How do I know if my dog or cat is in pain?
Sometimes, it is obvious. Either, our pet's
expression or outward behavior clearly indicates pain and discomfort,
by showing signs such as limping, growling or whining when touched, or guarding specific painful areas. Or, they have a condition which we know through human experience and reports, is painful, such as osteosarcoma (bone cancer), pancreatitis, stomach ulcers, and radiation burns.
Sometimes, though, it's not so clear. Are they not eating because of pain, or nausea? Are they panting because of pain or anxiety or something else? Are they pacing because of pain, anxiety, or disorientation and confusing? Are they vocalizing because of pain, or confusion, or anxiety? Are they clingy because of pain, or because their afraid? Are they reclusive because of pain or fear or some other symptom, such as just low energy due to anemia and heart failure? Are they trembling because of pain, muscle weakness, chills, or fear?
In these cases, it helps to have an experienced veterinarian observe and evaluate your pet in the home, where fear and anxiety are minimized. If this isn't possible, sometimes a video of the behavior can be helpful. And understanding that most pain in our hospice patients, or patients receiving palliative care, is not simple nociceptive pain. It is often chronic, maladaptive, or neuropathic pain, and this kind of pain is closely intertwined with our emotional state. Chronic fear, anxiety, nausea, loss of appetite, and changes in mobility and movement effect how our sensory system up regulates or down regulates sensory information. You can read more about how emotions and pain are intertwined in humans, and presumably in all mammals, here and here. And a hundred other references on the interwebs.
Often, treatment of simple pain is simple, but chronic or complicated pain requires a multimodal approach, which often includes medications that address neuropsychological factors, physical exercises, massage, behavior modification, and acupuncture. This explanation of how acupuncture can help with chronic pain, nausea, and anxiety through neuromodulation is helpful in understanding some of the complexities involved in pain and symptom management, and why a simple non-steroidal anti-inflammatory is often not enough for many pets with chronic pain:
Depending on the severity of the pain, and the type of pain, acupuncture is often not enough. Sometimes we don't have the time to retrain the nervous system, as in end of life care and hospice care, so our approach is going to be more aggressive management of symptoms and less focus on modifying pain as a disease.
Honestly, though, let's all try to remember your worst day, the time when you were hurting the most and wanted it to just stop. Your lowest low. Was it because you were in a lot of pain, or were you sad, lonely, afraid, and depressed? Most of us will say the later. Most people choose to end their lives from emotional desperation and severe distress, not to avoid physical pain. The two certainly can be intertwined, but there is no reason to expect our pets to feel any differently about their quality of life, and what makes it worth living, than we do. Dr. Dani McVety discusses this in her article in DVM360. We've all seen the Labrador Retriever who just got run over by a car, broken bones, etc, come in waging his tail and smiling, because People! Food! Life! And we've also seen the little under-socialized tiny perfectly healthy chihuahua who screams when you reach to touch him because "OMG, every wants to kill me and I am so terrified!!" Are these animals born with different nervous systems? You bet, but it's not the peripheral nerves that are different, it's the big glob of nerves in their skull, known as a brain, that's different between individuals. That little stressed out chihuahua is not going to do any better with vaccines if you give him an NSAID or Tylenol first, but if you load him up on anxiolytics, or do some behavior modification and desensitization to change his emotional response, he will likely not even notice getting 2-3 vaccines.
My take home for pet owners, is that your pet is likely in some pain. Most of us are, pain is unavoidable. The question should be, is the pain preventing your pet from enjoying life? Is there chronic pain, and if so, are we addressing that with multimodal therapy and the emotional and psychological aspects of the pain? Check out some of the links below for more information, and the Resources section on my website, where there are several quality of life and pain scales to help identify signs of pain. And thanks for hanging in there to the end, I know this stuff can be dense and boring for some.
Fear is Worse then Pain by Dani McVety in DVM360