, 513l-517.
Luccarinia P., Childerick. A., Gaydier, A-M., Voisin, D., & Dallel, R., (2006),
‘The Orofacal Formalin Test in the Mouse: A Model for Studying Physiology and
Modulation of Trigeminal Nociception,’ The Journal of Pain, 7, 908-914.
Madigan, J. E., & Bell, S. A., 2001, ‘Owner survey of headshaking in horses’,
Journal of the American Veterinary Medical Association, 219, 334-337.
Mills, D. S., Cook, S., Taylor, K., Jones, B., (2002), ‘Analysis of the variations
in clinical signs shown by 245 cases of equine headshaking’, Veterinary Record,
150, 236-240.
Muzyka, B. C., & De Rossi, S. S., (1999) ‘A review of Burning Mouth Syndrome’,
Cutis, Cutaneous Medicine for the Practitioner, 64, 29-35.
Pawl, R., P., ‘Trigeminal Neuralgia and Atypical Facial Pain,’ (1997), Current
Pain and Headache Reports, 1, 175l-181.
Rusbridge, C., Johnson, N., Heath, S. E, Gunn-Moore, D.A., (2006), ‘Feline Orofacial
Pain Syndrome’, Feline Advisory Bureau Conference Proceedings, 18-19.
Rusbridge, C., (2009) ‘Feline orofacial pain syndrome face and tongue mutilation
in Burmese’ Feline Information Bureau. Available at: http://www.fabcats.org/breeders/infosheets/orofacial/orofacial.html
Accessed 27 February 2009.
Turp, Sommer, C.,& J. C., Hugger, A., (2007),The Puzzle of Orofacial Pain. Integrating
research into Clinical Management, Basel, Switzerland, Karger.