In the words of the philosopher and ethicist, Bernard E. Rollin, “both human and veterinary medicine can no longer ignore the moral and medical dimensions of felt pain.” But pain medicine in the veterinary profession is still a “touchy” subject.
On the one hand, more veterinarians are expressing interest in learning how to recognize and definitively treat pain; the International Veterinary Academy of Pain Management now offers certification in this field. And the lead author of the Association of Shelter Veterinarians’ guidelines for spay-neuter programs recently wrote, “[W]e acknowledge that analgesia [should] be provided to each animal independent of economic status of the program.”
On the other, however, some veterinarians still cling to the outdated notion either that animals don’t feel pain (ouch!) or they think that instituting pain control after surgery adds too much cost or takes too much time (although neither argument holds water). Some merely forget to think about it, having become desensitized or never truly appreciating how animals express pain, therefore ignoring how much pain they may cause with spays, neuters, and orthopedic surgeries or amputations, such as declaws.
Fortunately, more veterinary hospitals and animal shelters are agreeing that leaving animals in unmitigated pain is inexcusable. A wide variety of safe, inexpensive, and effective analgesic (pain relieving) options exist; treating pain successfully may include non-drug measures as well such as acupuncture, massage, and cold packs, in addition to medication.
At our Center for Comparative and Integrative Pain Medicine at Colorado State University, we welcome the evolution of veterinary medicine into a kinder, gentler profession in which practitioners no longer regard adequate pain management and the ethical treatment of animals as irrelevant to veterinary medicine.
Sometimes, though, the progress seems slow. It’s hard to change the minds of those who either don’t know or don’t care about treating pain. This is not unique to veterinary medicine; the same holds true in the human field. The difference, though, is that most humans can tell their doctor where they hurt.
Because the majority of non-humans cannot utilize the English language to inform us if, let alone where, they hurt, a vast amount of pain goes unrecognized. We may misinterpret a reluctance to go on walks as stubbornness instead of our dog telling us it hurts too much to go on a run today. When our older cat urinates outside of the litter box, could he be telling us the sides are two steep and his hips too painful to make it over time and again?
In order to alert the public to the cues their companions are giving about pain, my pain medicine colleagues and I developed a bookmark from our center that lists the Top Five Telltale Signs of Pain. We did this to empower people to detect pain in their own animals so that they can bring this to their veterinarians’ attention.
To get you started, then, here is our list on the “Top Five Telltale Signs of Pain,” based on our experience treating small animals in our pain practice at CSU:
1. Postural changes
- To begin with, look at your dog or cat. Is the back hunched up or sunken down? Back pain is a big problem in our four-legged friends. You might notice that midway down the back, just past the ribs, the back arches up. Press gently but firmly on either side of the spine, for several inches above and below this spot. Does he or she wince, look around at your hand, or sink down? Does the tissue feel ropy, or is there muscle atrophy (thinning) in the area? This is an especially common issue for geriatric animals; the disks between the vertebrae and the ligaments holding them in place deteriorate over time, and spinal cord compression, compromising neurologic function, could start to appear. Also check the lumbosacral junction, just ahead of the pelvis where the back ends and the sacrum begins. This is another common location for disk disease, arthritis, and nerve compression.
- Have you noticed that your dog walks with his head down? When was the last time he looked up to see what you were doing? If you hold a treat in front of him while he is sitting, does his neck only extend (bend backward) so far and then stop, causing him to follow the cookie with the eyes only? He could be having neck pain. If so, you may also find that the neck feels tense and thick. Have him eye the cookie as you bring it to the right and then the left, and notice if he turns more readily to one side than the other. Does he engage his body to turn to follow the morsel after a certain point? When it becomes too painful to turn the head by bending the neck, they will then use their body to complete the motion.
- Has your dog or cat become “rickety”? Do they walk with a stiff, painful-looking gait, reluctant to bend the limbs, neck, or back? Arthritis causes pain in our four-legged friends like it does in us, but be careful about assuming that everything that causes stiffness and soreness must be stemming from arthritis. Other problems can cause pain in older animals, including cancer and spinal cord injury. Treating pain appropriately first requires establishing a diagnosis. This may entail taking a radiograph (x-ray) but most certainly should include a neurologic and orthopedic examination by a veterinarian.
- Finally, look for other features of pain as well, such as asymmetry in gait (right versus left), indicating a painful limb. If the head bobs up and down when walking, your dog or cat could have a painful forelimb; the head drops down when the less painful limb strikes the ground. This takes the weight of the foot strike off of the hurting limb.
2. Activity changes
- All too often, a decline in activity becomes misinterpreted as “just getting old” or worse, “she’s a lazy couch potato”. Before counting couch-sitting as simply a life-style preference, think about times earlier in life when she may have bounded up and down stairs, begged for walks, and sought play with others of her species. Has that changed over the years? For cats, especially, no longer jumping on chairs or other objects can be a clear giveaway that he’s in pain.
3. Mood changes
- How do you feel when you hurt? Do you want to interact and be sociable, or do you withdraw? Does pain make you anxious, irritable? Do you become less affectionate, not able to reach out to others because you are lost in your own world, enveloped in your discomfort? Like you, your animal members of the family react emotionally to pain, stress, and other forms of discomfort. Be understanding and instead of retaliatory, and check with your vet not only about pain, but also about cognitive dysfunction and internal medical disorders.
4. New habits
- What else might have changed in the past year? Do you notice that your dog or cat keeps licking a certain area? Are they panting at night, unable to settle down? Does he cry or groan when shifting position? Has it become more difficult to keep him clean or brushed because he will not tolerate touch? All of these can point to pain.
5. Changes in Daily Habits
- Animals that hurt lose their appetite and cannot rest comfortably. They shift positions constantly and may find it difficult to adopt a suitable posture to urinate or defecate. Abnormalities in the activities of daily living such as eating, sleeping, pooping, and peeing show us that something isn’t right. Whether due to pain or some other cause, it’s worth looking into sooner rather than later, when the problem may no longer be treatable.
Identifying pain is merely the beginning. Treatment options include drugs (anti-inflammatories, anticonvulsants, opioids, etc.), interventional pain medicine procedures (e.g., nerve blocks, joint injections), herbs, supplements, lifestyle changes, and physical medicine modalities such as acupuncture, massage, heat, and cold.
A “multimodal” pain management approach institutes an array of options because when an animal has chronic pain, starting out with only one approach may be insufficient. Your animal will reap the benefits of a treatment plan tailored to the source and type of pain.
How will you know it’s working? Re-take the pain inventory described above a week or two after treatment begins. You should start seeing a difference.
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A week after notifying retailers, Wysong Pet Foods just put a notice on their website about a recall. Via Therese at 
From Edie Lau and the VIN News Service, this odd report:
I’ve always been a rather neurotic hand washer, even before I had non-specific hepatitis not once but twice (once idiopathic, once from a blood transfusion). I hate anything sticky on my hands, and so I wash after eating an apple or something that drips, or after cleaning the kitchen or bathroom. Knitting dries my hands. Sadly, thanks to genetics I also have fairly dry skin.