In the last two decades, veterinary medicine has advanced dramatically in the pursuit of pain prevention and management. However, despite our best efforts, a non-essential surgical procedure that includes amputation of part of a digit inevitably causes pain. Even the best multi-modal pain management protocols cannot prevent or eliminate this pain. There is no medical justification to amputate feline digits. The procedure does not reduce risk of disease in the patient, nor does it improve quality of life. During a declaw procedure, anesthesia may protect the patient against perception of surgical pain, but the associated tissue damage leads to nerve firing, inflammation and subsequent post-operative pain. Managing this pain is beneficial, but the immediate and long-term effects are hard to define and predict.
Short-term acute pain predisposes to chronic pain
Following a declaw procedure, the opportunities for chronic pain are numerous. Immediately post-operatively the patient is at risk for painful surgical site infections, inflammatory pain as well as reactions to suture material or tissue adhesive. Veterinarians utilizing laser to declaw may have little training, thus putting the patient at risk for soft and skeletal tissue burning. Veterinarians utilizing scalpels and nail scissors may unnecessarily traumatize surrounding tissue including digit pads. Excess amounts of bone may be removed when P2 is accidentally cut and more commonly remnants of P3 are left behind (see inset). This predisposes to painful ambulation and painful regrowth from the unguicular process of P3. Veterinarians utilizing tourniquets place the patient at risk for tissue damage secondary to decreased perfusion, as well as reperfusion injury if the bandages are too tight and/or left on for too long. When not identified or managed, these types of acute pain and trauma are more likely to lead to wind-up pain and long-term, chronic pain. Pain from amputation can lead to phantom/ghost pain, a devastating, permanent condition.
Chronic pain: Absence of evidence is not evidence of absence
If cats are masters at hiding illness, they are adept geniuses at hiding pain. Assessment or identification of long-term chronic pain in declawed cats becomes the ultimate of challenges. A client’s ability to identify any long-term discomfort is compromised by the cat’s mastery at hiding pain. Further to this, there is an unwillingness to admit that anything negative could result from their decision to declaw. The reality is that this same assessment applies to veterinarians. If we are to admit that there are negative consequences, then we are admitting that we should not be performing the procedure. Willful denial is the consequence. Patient harm the certain sequel.
Declaw patients are at risk for long-term pain related to numerous causes. Chronic pain may result from severe acute post-operative pain. The presence of P3 remnants, or the ‘accidental’ surgical removal of P2 or even P1 fragments unavoidably causes problems. Tissue glue fragments can also act as painful foreign bodies persisting for months to years in the feline tissue. The development of fibrosis in the superficial and deep digital tendons as a result of incision during the declaw process can also lead to tendon contracture and painful digital flexure (Figure 2). This condition has been only recently defined in the declaw patient. It can affect cats declawed by any method at any time after their surgical procedure. It can lead to painful ambulation as well as pressure necrosis at the site of soft tissue contact with the ambulatory surface. Some cats will experience necrosis leading to tissue perforation and chronic infections (Figure 3). With the adept feline genius hiding pain and the human missing the subtle signs, the patient suffers in silence. There may be subtle changes in behaviour, gait, and activity, but these will usually go unnoticed.