Signs of Chronic Pain in Dogs
By: Jessica Vogelsang
As a veterinarian, it was the worst mouth I had ever seen. As my technician and I peered into the malodorous crevasse that passed for a Dachshund’s mouth, we looked at each other in horror. “Are there any teeth we can save?” I asked her.
“Two or three,” she replied.
The dog’s owner, who adopted her several months prior from an elderly neighbor, was reluctant to pay for the extractions. “She seems fine,” she told me.
“How’s her eating?” I asked.
“OK,” she replied. “She’s an old girl. She doesn’t eat much.”
After describing the sad state of affairs in Daisy’s mouth, the owner finally agreed to let us remove the teeth that were barely in there to begin with. We also sent her home with a hefty dose of antibiotics and pain medications. A week later, Daisy’s owner called us to ask if we had switched Daisy with another dog when she was in the hospital.
“I barely know who this puppy is,” she laughed. “I had no idea she had this much energy. And her appetite! It’s like she hasn’t eaten in months!”
That is the power of pain, particularly unrecognized pain- which, in veterinary medicine encompasses most of the pain we see. As a hospice veterinarian I work primarily with senior pets, and many owners interpret signs of pain as “he’s just slowing down” or “getting cranky in his old age.” One week of anti-inflammatory later, their pet proves them wrong.
Most pet owners may miss signs of pain in their pets, particularly chronic pain such as that caused by arthritis. While acute severe pain can cause the classic symptoms we all know about such as vocalizing and limping, the signs of chronic, ongoing pain are more subtle.
Here are some of the most common indicators of chronic pain in dogs:
- Hunched stance
- Difficulty getting comfortable/restless - fidgeting in the night, which may decrease the Longest Period of Uninterrupted Rest in the Voyce portal
- Reluctance to walk, jump in car, or go up and down stairs
- Decreased appetite
- Changes in tail position
- Licking one part of body repeatedly possibly leading to hair loss or a lick granuloma
- Change in gait
- Uneven weight distribution when standing or walking
- Vocalizing pain when touched
Some dogs are so stoic that neither owner nor veterinarian can elicit much of a reaction out of them, even when we suspect a painful condition exists. In human hospice medicine, statistics indicate somewhere between 45-80% of patients receive suboptimal pain control, and that’s in patients we know are ill! Imagine what those numbers must be for pets.
In my practice, we have adopted the mantra “Assume pain exists.” We don’t wait for the elderly or ill pet to give us obvious signs of pain. There are plenty of medications out there so that we can always find at least one that is safe for the pet. Almost invariably, their attitude improves, and we know we made the right decision.
Pain Control Options
Aggressive pain control is a relatively new concept in veterinary medicine. For routine surgical procedures it’s not uncommon to give one type of pain medication, two at most, and consider it done. A better understanding of the pain pathways in the body has led veterinarians to pursue multimodal anesthesia, with wonderful results.
The perception of pain involves a long pathway. When you touch a hot pan, the receptors in your fingers send a signal up through the spinal cord to the brain, which has to then recognize the signal and perceive it as pain. A thoughtful clinician can address pain at various places in this pathway, and greatly reduce the patient’s distress.
Veterinarians have many pain control medications in our arsenal. Some of the most common are:
- Opiods such as morphine and fentanyl
- NSAIDS such as carprofen and meloxicam
- Local anesthetics such as lidocaine
- Antidepressants such as Prozac (fluoxetine)- yes, they can help with pain!
- Add-on drugs such as gabapentin and amantadine, which are not used alone but in conjunction with other medications.
In addition to medical management, pain patients often benefit from additional therapies such as acupuncture, physical therapy, massage, and laser treatment. Additional opportunities include nutritional support, weight loss, and supplements to control or mitigate pain. This diversity of choice allows for a very customized plan to be developed for each patient.
Pain may be the most underdiagnosed condition in veterinary medicine. Well, that and obesity, but at least we can see obesity. In fact, obesity can contribute to pain, by excessively stressing the joints, muscle, and nervous system. Be proactive if you suspect your pet is experiencing pain- often the subtle changes that we can’t quite put our finger on are the only signs we get. Your dog will thank you for it.-