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Managing Pain In Dogs
This article by Dr. T. J. Dunn appeared in the Dog World Magazine

Pain is personal.  Anyone who ever experienced a throbbing, wracking headache while the rest of the world went about its business knows just how personal pain can be.  And unless you tell someone you are hurting nobody will know or care about your personal pain.  It is only when you verbalize or otherwise indicate you need something to help alleviate that pain that anyone other than yourself will even consider coming to your aid.  And so it is with managing pain in the dogs and cats in our care.  They too often suffer in silence.

Fortunately this issue of pain management in pets has recently been a topic of high priority within the veterinary profession. The 2001 AVMA Animal Welfare Forum was presented in October 2001, in Chicago, by the American Veterinary Medical Association.  It was attended by over one hundred veterinarians interested in developing a better understanding of pain management in dogs and other animals.  It is through these types of educational efforts that our canine companions will have an improved quality of life… even though they cannot verbalize when they are in discomfort.

You play a major role in this new effort to ease canine discomfort and pain, too!  Not only must you learn to recognize the cues indicating pain or discomfort in your dog but also dog owners need to be proactive advocates for their dogs.  Taking a posture that you will request pain-alleviating medications whenever your dog needs a major surgical procedure is one way of being an advocate for your dog.  We need to be aggressive in dealing with the various types and causes of discomfort most dogs experience during their lifetimes.

Dr. William Tranquilli, Professor of Clinical Medicine at the University of Illinois, College of Veterinary Medicine, and Director of the school’s Pain Management Program believes that a partnership between the dog’s owner and the attending veterinarian is crucial to developing pain management strategies for any canine patient.  “We veterinarians must really tune in to what our clients tell us about their dog’s behavior and activity, and partner with the client, to effectively address the dog’s needs for pain management” says Dr. Tranquilli.

What is pain? 

One definition presented by the Veterinary Medical Teaching Hospital at the University of Wisconsin is “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.”  Pain is very subjective and difficult to measure.  I have seen in my practice numerous occasions where a dog will hobble in to the hospital, happily wagging its tail as it holds up a limp and fractured limb!  Another dog with the same type of fracture might be frantically yipping and crying in extreme panic and pain.  One patient obviously needs medication but how does one judge the pain in the stoic patient?

Recognizing Pain

There are situations where we can safely assume a dog is experiencing pain such as with obvious injuries or after some surgical procedures.  With more subtle evidence we have to trust our intuition and train ourselves to be keen observers.  Most dogs that are experiencing pain will change their behavior patterns.  We will see them being reluctant to climb stairs, observe them becoming more withdrawn and inactive, or notice them reacting negatively to being held or picked up.  These subtle changes in behavior may be our only clue that the dog is hurting.  Back pain is common in mature dogs and anyone who has witnessed an older dog struggle to arise or even refuse to stand after laying down knows the discomfort these arthritic dogs must endure.  Look for those subtle changes in behavior where the dog seems to be guarding itself from movement or looses interest in interacting with its environment… the changing of behavior may be the only way your dog communicates a need for pain management assistance.

Treating Pain

In the animal hospital… If your dog is undergoing a surgical procedure, do not be timid about asking “And what type of pain management will you be providing for my dog, Doctor?”  Quite honestly, some surgery cases do not require postoperative pain management (obviously, to perform the surgery there will be a local or general anesthetic administered).  Wart removal or minor suturing of a laceration are examples.  However, if your dog will be undergoing major surgery, you can and should inquire about post-procedure comfort for your dog.  According to Dr. Tranquilli there is a wide spectrum of attention given to pain management among small animal practitioners; there are some who have consistent pain management strategies and some who do not.

In the home… Our knowledge of how to reduce pain in dogs has taken some very positive strides in the last ten years.  As a dog owner you have a number of products from which to choose to keep the quality of life where it needs to be, even in the face of the degenerative effects of aging and the traumatic damage inflicted by accidents.  The very first thing you need to address is diet!  Any dog will be better able to resist degenerative illnesses and repair damaged or failing tissues if it is fed a high quality, meat-based diet.  That said, we need to be aware of the nonverbal clues the dog provides regarding its discomfort.  Once we intuitively determine that a dog would benefit from pain management, we need to provide safe and effective products to assist our canine friends.

Products that assist pain management…

Nutraceuticals… Nutraceuticals are non-drug nutrients that play a major role in strengthening normal body tissues, aid in repairing damaged tissues and assist in improving efficient body metabolism.   Adding nutraceuticals to the daily diet has noticeably improved the life quality of many dogs.  Most commonly used nutraceuticals include in their ingredients EFAs (essential fatty acids such as Omega-3 and Omega-6 Fatty Acid).  Other ingredients such as Glucosamine, Chondroitin Sulfate, Methylsulfonylmethane, and Flax Seed Oil have proven to be helpful in decreasing pain and discomfort from arthritis and degenerative processes.  Many believe that using nutraceuticals life-long will assist in delaying the degenerative effects and the discomfort of aging.  Nutraceuticals are employed to assist with low-grade pain and discomfort and can take six to eight weeks for their beneficial effects to be noticed.

All may have side effects	These products can be ordered online so be sure to consult with your veterinarian prior to using any of the products shown below.					All may have side effects
	COMMON NUTRACEUTICALS USED IN DOGS AND CATS
Flax Seed Oil	MSM Methylsulfonylmethane	Omega Fatty Acids	Glucosamine/ Chondroitin/other	Herbal Products	The Missing Link	Bee Pollen

NSAIDS… (Non-Steroidal-Anti-Inflammatory-Drugs) These non-hormonal products include non-prescription aspirin (and other pain  relievers) and prescription required products such as Rimadyl and Etogesic.  These and other NSAIDS interfere with the body’s production of inflammatory molecules that actually trigger pain and swelling.  Some non-prescription NSAIDs should not be used in dogs.  All these products must be used with caution because there is potential for stomach and intestinal problems and prolonged blood clotting time. NSAIDs are used for low to moderate pain and discomfort.

All have side effects	Many of these products can be ordered online so be sure to consult with your veterinarian prior to using any of the products shown below. Do not attempt to order a prescription product without a valid prescription from your veterinarian.						All have side effects
	COMMON PRESCRIPTION NSAIDs USED IN DOGS   (and in special situations with caution in cats ) New NSAID products become available regularly so periodically ask your veterinarian about new and improved arthritis discomfort medications.
DERAMAXX	METACAM	ETODOLAC	ETOGESIC	PIROXICAM	RIMADYL	ZUBRIN	BUTAZOLIDIN

Opioids… Used for more severe pain, this class of pain relief medication includes morphine, codeine, Demerol and other prescription products.  Used in advanced cases of cancer or severe arthritic pain, opioids do have a place in selected cases where the quality of life for the dog can he maintained.  (Although not opioids, some antidepressant medications such as Amitriptyline may be used to treat severe chronic pain.)

Steroids… Cortisone and synthetic cortisone-like drugs such as dexamethasone and Depo-Medrol are potent anti-inflammatory medications and can have a very soothing impact on the patient.  However, they are always a double-edged sword and you should question any long-term use of corticosteroids when they are employed to reduce arthritic, allergic or dermatologic discomfort.  Unfavorable side effects can be a deterrent to their use. 

Chiropractic care… There is mounting evidence that acupuncture, body manipulation and massage can noticeably decrease discomfort and improve function in many dogs.  There is a wide range of skill levels among practitioners and therefore benefits to be derived from canine chiropractic care; nevertheless it may be rewarding in selected cases.

If you notice a diminished enthusiasm for daily activities or other signs of subtle discomfort in your dog, try to assess the possibility that pain or discomfort is a factor.  Work closely with your veterinarian regarding medical tests and radiography to evaluate the true medical status of the dog.  Remember, as Dr. Tranquilli said, to develop a partnership with your veterinarian to do whatever is needed to manage and control pain and discomfort in your dog. Pain is personal… it’s up to you to get personally involved with pain management for your dog.

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