Feline Orofacial Pain Syndrome

"FOPS" in Cats

“Dion” was a beautiful Blue Burmese cat. He was brought into the clinic as he had been constantly worrying and clawing at his face and mouth, and this had been happening for some time. After a thorough examination, it was noted that Dion did have some Dental disease, so he was booked in for Dental treatment. After this his previous symptoms did persist though, and Dion was still displaying some symptoms of FOPS. 

FOPS: Feline Orofacial Pain Syndrome in cats is a disease characterised by face and tongue mutilation and other behavioural signs suggesting oral and facial discomfort with patients showing exaggerated licking and chewing movements and pawing at the head and face.   

The apparent discomfort and self-mutilation symptoms are often disproportionate to any possible causes for the pain, for example dental pain. The disease is most likely caused by a neuropathic pain disorder, like trigeminal neuralgia in humans. 

FOPS is characterised by symptoms of face and oral discomfort, and severe cases can result in severe self-mutilating wounds. The discomfort tends to be worse on one side. The symptoms of pain are often episodic, and bouts can be triggered by touch or by tongue movement for example during grooming, eating, or drinking.  Bouts can last between several minutes to several hours and are often preceded by a short period of vocalisation and anxiety. Some cats sadly are in some continuous discomfort and are at greater risk of self-mutilation and may also be anorexic or unwilling to eat.  

FOPS is more common in the Burmese cat; however, the disease may be seen in any variety including Siamese, Tonkinese, Burmilla, and the domestic shorthair. It is thought that it may be an inherited condition. Any age of cat can be affected, however, many affected cats will first show clinical signs when erupting their permanent teeth. Also, any concurrent dental disease, and environmental stress can precipitate the condition. 

FOPS has similarities to trigeminal neuralgia in humans and is a neuropathic pain disorder i.e., pain due to an abnormal nervous system processing of pain messages. The trigeminal nerve conveys sensory information, e.g., pain and touch around the face and mouth to the brain. It is suggested that affected cats have an abnormal “misfiring” of this nerve.  

Conditions of neuropathic pain can also be greatly influenced by environmental factors. The most common environmental factor that can trigger FOPS in cats is stress. for example, any stressful interaction with other cats, house mates, or neighbourhood cats invading the home and garden territory. Transportation and visits to the Vet and Cattery can also be a trigger. 

There is no definite diagnostic test for this disease, and a diagnosis is made based on the characteristic clinical signs, elimination of other explanations and identification of any contributing causes. 

Firstly, in managing this disease, it is important that any other causes of facial and oral pain are ruled out. A medical examination is advised to rule out other causes of oral/facial pain, in particular dental disease. The difference between FOPS and a case of straightforward dental disease is that in FOPS the response to dental disease pain is inappropriate and characterised by self-mutilation, so it is very important to identify and treat any concurrent dental disease promptly. In FOPS cases the trigeminal nerve sends out an inappropriate message, and so even apparently minor dental disease should be treated. Cats are predisposed to feline oral resorptive dental lesions: FORLs, which may be hidden under any plaque or swollen gums. FORLs are characterised by loss of the tooth enamel and exposure of the sensitive pulp, and these lesions can be very painful. Other Blood work and skull radiographs are also advised, and further referral for a full Neurological examination with advanced imaging may be necessary in some severe cases.  

Also, with this condition it is important to Identify and rule out any other environmental stress triggers. it is important to look for possible contributory factors such as social stress. Identification of a social incompatibility in a multi-cat household is a key step. Reducing stress and providing a secure core territory for the affected cat is very important. For example, providing its own litter tray, feeding area and private space, easy free access in an out of the home, and areas for escape and safety such as elevated platforms and safe hiding places. The use of commercially available diffusers or sprays containing feline facial pheromone F3, can also be useful. 

The main aim of treating FOPS is to reduce the discomfort, limit self-mutilation and identify and treat, or prevent, any underlying triggers. 

Until the symptoms can be controlled, mutilation should be prevented by using an Elizabethan collar. However, this is a painful disorder and merely preventing your cat from mutilation without attempting to prevent the discomfort is inappropriate, so it is important also to identify and treat dental disease and reduce environmental stress. Affected cats are prescribed drugs to reduce pain and discomfort. For mild cases these may include non- steroidal anti-inflammatory drugs such as meloxicam and / or opioids. However, common painkillers are not always effective for neuropathic pain and consequently your vet may recommend unlicensed drugs used to treat this. These drugs reduce the misfiring of nerves, and consequently reduce pain. After starting treatment, the discomfort should hopefully lessen within 7 days of therapy. Attempts should be made to wean patients off medication after about 4 weeks if the predisposing causes have been treated or have resolved. Unfortunately, in a proportion of cases, the symptoms of FOPS become continuous and long-term therapy is required and sometimes more than one drug is necessary to control the discomfort.  
 

“Dion” did have some dental disease noted which required necessary Dental treatment. His ongoing FOPS was then managed reasonably well with a long-term medication regime for his neuropathic pain, and he was a much happier, comfortable, and content cat thereafter. 

If you are concerned about any symptoms of oral or facial pain in your cat, please arrange an appointment with your vet for an initial examination and check-up. 

 

Alison Laurie-Chalmers, 
Senior Consultant, 
Crown Vets 

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