Most dog owners miss subtle signs of pain. How can veterinarians help?

Many of your clients may be unknowingly allowing their dogs to suffer in silence.

A new peer-reviewed study in PLOS One reports that fewer than half of dog owners correctly identify subtle behavioral changes as likely indicators of pain. Researchers from Utrecht University in the Netherlands say the findings have important implications for veterinarians, who depend heavily on owner-reported behavior changes when assessing pain in canine patients.

The investigators surveyed 530 dog owners and 117 non–dog owners using an online questionnaire. Participants were asked to:

• Rate how likely 17 specific dog behaviors were to indicate pain
• Evaluate 3 written case scenarios describing dogs with varying degrees of pain-related behavioral change

When presented with obvious signs (a dog hopping on 3 legs, favoring a limb, or showing reduced enthusiasm for exercise), owners performed pretty well. In a case describing overt, movement-related pain (a dog with patellar luxation), 97% of dog owners correctly identified pain as a likely motivation for the behavior.

Performance dropped sharply when the pain signs were more subtle. In a scenario describing a dog with panosteitis, whose behavior included increased clinginess, shadowing family members, nighttime restlessness, and a shorter-than-usual walk, only 53% of dog owners rated pain as a likely explanation. Non–dog owners did not perform better, with 55% correctly attributing the behavior to pain.

Subtle signs owners commonly miss

The study identified several behaviors that owners frequently failed to connect with pain, including the following:

• Shadowing or closely following family members (increased attachment behavior)
• Restlessness at night
• No longer lying in a curled-up position

• Shortening walks or reduced willingness to exercise
• Yawning
• Nose or lip licking
• Air sniffing
• Turning the head or body away
• Freezing
• Fluctuating mood
• Changes in coat appearance or increased grooming
• Increased blinking
• Increased scratching

By contrast, behaviors more readily recognized as pain-related included hesitant paw lifting, personality changes, and reduced play.

Why owners may be missing the signs

One explanation the researchers offered is that dog owners may have learned to associate certain subtle behaviors with stress or fear rather than pain. Behaviors such as turning the head or body away and freezing—both of which can be signs of discomfort—were rated by dog owners as less likely to indicate pain than by non–dog owners, suggesting that familiarity with canine body language may lead owners to default to stress-based interpretations.

The 3 behaviors participants were least likely to recognize as pain signs were yawning, nose licking, and air sniffing—all behaviors that overlap significantly with stress signaling in dogs, potentially contributing to owner confusion.

Among the subtler signs evaluated, behaviors like changes in personality, hesitant paw lifting, and fluctuating mood were more readily associated with pain. Reduced play was also recognized at higher rates, consistent with prior research.

Experience shapes recognition

The study identified 2 factors associated with better pain sign recognition: the owner’s personal history of painful illness or injury, and prior experience with a dog that had undergone a painful medical event.

Dog owners who had previously experienced pain themselves were more likely to rate a dog’s changed personality, increased blinking, and yawning as possible pain indicators. More strikingly, owners whose dogs had previously gone through a painful event showed significantly higher recognition of subtle pain signs across multiple behaviors, including changes in coat appearance, increased grooming, reduced play, and altered expression.

The researchers suggest this may reflect brief educational interactions that occurred when veterinarians treated the dog’s painful condition, underscoring the value of client communication at those moments.

How veterinarians can help

The study points to a clear opportunity for veterinary teams. If subtle pain signs are routinely missed or misattributed at home, dogs with conditions like early osteoarthritis, inflammatory bone disease, or chronic soft tissue pain may go weeks or months without appropriate intervention or even a veterinary visit.

The researchers call for educational tools specifically designed to teach dog owners how to recognize early, subtle pain signals—before a dog’s suffering becomes obvious enough to be unmistakable. They note that even brief educational interventions have been shown in prior research to improve the owner’s ability to recognize pain-related behavioral changes.

For clinicians, this research reinforces the value of proactively walking clients through subtle pain signs at wellness visits and during treatment of painful conditions, not just when overt lameness is already present. Clients who understand what to look for are more likely to return sooner when something is off.

“We suggest that dog owner education also addresses dog pain recognition, with a particular focus on subtle pain signs,” the authors conclude. “In doing so, dog owners may be provided with early warning signs of pain, and such early recognition may benefit dog welfare and prevent behavioral problems, including unwanted aggression.”

Reference

Gardeweg SMA, Picard DE, van Herwijnen IRV. The abilities in dog pain sign recognition as assessed by presenting seventeen listed dog behavioural signs and three case descriptions to dog owners and non-dog owners. PLoS One. 2026;21(4):e0344512. doi:10.1371/journal.pone.0344512