Evidence Update: Pheromone Therapy for Stress in Cats

Back in 2010, I reported on a systematic review evaluating the use of pheromones to treat stress or other undesirable behaviors in cats and dogs. Of the 7 studies in cats and 7 in dogs that were of sufficient quality to be reviewed, no convincing benefit was seen in cats, and only one study showed a possible small effect in dogs. In another dog study published later that year, a few of the behaviors measured seemed to be affected by the pheromone, but there wasn’t any compelling evidence of a meaningful benefit. Now, another cat study has been published looking at the effect of a widely available pheromone product on physical and behavioral response to handling stress in cats both at home and in a veterinary hospital.

Conti, LMC. Champion, T. Guberman, UC. et al. Evaluation of environment and a feline facial pheromone analogue on physiologic and behavioral measures in cats. J of Feline Med and Surg. 2015. Epub before print.

This was a quite nicely done study in which 30 cats were evaluated at home and in a veterinary clinic for responses to pheromone (Feliway) or a placebo. Objective measures, such as heart rate, respiratory rate, blood pressure, and so on were taken, as well as more subjective measures, such as struggling. Cats were tested in response to routine handling at home and in the clinic after environmental treatment with either the pheromone or a placebo containing the vehicle (ethanol).

The results were pretty clear. While the clinic environment is generally more stressful than the home (reflected in differences in heart rate and respiratory rate), cats tolerate being handled and restrained in an unfamiliar environment better than in their own home (reflected in behavioral differences). In neither environment did the pheromone make any difference in the cats’ responses compared with placebo. The authors concluded that the pheromone had no influence on the markers of stress evaluated in this study.

Given the consistency of results across a number of studies, it is pretty clear at this point that pheromone products are unlikely to have any beneficial effects for dogs and cats.

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30 Responses to Evidence Update: Pheromone Therapy for Stress in Cats

  1. Leah says:

    What about other behaviors, such as improper urinating and separation anxiety, or anxiety when moving and generalized anxiety? It looks like these were not tested, yet these are the most common uses for this products.

  2. B says:

    Hi SkepVet,

    Kudos to you for finding this. FYI, I’m the person that emailed you about Dr. Elizabeth Hodgkins. She endorses this product on a pet radio show. You can find it on YouTube by searching “Steve Dale: Why Do Cats Spray?”.

    However, I’m quite confused. There’s about 2,147 reviews on Amazon and the consensus is that the product works. I’m guessing the majority experience placebo. Could they really all be wrong?

    Thanks!

  3. skeptvet says:

    Many of these have been examined in other studies, discussed in my previous article. While not every possible use has been examined, so far no meaningful benefit has been found for any use that has been examined, which is not a good sign.

  4. skeptvet says:

    There are a number of reasons why such testimonial collections are misleading. One is that people are more likely to post positive reviews than negative ones. And unfortunately, if each individual anecdote is subject to bias and placebo effects, then it doesn’t matter how many individual anecdotes you collect, they are not more reliable as a group than the individual stories that you collect.

    Think of every idea that you currently believe is mistaken, from medical practices like bloodletting to the religious rituals like those of ancient Egypt and Greece that are no longer practiced today. For every one of those ideas, you could at one time have found thousands of people convinced they have seen proof positive that those ideas were true and those practices worked. Either no idea is every wrong or belief, even by many people, is not in itself good evidence for ideas.

    Here are some more detailed discussion of this subject, including some research looking specifically at the unreliability of online testimonials for healthcare products:

    Why We’re Often Wrong

    The Role of Anecdotes in Science-Based Medicine
    Why We Need Science: “I saw it with my own eyes” Is Not Enough

    Don’t Believe your Eyes (or Your Brain)
    Medical Miracles: Should We Believe?
    Testimonials Lie

  5. Art Malernee Dvm says:

    EPA regulates these as pesticides the best I can google. That regulation justification seems to be at best a delusional stretch of the federal government. I sold synthetic phermones in my pre ebm days about twenty or thirty years ago so have no cans to look at. Is the word EPA on the cans?

  6. As an accredited feline behaviorist, I do find that a majority (%70) of my clients’ cats do better on Feliway, which is the only pheromone brand I have used. I have found, however, that spraying the collar, rather than on objects or bursts of it in the vicinity, is a less expensive and more effective way of finding out if the stuff even has an effect. I find it unhelpful regarding veterinarian visits, but Feliway definitely has a place when it comes to the cat displaying stress by urinating inappropriately or showing aggression to a new cat in the home. The placebo effect may be a human response, but it’s not an animal one.

  7. skeptvet says:

    All too often in veterinary medicine, we have to rely on clinical experience alone when there is limited or no controlled research evidence. However, we have to be mindful of the fact that such evidence is subject to many forms of bias and error, and there is good reason to believe that well-conducted controlled research is more reliable. In the case of pheromones, we have a plausible theoretical mechanism of action, and we have anecdotal evidence of both success and failure. We also have, however, a number of controlled clinical trials that suggest little to no benefit. It is certainly possible that these studies are mistaken and your experience or method of using the product is correct, but the overall history of medicine suggests the reverse is more likely.

    As for placebo effects, I think you underestimate the extent to which various sources of error that can be controlled with placebo groups in clinical trials influence our perceptions. There is, for example, strong evidence for the caregiver placebo effect, in which we perceive improvement because of placebo effects on our perceptions rather than objective improvement in our pets or patients. In clinical trials of arthritis medications, for example, 56% or clients and 40-45% of veterinarians reported significant improvement in patients receiving placebo. Such effects are more likely in the arena of behavior, where there is more subjectivity in outcome measures than in conditions where outcomes are measured in terms of mortality, clinical lab parameters, etc.

    Even fairly objective outcomes, however, can be the product of error rather than a true treatment effect. One review has shown a high rate of improvement in seizure frequency for epileptic dogs receiving placebo treatments. This is most likely due to the Hawthorne Effect, in which clinical trial participants receive better care once enrolled in a study and thus improve even when given a placebo. The relevance of this to clinical observations is that we often provide multiple interventions at once, and our choice of which intervention to credit with any improvement is subjective and potentially unreliable. I have also written about cognitive biases and other sources of error that make clinical observations less trustworthy than controlled data.

    Ultimately, we have to decide when, if ever, we are willing to accept that controlled research evidence outweighs our own perceptions. Certainly the evidence concerning Feliway isn’t perfect or incontrovertible, so it could be all the studies are wrong. But 7 or 8 studies in cats, and as many on DAP in dogs, without any convincing sign of a meaningful clinical effect is good reason to at least wonder if we and our clients are seeing what we want or expect to see rather than what’s really there.

  8. Dr V says:

    This may be a far stretch, but is it possible that the placebo effect on the caregiver has a real and positive effect on the cat? I.e. if the owner expects improvement, their attitude is picked up by the cat who in turn becomes more relaxed and behaves differently?

  9. v.t. says:

    Art, where did you find that the EPA regulates this as pesticides? Feliway products don’t contain ingredients classified as pesticides (that we know of), are not applied to the skin, and didn’t we have this conversation a few years ago? (FDA doesn’t regulate it under the FD&C, and the plug-ins and pump sprays should be regulated by the Consumer Product Safety Commission, as they do air-freshener/plug-in products).

  10. art malernee dvm says:

    vt, EPA regulates phermones in pesticides. i looked up definition of a pesticide and if you consider your dog and cat a pest. (mine are at times) the felioway becomes a repellent.

  11. CannedAm says:

    I came over here just to see if you’d posted anything about pheremones and was delighted to see the top-most article addressing them.

    I’ve been fostering cats and kittens for a decade and our organization (and the vets we work with) is rife with woo, particularly homeopathy and natural-based cures. I need evidence that something is going to work before I use it and this blog is my one trusted resource.

    The aggressive cat I’m fostering will not be getting pheremones. I’ll continue rewarding wanted behavior and providing safe, quiet spaces away from Mr. Smackey for the other fosters.

    Thank you!

  12. Dr V says:

    Mr Smackey – that’s priceless! Fortunately for him and you, not all natural-based cures are woo; they are definitely not the same as homeopathy. Nothing like good old valerian or catnip to get a cat “relaxed.” It’s certainly not a solution for problem behaviour, but it’s a mighty potent distraction 😉

  13. Art Malernee dvm says:

    Check out the Amazon reviews for Feliway. There are hundreds of positive reviews. The negative ones are mostly because something bad happened to the pet around the time they used Feliway and the users probably wrongly assumed the pet was having an allergic reaction to the product. What a magic show. And studies show veterinarians after 8 years of study get fooled using placebos about as often as their clients. Remember that the next time you take your pet in for a annual wellness visit.

  14. B says:

    May I suggest that you post an “objective” review on Amazon on Feliway providing all of the evidence you’ve done so here? Hopefully, with time, skeptical consumers can find it and thumps you up and eventually be on the the first page. If anything, you may be saving consumers money.

    🙂

  15. skeptvet says:

    Done. Not going to convince very many people, of course, but worth a try anyway.

    Here’s my review:

    Anecdotes say “Yes! but Science says “Probably Not!”

    Despite the large number of positive testimonials, it is quite likely this product is not effective for behavior problems in cats. About 8 scientific studies have been conducted to test feline pheromone analogues for behavioral benefits, and none of them have shown meaningful improvement. The evidence has been summarized here:

    Frank,D. Beauchamp,G. Palestrini,C. Systematic review of the use of pheromones for treatment of undesirable behavior in cats and dogs. J.Am.Vet.Med.Assoc., 2010, 236, 12, 1308-1316.
    http://skeptvet.com/Blog/2010/06/pheromone-therapy-for-dogs-and-cats-whats-the-evidence/

    Conti, LMC. Champion, T. Guberman, UC. et al. Evaluation of environment and a feline facial pheromone analogue on physiologic and behavioral measures in cats. J of Feline Med and Surg. 2015. Epub before print.
    http://skeptvet.com/Blog/2016/01/evidence-update-pheromone-therapy-for-stress-in-cats/

    While many readers will feel that their personal experiences and anecdotes matter more than such scientific research, I will point out that there is also research showing that online reviews are unreliable in evaluating medical products. People are far more likely to post if they are happy with a product, and since each anecdote is unreliable, having a bunch of anecdotes doesn’t make them any more accurate.

    Mícheál de Barra; Kimmo Eriksson; Pontus Strimling. How Feedback Biases Give Ineffective Medical Treatments a Good Reputation. J Med Internet Res 2014;16(8):e193)
    http://skeptvet.com/Blog/2014/08/testimonials-lie-more-evidence-for-why-you-cant-trust-anecdotes-or-personal-internet-reviews-of-medical-treatments/

  16. art malernee Dvm says:

    Where is the Amazon link? I will add my two cents selling Feliway in my pre ebm days.

  17. v.t. says:

    The problem with review sites like Amazon and especially Amazon, is that any negative reviews get lost in the sea of positive reviews and not likely to be read if there are hundreds of reviews on a product.

    That said, any review critical of claims without evidence is better than nothing, so thank you, skeptvet for offering the review on Amazon. 🙂

  18. B says:

    Hey, I can’t seem to find the page with your review. I filter the reviews to most recent and I can’t find it. I just want to gives you a thumbs up. I think you should double-check if you actually publish it or not.

    “Done. Not going to convince very many people, of course, but worth a try anyway.”

    It only takes one to start a trend!

  19. Art Malernee dvm says:

    I clicked on “found helpful”. So far B and my click makes 2. I laughed when I saw skeptvets Amazon review was listed as two stars rather than one. My wife has Amazon prime so I will ask her if I can use her account to write a ONE star review. The nice thing about Brennan’s website is all you need to do is google skeptvet and Feliway and you can click on the quality studie links on your phone. When I was at a veterinarian CE conference as I finished my desert a boarded vet told us studies show Feliway works. I just put down my fork googled up the studies showing no efficacy and passed my phone around the table as the behavior speaker continued.

  20. B says:

    Yeah, I gave you a thumbs up. Likewise, I find it odd you would give it two stars. I was looking in the one star section this whole time. What’s your rationale here?

    Time to spread the word and ask you friends, colleagues, siblings, parents, grandparents, relatives and extended families to thumb up!

    The front has a top five reviews. The minimum number of review to reach that page is at least 56 finding your review helpful. You need 53 more votes to go! 🙂

  21. skeptvet says:

    Well, if you look at the scale for the number of stars, one-star is “I hate it!” Ultimately, I think it’s harmless, plausible, and probably ineffective, but it’s not a violation of all that’s holy or anything! 🙂 One star would be something magical/crazy (like homeopathy) or actively harmful (like Neoplasene).

  22. C.C. says:

    I was at a CE conference last year and attended a talk where the boarded feline practitioner was going on and on about the benefits of Feliway. Like an idiot I believed her without verifying anything for myself. I got a bottle for free from the distributer’s booth in the exhibit hall and brought it back to work with me, thrilled that I would have a new tool in my toolbox for helping cats relax. I have to say that I haven’t noticed any difference at all (anecdotal, I know) but I do feel a bit relieved, if gullible, to see that the research so far backs up my own observations.

  23. Justin says:

    I tried Feliway a few times with 2 of my cats, and having it sprayed anywhere near them actually seemed to scare them. I think that maybe they had learned that Feliway always meant that there was a trip to the vet in the offing.

  24. Cheryl says:

    I have been using Feliway plug-ins for over 6 months along with kitty Prozak and finally decided to give up on the Feliway because of the cost along with the fact that my troubledad cat seemed to avoid the rooms they were in. Since I discontinued using feliway she seems better and more normal. I’m not a believer in Feliway and have spent hundreds of dollars on this based on reviews and my vets suggestions. I actually wonder if it had the opposite affect and made her more stressed. Is that possible?

  25. skeptvet says:

    It seems unlikely, but unexpected reactions happen with all treatments sometimes.

  26. Deb says:

    I was so disappointed to have my vet recommend Feliway for my cat. He’s having a problem dealing with a stray cat in the yard that he sees through the window. I knew I read about it and a quick Google search brought me back to this article. I’m going to forward it to her.

  27. No one says:

    Is it plausible that this and various other treatments might simply work for some small number of cats but not everyone? Especially considering the reasoning behind it seems plausible.. and then it would be less likely this effect would be recognized, even over quite a few studies

  28. skeptvet says:

    It is possible, of course. The question, though is what do we do with that possibility? If every treatment might work for a few individuals but cannot be shown to work in controlled studies, then do we randomly use every treatment with anecdotal support in every patient it might help hoping that sooner or later we will do some good? And it is just as plausible that this or any other product might have negative effects in a few individuals as it is that they might have positive effects in a few, and if neither benefit nor harm show up in group studies, how are we going to know if we are doing more good than harm?

    History suggests that overall we do more good for a greater number of patients if we rely on controlled research studies rather than simply hoping our treatments might help a few and not harm as many or more. All measures of health have improved dramatically since reliance shifted from trial and error to research-based practice, so I think it’s pretty clear that this strategy helps a lot more patients. So while you raise a legitimate issue, it doesn’t do much to help us select treatments.

  29. No one says:

    Yes, that makes sense of course. I guess I meant more to ask how we can differentiate that in studies from just a random effect from other causes? Just having high quality studies with large enough samples (which seems pretty challenging in vet medicine)? It would be unfortunate to dismiss something plausible as totally useless when it really might not be for some patients

    although potential health dangers, as you said, are a frightening part of this too. I would hope to say that some things seem less likely to present any risks (like a pheromone based off cats’ own chemicals), but I guess even that still must use -some- other ingredients, and the more I learn about the complexity of everything, the more difficult it is to take the assumed safety of ANYTHING for granted 😐 !

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