Speaking for our canine patients: How to find and communicate signs of chronic pain

February 9, 2021
Kate Boatright, VMD

dvm360, dvm360 March 2021, Volume 53,

Identifying pain in a dog and discussing it with owners can be difficult, but proper pain assessments will improve your canine patients’ quality of life.

Veterinarians are keenly aware that many patients present with signs of pain that may be unrecognized or misinterpreted by the owner as normal aging. During a recent Fetch dvm360® virtual conference, Michael Petty, DVM, owner of Arbor Pointe Veterinary Hospital and Animal Pain Center in Canton, Michigan, discussed how veterinarians could better detect pain in their canine patients and communicate this pain to owners. Owners “see their dog every single day, and many painful behaviors can become the norm for that owner to observe,” he said.

Addressing owner misconceptions and concerns

There are many reasons why owners may not realize their dog is in pain, and it is the veterinarian’s responsibility to show them what we are seeing. Petty started by dispelling common myths surrounding pain in dogs.

Many veterinarians have heard owners say that their older dog can no longer do a particular activity, such as jump on the couch, followed by, “Well, at least they’re not in pain” because the dog is not vocalizing. But, as we watch the dog walk around our exam room with a stiff gait or struggle to rise, we know the truth. Silence does not signify the absence of pain. Although dogs will vocalize in an acutely painful situation, they rarely convey when pain is chronic.

Another common misconception is that the dog is just getting old. Petty noted that old dogs can still do the same activities as younger ones. They lose muscle mass over time, just like humans, so they must do these activities at a lower level, but many older dogs still want to run and jump and go for walks. Chronic pain is what keeps many of these dogs from doing activities they previously enjoyed.

In some cases, owners are aware that their pet is in pain, but worry that medications aren’t safe for older pets. This is our chance to educate clients that many medications are, in fact, safe but that alternative therapies exist as well, such as physical therapy and acupuncture, Petty said.

Finally, some owners are concerned about their budget and whether they can afford to treat their dog’s pain. According to Petty, there are 4 budgets that we deal with in each case: emotional, physical, time, and money. One of the great things about veterinary medicine is that we can often do something for the pet to help ease its pain and stay within the owner’s financial constraints.

Finding pain in our patients

Before the exam

Before we can show an owner that their pet is in pain, we must find it. Detecting pain starts as soon as the patient arrives at the clinic, and all members of the veterinary team play a role. When patients enter the clinic, team members should observe how they walk. Do their hind feet scuff on the floor? Do they lag behind the owner? How do they take a step, such as over a curb in the parking lot? Team members can pass this information on to the veterinarian prior to the exam.

The next step is to screen for pain using chronic pain scales. “It is always important because pain might not be obvious to the client or to you,” said Petty. “It is always obvious to the dog or cat in pain, but they may not care to show it.”

Several validated pain scales exist. Veterinarians should select a scale that is easy to use and designed specifically for dogs in chronic pain situations, such as the Canine Brief Pain Inventory1 or Liverpool Osteoarthritis in Dogs.2 The client questionnaire portions of these scales can be used to screen for signs of pain that may not be observed in the clinic. Veterinarians can use pain scales along with the examination as a part of the new Canine OsteoArthritis Staging Tool,3 which allows them to assess for early risk factors and monitor patients throughout their life for the advancement of disease and assessment of therapy.

The pain exam

Once initial observations and screening questionnaires are completed, the veterinarian can perform a thorough pain examination. Once the veterinarian becomes skilled at this exam, it can usually be performed in a matter of minutes as part of a thorough physical. Petty offered several tips for how to perform a pain exam on canine patients:

Except in the case of very small dogs, pain examinations are best performed with the patient on the floor.

Observe the patient’s stance and how they rise from the floor. A nonpainful dog will jump up with all 4 limbs nearly simultaneously. A dog with hind end pain will stand with front limbs first, then pull the rest of the body to a standing position.

Many dogs will shake their body after rising. A normal dog will shake from nose to tail, whereas a dog in pain will stop shaking their body at the painful location.

Start by petting the dog to help it relax and to generally feel for areas of heat or sensitivity.

Assess passive range of motion in each limb. Multiple joints can be assessed together by moving the limb, and placing a hand or finger over the joint can allow you to feel for the presence of crepitus.

Don’t forget to check the toes and look for signs of scuffing in the hindlimbs. This will be most notable on the nails of the middle digits, which may be worn down.

Check for spine and neck pain. An easy way to assess neck pain is to hold a treat, move it around, and watch how the patient moves its neck and head to follow the treat.

If a patient is too aggressive to examine, reschedule for a day when an oral premedication can be given. It is also okay to perform the exam and radiographs under full sedation, but there are some pain responses you won’t be able to assess in these cases.

The final step in confirming pain in canine patients is diagnostics.

“Radiographs are the number one diagnostic tool we have to find a problem, confirm our clinical impression, and convince the owner that their pet is painful,” Petty said. He encouraged veterinarians to show the client the radiographs, point out abnormalities, and even consider sending them a copy of the image with markings on it to show concerning areas along with a written explanation of the findings.

For the good of our patients

It is in our patients’ best interest that we identify pain early so we can intervene and improve quality and quantity of life. By building confidence in our skills to detect pain and communicate it clearly with owners, we can discuss treatment options. By treating our painful patients, we will not only improve the quality of their life but also the strength of the bond they share with their owners.

Kate Boatright, VMD, a 2013 graduate of the University of Pennsylvania, is a practicing veterinarian and freelance speaker and author in western Pennsylvania. She is passionate about mentorship, education, and addressing common sources of stress for veterinary teams and recent graduates. Outside of clinical practice, Boatright is actively involved in organized veterinary medicine at the local, state, and national levels.

References

  1. Brown DC. The Canine Brief Pain Inventory. 2017. Accessed, February 2, 2021. http://www.vet.upenn.edu/docs/default-source/VCIC/canine-bpi-user's-guide-2017-07
  2. Liverpool Osteoarthritis in Dogs (LOAD). University of Liverpool. December 2013. Accessed February 2, 2021. https://mjhassoc.atlassian.net/jira/servicedesk/projects/CED/queues/custom/307
  3. Cachon T, Frykman O, Innes JF, et al. Face validity of a proposed tool for staging canine osteoarthritis: Canine OsteoArthritis Staging Tool (COAST). Vet J. 2018;235:1-8. doi:10.106/j.tvjl.2018.02.017
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