5 Barriers to Proper Pain Relief for Dogs
Posted by Joanna Woodnut, MRCVS
We’ve all winced when we’ve felt an arthritic dog’s hips, and then had a difficult conversation with the owners to help them see that their dog is in pain. It’s a common enough scenario in practice, and unfortunately many pet owners find it difficult to recognize pain in their pets. The World Small Animal Veterinary Association (WSAVA) Global Pain Council acknowledges this as a problem (1), but it’s not the only reason that pets aren’t getting pain relief.
The WSAVA Global Pain Survey found that two-thirds of participants (veterinary societies) felt there were entrenched views that limit pain management, and that those views could be held by pet owners or veterinarians (2). Though lack of recognition of pain was one of the most common reasons for pain relief not to be given, the WSAVA specifically cites pain myths as one of the barriers to proper pet pain relief (2).
With improved understanding of pain in veterinary species and education, these myths are fading in many parts of the world. However, it is important to be aware and watch out for these viewpoints to help provide optimal care for patients. By far the majority of pet owners care about their pets and do not want them to be in pain—they just need help understanding the signs and how to manage it. Let’s take a closer look at misunderstandings about pain in dogs—and how to set the record straight.
5 Myths About Chronic Pain in Dogs
1. If a pet doesn’t ‘cry out,’ it isn’t painful
Many of us have heard owners say something along the lines of, “He’s a bit stiff, but he isn’t in pain… he doesn’t cry out or anything.” On the face of it, this myth is a strange one. After all, humans with severe osteoarthritis don’t cry out with every movement. But it is a persistent myth that requires a lot of education to reverse.
The reality is that many dogs put up with pain without vocalizing—it’s their behavioral changes that reveal what they are really feeling. Pet owners need help to understand that these changes are not just a result of “getting older” and are in fact signs of pain, even if their dog isn’t crying out. Veterinarians can help educate pet owners so they know what behavioral changes to look for at home, in their pet’s natural environment. This is the ideal opportunity to observe their pet’s daily activities and monitor for changes, even if they’re subtle. It’s more difficult to observe these changes during a vet visit, due to restricted time, limited space, and behavior modifications.
Using a validated clinical metrology instrument (chronic pain assessment tool) in your practice is an excellent way to support the conversation and present a visual score that can help pet owners realize that their dog is in pain. There are many validated chronic pain questionnaires for dogs. (WSAVA has compiled a list here.)
2. Animals don’t feel pain like we do
As we vets know, animals experience pain and the similarities between pain in humans and animals continue to grow. In a recent study, dogs with long-standing, osteoarthritis-related pain showed increased somatosensory sensitivity, which is likely indicative of central sensitization (3). This further supports the spontaneous canine osteoarthritis model as a good translational model of human osteoarthritis pain (3). Pain associated with joint disease has also been found to disrupt sleep in dogs (4). The difference is that dogs don’t necessarily show and communicate pain in the same way as humans, and this is what we need to explain to owners. Even in social predatory species like dogs, overt signs of pain are limited. Instead of expecting dogs to “tell us” that they’re uncomfortable, we need to help our clients recognize expressions and behaviors that indicate that their dog is in pain.
Perception of breed-level differences in pain sensitivity may also influence the recognition and treatment of pain in dogs. In a recent online survey, more than 90 percent of both the general public and veterinarian respondents indicated belief that dog breeds differ in their sensitivity or response to pain (5). There is a misconception among pet owners that smaller, lighter dogs are more sensitive to pain than larger, heavier dogs. While all individuals can experience pain differently, the breed and size of the patient should not influence assessment of pain.
3. Giving pain relief will mask pain and pets will engage in too much activity
Today, NSAIDs are at the cornerstone of canine OA treatment. With a wide range of NSAIDs available, adjunct therapies, and non-drug options, practitioners have many options to keep dogs comfortable. However, some clients may mistakenly believe that if they give their dogs pain relief, the dogs may engage in too much exercise and cause further damage. This was an old veterinary perception as well. This outdated theory involves allowing an animal to be in pain in order to stop them from exercising. However, even with osteoarthritis, appropriate exercise is important to help keep the joints healthy and strengthen the muscles that support them. A dog’s activity level can be controlled with other, more humane, methods, such as leash-only exercise for pets with OA or short-term crate rest and room restriction post-surgery.
Therapeutic exercise is an integral component of rehabilitation programs for dogs with chronic pain. Pet owners may need help understanding that pain medication is an important first step, since it helps control the pain to make it possible to exercise. Giving pet owners other options to limit intensive or excessive exercise, and providing a list of do’s and don’ts for their dog, can help yield better patient outcomes.
4. Chronic pain only affects older dogs
Clients are often not on the lookout for chronic pain unless their dog is older. However, chronic pain can occur in animals of all ages. Osteoarthritis is often considered an old dog disease when in fact it can manifest early on in life, such as in dogs with developmental abnormalities (e.g., patellar luxation, elbow dysplasia, hip dysplasia) or dogs with joint injuries. While joint injuries can occur at any age, young, energetic dogs are at risk. Approximately 25 percent of dogs over 1 year of age are estimated to have OA (6). Using a staging tool like the Canine Osteoarthritis Staging Tool (COAST) early in life can help monitor osteoarthritis more accurately, especially if patients have risk factors for the disease.
In some cases, surgery can lead to chronic pain, but there are approaches taken by veterinarians to preemptively and perioperatively manage pain to decrease the chance of this happening. We know very little about whether dogs get “phantom limb pain,” but a recent study suggests that they do, and that the phantom complex is worse the longer pre-amputation pain lasts (7). Pet owners unfamiliar with the signs of post-operative pain in their pets may not recognize the need to administer the prescribed medication. Talking to your clients about the importance of pain management, especially post-surgery, is essential.
Chronic pain should also be considered when dealing with behavioral issues, no matter the age of the patient. Recent studies have suggested that at least one-third of behavioral referrals have some sort of pain that could explain their symptoms, and the figure might be as high as 80 percent (8). Combining owner assessments with a pain relief trial is an option where clinicians are unsure whether chronic pain could be a factor.
5. Being on daily medications is dangerous
It takes time to bring pain under control. However, clients can be anxious about the side effects of medications or have a view that daily drugs are an inherently bad or dangerous thing. They may not feel that their dog needs daily medication or they may not really understand the signs of pain. These clients often end up skipping doses or using the drug “only on the bad days,” which means that the dog does not receive consistent pain relief. In some cases, this is encouraged by prescribing the medication “as needed.”
Veterinarians may also have concerns about the long-term safety of NSAIDs, but we know how to mitigate, manage, and reduce risks wherever we can. We also know that the majority of patients tolerate NSAIDs well and that the fear of complications is not a reason to avoid treating pain. Of course, it is always important to perform a benefit:risk evaluation for each individual patient but in many cases, the potential benefits of daily medications outweighs the risks.
An analysis of peer-reviewed literature found no indication that longer-term NSAID use in the treatment of canine osteoarthritis is associated with a reduction in safety (9). The majority of evidence supported longer-term use of NSAIDs for increased clinical effect. Of course, not all dogs will be on NSAIDs daily for life—it depends on the individual patient and the severity of the case. However, compliance in the initial period is particularly important for all cases, so that the veterinarian can work out a long-term management plan from there. Some dogs, such as those with severe cases of osteoarthritis, may need to be on medication for life.
The time you take to discuss the safety profile of your chosen drugs and explain the ways in which you can mitigate risks through pre-evaluation and monitoring in-clinic can go some way to alleviate pet owner fears. Pet owners can also keep an eye out at home and let you know if any issues or concerns arise. For some pet owners, all it takes is a reminder that pain relief is an important welfare point, since none of us want an animal to suffer in pain.
When discussing other treatment modalities, such as acupuncture, herbal remedies, physiotherapy, canine massage, and scientific advancements in stem cell therapy, available data and information can be leveraged to assess which may be helpful to the individual patient.
Prioritizing Chronic Pain Relief for Dogs
Chronic pain is underdiagnosed, but recognizing it is essential for providing proper animal welfare. Myths exist within both the pet owner and veterinarian communities. Since pain is variable and differs among individuals, there are a lot of barriers to proper pain relief for dogs. Engaging pet owners and increasing their understanding about pain in dogs can be extremely beneficial. While regular veterinary evaluations are important, the in-clinic assessment is only a part of the story. Pet owners can play a supporting role by looking for behavioral changes at home, in the yard, at the park. They are like an extra pair of eyes and ears that can give you all the information you require to most effectively manage the patient.
A good fallback option is to ask clients to start dogs on a short-term pain control plan, such as NSAIDs along with appropriate exercise, to see whether their pet’s symptoms improve. And more often than not, they do, and the client is now willing to talk about a long-term plan for their pet.
Veterinarians are pivotal to pet owners’ understanding of chronic pain in dogs. Treating chronic pain requires veterinarians and pet owners to work together. While some myths and concerns about pain persist, in general, there have been significant advances in approaches to pain management. Thanks to new research and new ways to assess, monitor, and manage pain, there is continuous improvement.
Disclaimer: The author received compensation from Elanco Inc. for her services in writing this article.
- Guidelines for Recognition, Assessment and Treatment of Pain. The World Small Animal Veterinary Association Global Veterinary Community. Retrieved from https://wsava.org/wp-content/uploads/2020/01/Recognition-Assessment-and-Treatment-of-Pain-Guidelines.pdf
- WSAVA Global Pain Council 2013 Global Pain Survey. July 5, 2013. Retrieved from https://wsava.org/wp-content/uploads/2020/01/GPC-Survey-Results_July_2013.pdf
- Kňazovický, D. et al. “Widespread somatosensory sensitivity in naturally occurring canine model of osteoarthritis.” Pain 157 (2016): 1325 - 1332.
- Knazovicky, David & Tomas, Andrea & Motsinger-Reif, Alison & Lascelles, B Duncan X. (2015). Initial evaluation of nighttime restlessness in a naturally occurring canine model of osteoarthritis pain. PeerJ. 10.7717/peerj.772.
- Gruen ME, White P, Hare B (2020) Do dog breeds differ in pain sensitivity? Veterinarians and the public believe they do. PLoS ONE 15(3): e0230315. https://doi.org/10.1371/journal.pone.0230315
- Lascelles D. Joint Pain in Pet Dogs and Cats. International Association for the Study of Pain (IASP) Fact Sheet. 2016.
- Menchetti, M, Gandini, G, et al. Approaching phantom complex after limb amputation in the canine species. Journal of Veterinary Behavior. 2017;22:24-28, https://doi.org/10.1016/j.jveb.2017.09.010
- Mills DS, Demontigny-Bédard I, et al. Pain and Problem Behavior in Cats and Dogs. Animals. 2020; 10(2):318. https://doi.org/10.3390/ani10020318
- Innes JF, Clayton J, Lascelles BD. Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Vet Rec. 2010;166(8):226-230. doi:10.1136/vr.c97