Animal Pain Awareness Month - How Can We Detect Pain Earlier?

If you weren't aware, September has been designated Animal Pain Awareness Month by the IVAPM (International Veterinary Academy of Pain Management). Recently, I have been thinking a lot about chronic pain in our four-legged friends - and how we can identify it earlier - so it only felt right to share my thoughts on the matter this month. 

Chronic pain often goes undetected for months, if not years, in our companion animals. Why? Because it is oftentimes expressed via subtle, intermittent signs that are frequently misinterpreted or dismissed as unimportant. So, how do we detect it earlier? There's no simple answer. If there were, I would not be writing this blog post! 

Let's first remind ourselves of the differences between acute and chronic pain. To put it very, very simply - acute pain occurs immediately upon injury (e.g., a strained muscle or a prick from a thorn), and it generally goes away once that injury has healed. Acute pain serves a purpose in that it discourages us from using the injured body part, helping to prevent further injury and enabling it to heal more quickly (it also acts as a deterrent because we're less likely to repeat doing whatever caused the pain). Chronic pain, on the other hand, does not serve a purpose. It is insidious and persistent, continuing long after whatever initially caused the pain has fully healed - when there is absolutely no reason for it to still hang around. Chronic pain is incredibly complex and it affects every aspect of an animal's life - from their physical capabilities to their emotional health. 

I am not an "expert" on chronic pain - not even close! - but I have learned a lot in the past several years...And the nearly 5-years I have spent as a team member at Canine Arthritis Management has certainly helped, too! I don't have any grand answers as to how we solve this chronic pain epidemic in our four-legged companions, but I have some ideas as to how we can help fight it so that we start to catch pain earlier.

1. Educate ourselves and others. If we improve our knowledge of how chronic pain may present in our pets, we are well on our way to identifying it earlier in the disease process. One of the most common misconceptions I have come across in my career is that animals will vocalize if they are in pain - 'Well, she never yelped, so I don't think it hurt,' or, 'He never cries out, even when he's limping!'

Now, if I were to step on my dog's tail (accidentally, of course!), he likely would let out a little yelp. But hang on - that's acute pain, not chronic. Let's think about this from a human's point of view for a moment. Like I'm sure many of you have, I have been afflicted by chronic pain in my lifetime. Whether it is low-intensity or high-intensity pain, it is relentless. Sometimes, every movement hurts. Do I say, "Ow!" every time I move? Nope. So, why would our dogs?

Let's take my dog, Piccolo, as an example. As some of you may know, he has a rather traumatic past. I didn't know this when I adopted him, but he was likely hit by a car in his past life. The left side of his pelvis is crushed inwards, with healed fractures in the acetabulum (hip joint), which predisposes him to early onset osteoarthritis (OA) in that joint.

He also has IVDD (intervertebral disc disease), as well as OA in his left carpus. The radiograph on the right is of his pelvis and hips, taken earlier this year - just look at how crooked that pelvis is! Now, with that lovely little laundry list of chronic problems, has he ever let out a yelp of pain? Never. His gait is abnormal, yes, but he has never vocalized from his chronic pain - even when skipping strides with a hind limb due to nerve pain. He has his own personal pharmacy now to make sure his pain is well-managed, but prior to our getting on top of his pain, he was depressed. He wasn't really all that interested in going for walks. And when he did go out, he usually moved at a snail's pace. He didn't play with his toys much at all. He would just sleep the day away - or lie around in his bed looking sad. It was heartbreaking. But he never made a peep.

Long story short, if Piccolo can teach us anything, it is that we need to move away from expecting our dogs to vocalize if they're in pain. They tell us in myriad other ways - admittedly, many of those ways are often subtle, or intermittent, or even difficult to pinpoint - but they do tell us. We just need to learn how to understand them! 

So, how do dogs indicate that they are in pain? That very much depends on the individual dog! We often expect to see lameness, but in reality, dogs generally do not limp until the pain is quite severe - Dr. Chris Zink has previously said that pain is likely a 6-7/10 by the time a dog shows visible lameness. Again, it is the subtle signs we need to look out for!

Some common signs of chronic pain in dogs include:

• Stiffness or "slowing down"
• Licking or chewing at limbs or joints
•  Changes in  posture (e.g., sloppy sitting)
• Behavioral changes (e.g., reactivity to dogs/people/handling, becoming more aloof, new phobias, etc.)
• Noise sensitivity (e.g., suddenly developing sensitivity to thunder)
• Restlessness or inability to settle
• Difficulty sleeping at night (e.g., panting, pacing, frequent changes of position)
• Changes in coat pattern or color (e.g., developing new whorls, fur that doesn't lie flat, etc.)
• Sleeping more

(For a more exhaustive list of potential signs of pain in our pets, please head over to Canine Arthritis Management's website via the button below.)

If you noticed a few of the items in my list above are in bold, it's because those are, in my opinion, some of the signs that are most commonly overlooked or dismissed. Stiffness and/or slowing down do indicate potential pain. It is important to remember that age is not a disease. Osteoarthritis (OA), however, is a disease, and a very common one at that - it affects at least 35% of all dogs. Its most common cause is developmental joint disease, which further means that it is a young dog disease - yet 50% of dogs with OA are not diagnosed until 8+ years of age! A recent study by North Carolina State University found that 40% of dogs between the ages of 8 months and 4 years have arthritic joint changes visible on radiographs. So, yes, young dogs can have arthritis, and we all need to be more cognizant of that fact. Developmental joint diseases such as hip dysplasia can be diagnosed from a very young age, so if something seems off with your puppy, it is very much worth having a discussion with your veterinarian and investigating the cause. 

Identifying Signs of Pain

Another awesome resource from CAM is this short course - 'Is My Dog in Pain?' It offers resources and info on collecting data and photos/videos for your vet that can aid in the diagnosis process.
​You can sign up for FREE at the button below.

'Is my dog in pain?' course

Now, when it comes to our performance dogs, yes, we may see any or all of the signs listed above, but there could also be other signs that are more sport-specific. A really common one that is often dismissed as a training issue is the dog avoiding, refusing, or struggling with certain obstacles in agility. This may start suddenly - a dog that previously loved doing the A-frame begins running around it rather than going up it - or it could be more of a gradual onset. Sometimes undiagnosed pain is mistaken as a behavioral/anxiety issue - perhaps the dog shuts down in the ring, or shuts down after only certain obstacles. Or instead of running with their handler, the dog ignores them and sniffs the floor. These are all potential indicators of pain - that doesn't mean that they are necessarily pain-related, but it does mean that we should always rule out pain rather than assuming it is a training or behavioral issue.

Sometimes it is far more subtle - the dog begins popping out of the weaves at pole 10, but not with every repetition, only every so often. Maybe the dog struggles with tight turns, but only in one direction. Maybe a dog that always loved their favorite sport isn't quite as enthusiastic anymore, but still participates because their handler asks them to. There's an infinite variety of ways that dogs may show us they are hurting, we just need to be open to the possibility and try to remain as observant as possible - both while participating in sports and at home. It is a bit like a jigsaw puzzle most of the time - a bunch of small, sometimes seemingly unrelated, pieces fitting together to make the full picture. 

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2. Screen our dogs for signs of pain regularly. Once we know what chronic pain might look like in our pets, we can remain vigilant for it​. I'm not suggesting we all need to become "helicopter parents" - let's not make this into an unhealthy obsession with looking for pain! What we can do, though, is pay attention. Regardless of whether your dog is an athlete or a couch potato, you can do the following every 6 months:

1. Take photos of your dog standing, sitting, and lying down - from in front, behind, and both sides. (Make sure the footing is grippy so that their legs aren't slipping out to the sides during the sit and down photos!)
2. Record videos of your dog walking and trotting - from the front, behind, and at least one side (ideally, both). If you can also record videos of your dog turning in a circle to both the left and the right, that's a great add-on to include.

This should all be done on a level surface - ideally, on a completely flat surface like pavement, or in a building. The photos and videos should be taken from the dog's level, not from our level. If you don't have someone to help you record, tripods that work with mobile phones are pretty cheap ($15-20) and work great for this sort of thing. 

These photos and videos will give you a baseline - something to compare to down the road if something starts to seem a bit "off." They can help you catch things early - maybe 6 months ago, your dog had a perfect sit, but now their right hind limb is a bit off to the side. When they're standing, the paw pads of the right hind limb aren't fully in contact with the floor - just the slightest offloading of the limb. It's really subtle, but it's a change from their normal posture, and now you can't stop seeing it every time they sit or stand. And maybe the hamstrings on that side look a bit "lacking" compared to that muscle group in the left hind - could that be some muscle atrophy?? 

In addition to paying attention to their posture, physical appearance, and gait, and making sure that we're keeping tabs on any changes there, we also need to pay attention to their behavior. Are they becoming a bit more anti-social? Have they developed a new reactivity to dogs or people? Are they just a bit slower to get going in the morning? Have they suddenly become scared of thunderstorms or the sound of planes flying overhead? If you notice anything that's new or different, write it down - it doesn't have to be anything fancy, just a little note in a phone app or a scribble in a notebook. These could all be pieces of the puzzle. 

Look at their capabilities - has your dog started going up the stairs more slowly, or have they started rushing down the stairs as fast as they can go? Are they hesitating before jumping up onto the couch or into the car? Do they self-stretch - both front and rear? Is it a full extension stretch on both sides, or do they sort of stop at a certain point during the stretch? What about shaking - is it a full body shake, or does the shake just "end" at a certain region or body part? Capability change is a big indicator of pain. Again, make note of anything you see that is different.


3. Say something. If you see something, say something. This goes for whether you are a pet parent or a canine professional like a trainer, groomer, or dog walker.

If you are a pet parent and have concerns about your pet, speak to your veterinarian. Come prepared with your photos, videos, notes. Believe me, you will make their day with all that data and information to work with! 

If you are a canine professional, do not be afraid to speak up and voice your concerns. Obviously, we need to work within our scope of practice, but if we see something that seems off - whether gait, behavior, or a growing pattern of "little" things - it is our duty as a canine professional to bring it to the attention of the pet parent and advocate for their pet.

Now, it can sometimes feel a bit intimidating to take your concerns to your veterinarian - or even to discuss your concerns with the pet parent as a canine professional. This is where tools can really help. Canine Arthritis Management has a whole host of free resources on their website to help with the identification (and long-term monitoring) of pain. I especially recommend utilizing the 'Suspicion of Chronic Pain Observations Form', which breaks down your observations into four categories of changes - behavior, posture/physical appearance, capability, and gait. You don't need to use technical jargon, just write down what you have noticed in your dog and bring that form along with you to the vet appointment (and/or email it to them prior to the appointment). If you are a canine professional, you can also fill out that form and give to the pet parent for them to take to the vet appointment. It really helps to distill everything into clear categories - and it takes the onus off of you to remember everything during the consult. 

What do I want you to take away from this blog post? Simply this: we, as human beings, are really not good at detecting pain in our animals. We know this. So, what we can do is educate ourselves so that we are more likely to recognize potential signs of pain. We can then take that knowledge and apply it by monitoring our own dogs regularly, collecting data on a consistent basis so that we have a better chance of catching pain early. And lastly, when we have concerns about our dog, we should not be shy of reporting our concerns or any other abnormalities to our dog's veterinary care team. Bring your collected data with you, bring your notes and/or a Suspicion of Chronic Pain Diagram with you, and have an open discussion with your veterinary care team about your dog. I can assure you they do not want your dog to be in pain, either - veterinary professionals entered that (incredibly tough) profession because they love animals and want to help them live healthy, happy lives. They are there to help you, and would much rather investigate your concerns and find nothing (yay!) than have your dog potentially suffer for months or years with undiagnosed chronic pain.

Advocate for your pet. You are all they have. 💜🐾

CAM downloadable resources

The IVAPM also has a number of resources available on their website that you can access below.

IVAPM resources