By Dr. Bruce Little
There has been much studied and written by researchers and clinical veterinary practitioners regarding the issue of pain in these pet family members. So much so that organizations such as the American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) have joined forces to write and publish extensive guidelines regarding the diagnosis and treatment of pain in our pets.
As a clinical practitioner after finishing veterinary college, I was aware that dogs and cats experienced pain, and that it was an individual concern as to how that affected their daily lives. However, I was not as grounded in diagnosing and treating pain in pets as the average veterinary practitioner must be in today’s environment. I had experienced both acute and chronic pain as a high school and college athlete; however, I seemed to have a rather high threshold to pain and it did not have immediate impact on my performance with a couple of exceptions including a dislocated shoulder and a broken finger. My point here is that how pain affects people and pets is an individual measure and cannot be considered with a one size fits all perspective. Each individual reacts to pain differently than others of the same species.
There is ample evidence that dogs and cats experience pain, and both will hide their pain as a method of protection against predators who would attack them due to physical infirmities, a cause not usually experienced by humans. This makes diagnosis and ongoing treatment more difficult because observations must be noted and acted upon by both veterinary professionals and members of the pet’s family to effectively diagnose and treat the condition and help to provide an acceptable quality of life for both the pet and the family members. Quality of life is diminished when pain impedes everyday life and function.
Acute or Chronic Pain in Dogs and Cats
As in humans, there are two kinds of pain in pets, acute and chronic. Each has distinct characteristics, although acute pain can occasionally turn into chronic pain if it’s not recognized and treated appropriately. Acute pain can be caused by injury, illness, surgery or some other intrusive procedure that can cause the pet discomfort. The medical term for this type of pain is nociceptive pain, and is usually acute and develops in response to a specific situation. Nociceptive pain is the most common type of pain, when nerve fibers are damaged by inflammation, chemicals, or physical events such as injury. Acute pain can come in all levels, from minimal to excruciating. It’s not uncommon for a dog to jump off the porch when seeing a strange animal cross his yard and come back with a whimper and a limp. Muscle strains due to the force with which the dog lands on his feet or broken bones must be taken into consideration, depending upon the level of pain exhibited.
Neuropathic pain, on the other hand, is a medical term used to describe the pain that develops when the nervous system is damaged or not working properly due to disease or injury such as diabetes, cancer or invasive surgery such as amputation. Many illnesses including urinary tract infections, digestive tract complications such as constipation or gastric dilatation, or something much less complicated like impacted anal glands can cause excruciating neuropathic pain.
How to Recognize and Diagnose Pain in Pets
The greatest challenge to both veterinarians and pet owners alike is recognizing and diagnosing pain in pets. Because of their inability to speak with us directly, there have been multiple diagnostic charts developed by the veterinary industry to determine where it hurts. The Colorado State University feline and canine pain charts are used by veterinary teams to attribute certain body language to various levels of acute pain. The AAHA has published charts to guide pet owners in determining whether their pet may be harboring pain at some level by recognizing certain activities such as:
- Vocalizing — Whining and groaning
- Self-mutilation — Licking and biting
- Facial expression — Panting or grimacing
- Daily habits — Depressed appetite or lapses in house training
- Self-protection — Limping or hiding
- Aggressiveness — Growling, biting, or pinning ears back
- Posture — Hunching back or laying on their side
The AAFP has developed a chart for cats to display the parts of the body where injury or disease may be causing pain with recognizable tips to identify what the problem may be. In all cases of suspected acute or chronic pain pet owners should take their pet to their veterinary team for professional diagnosis and recommended treatment protocols to alleviate or a least manage that pain.
Both acute and chronic pain can be almost as difficult to treat as it is to diagnose. Dr. Robin Downing, a Colorado veterinarian who has multiple post-graduate degrees and certifications including a Diplomate, American Academy of Pain Management, insists that many factors can and usually do enter into the formula for eliminating and/or controlling pain in pets. Dr. Downing states, “as a result of the amazing advances in veterinary medicine in recent decades, pet patients are living longer and better than ever. While old age is not a disease, there are important medical issues that are associated with aging. For instance, we know that approximately 20% of all dogs and cats across all ages suffer from the inflammation and pain of osteoarthritis. We know that the incidence of osteoarthritis increases with age, and that all cats that are 10 years old or older, more than 90% are likely to have osteoarthritis in at least one joint.” From this most impacting statement, it is easy to understand that the treatment possibilities as listed in the AAHA/AAFP Guidelines is quite long and inclusive, as follows:
- Approved nonsteroidal anti-inflammatory drugs (NSAIDs) — Helps control inflammation
- Corticosteroids — Helps reduce inflammation and swelling
- Opioids — Helps control pain
- Analgesic Drugs — Reduces pain
- Local and Regional Anesthetics — Controls pain temporarily depending upon product used
- Glycosaminoglycans (GAGS) — Helps restore lubricants and other joint tissues
- Therapeutic Joint Diets — Omega-3 fatty acids and microlactin helps restore joint tissues and reduces systemic inflammation
- Acupuncture — May help control pain
- Optimal Weight Management — Due to decreased mobility pets are inclined to gain weight. Excess weight causes further strain on the joints and excess fat increases hormone secretions that produce inflammation
- Exercise — Controlled exercise keeps the joints flexible and free from swelling
- Lifestyle and Environmental Changes — Ramps for going up and down stairs, elevated food and water bowls
- Physical Therapy — Stretching and mobility exercises help control pain
- Cold packs — May help reduce swelling and inflammation leading to pain relief
- Surgical Techniques — Anterior cruciate ligament surgery, tumor removal, tooth extraction
Treatments can be used independently of each other or in conjunction with several of these modalities. Never administer pain medications to a pet without consulting with your veterinarian. After diagnosing the problem, your veterinarian will explain the benefits, risks and cost associated with various treatment options. You and your veterinarian can then choose the approach that best meets the needs of you and your pet. If your veterinarian prescribes pain medication, always follow the prescribed instructions that you’ve been given. Watch for side effects including vomiting, diarrhea, yellowing of the gums, skin or whites of the eyes, changes in drinking habits, excessive urination, or changes in behavior such as appetite loss or depression. If any of these signs occur stop administering the medication immediately and call your veterinarian. Never change the frequency or dosage of medications without consulting with your veterinarian. Also, you should not give your pet any other drugs while they’re taking the pain medication without first consulting with your veterinarian. As always with all medications, keep drugs out of the reach of your pets and any children.
Pain control in any pet can be a challenge for the entire family. It’s difficult for family members to watch a pet suffer as their personality changes due to acute or chronic pain. We have a responsibility to help them overcome, or at least, manage their pain. The pets will appreciate it and the entire family will be much more comfortable with a painless pet in the house.
For more information, read the pain management guidelines found here.