¹Universiti Putra Malaysia, Faculty of Veterinary Medicine, Department of Companion Animal Medicine & Surgery, 43400, Serdang, MALAYSIA
²Lasbela University of Agriculture, Water and Marine Sciences, Faculty of Veterinary and Animal Sciences, Department of Veterinary Surgery, 90150, Blaochistan, PAKISTAN
³Universiti Putra Malaysia, Faculty of Veterinary Medicine, Department of Veterinary Preclinical Sciences, 43400, Serdang, MALAYSIA
⁴Universiti Putra Malaysia, Faculty of Veterinary Medicine, Department of Veterinary Clinical Studies, 43400, Serdang, MALAYSIA
⁵Universiti Putra Malaysia, Faculty of Veterinary Medicine, Department of Farm and Exotic Animal Medicine and Surgery, 43400, Serdang, MALAYSIA DOI : 10.9775/kvfd.2025.35417 This systematic review developed an evidence-based framework for feline pain management. The systematic search of Scopus, ScienceDirect, and PubMed from 1980 to october 2023 found 42 eligible studies that explored pharmacological and non-pharmacological approaches to feline pain management. The outcome measures included analgesic efficacy, rescue analgesia, and adverse effects. Rescue analgesia was a key endpoint in multimodal therapies and was mostly used in severe pain models. Multimodal therapies were mainly employed in complex cases/procedures with severe pain potentials, resulting in higher rescue rate (16.6%) compared to monotherapy in routine procedures/ neuter (5.29%). Pre-emptive analgesics were always associated with the best outcomes. The UNESP-Botucatu multidimensional scale was one of the most frequently used and validated pain assessment tools. The adverse effects were usually easy to manage, with the most frequent being opioid-related dysphoria and NSAID-related gastrointestinal effects. Following these results, we propose a tiered framework: a base of NSAIDs and local anaesthetics (Tier E1), supplemented with opioids for severe pain (Tier E2) and adjunctive stress-reducers (Tier E3). This is a pre-emptive, structured and severity-specific method necessary to ameliorate the cycle of treating pain insufficiently, thereby improving the welfare of cats, as well as staff safety and strengthening the veterinary practice. Keywords : Feline pain management, Multimodal analgesia, Pre-emptive analgesia, Systematic review, Tiered framework