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 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.

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 in one case removing most of the cat’s teeth did 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.

There are two 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 and Sarah Heath of Behavioural Referrals, 11 Cotebrook Drive, Upton, Chester CH2 1RA. I recommend asking your vet to refer the cat to either of these specialists as soon as possible.
There is a questionnaire on www.fabcats.org from Clare Rusbridge.

In Australia a final-year veterinary student, Julia Giles, is also collecting information about this syndrome. Read about it at http://www.felineorofacialpain.com/

The syndrome was first recognised in l997 and I wrote about it in my 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 is possible merely that sharp-eyed Burmese owners have identified something that occurs in other breeds or moggies.

A. If your cat has this problem you will need to make sure the vet investigates thoroughly, particularly the question of facial pain. 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 need to be considered early on.
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.)
5. Dental work too much or poorly done -this is why a specialist dental vet should be involved from the start.
6. Stress

B. Pain relief is essential while undergoing treatment. Failure to eat is a real danger. Insist on this being addressed from the start. Ask about syringe or tube feeding -see the case of Pepper.

C. After examination and proper treatment of any medical or dental causes, it is essential to look at stress as a contributing factor. Look at my website FAQ 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 inmates.

D. 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.

VETS' VIEWS
Sarah Heath and Clare Rusbridge, vets who are studying this syndrome emphasize in a paper (Proceedings of the 2003 CABTSG study day) 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) and phenobarbitone for severe ones. A few severe cases may need lifelong drug treatment with regular liver function tests.
Selgian might also help (licensed for dogs not cats). Ask your vet to contact either Clare Rusbridge or Sarah Heath, vets who have a particular interest in this syndrome.
Norman Johnson of Scottish Veterinary Dental Partnership 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 diso rder 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'.

• Burbage, a male Burmese with the same disorde r 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.

• 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 (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 Burme se 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 which is apparently difficult to spot. 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 f lu 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 p aws 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.

• Muffin, the 16 year old lilac Burmese compani on, 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.

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

There is also a questionnaire on www.fabcats.org from Clare Rusbridge.