Recognising pain is very important because our pets are unable to speak up for themselves, so it is down to us as vets and owners to interpret their behaviour.
Many animals have evolved to hide pain and suffering from others, but just because they are not expressing pain in the same way as us, does not mean they are pain-free. It is part of our duty of care as vets and owners to ensure our furry friends are happy and comfortable, which means we must relieve pain should it arise, and use preventative care whenever a painful incident is suspected.
The following pain score chart can be used to help determine if your dog is in pain. This form should be brought to your vet for discussion.
Dog Chronic Pain Score Chart
How do I complete the Dog Chronic Pain Score Chart?
Dogs can be very stoic, and they do not display pain the same way as people. The Pain chart is a short questionnaire which aims to identify signs of arthritis, monitor response to treatment and hopefully improve your pet’s quality-of-life.
As owners you often have a much better impression of your pet’s overall mobility and enjoyment of life at home that we can gauge during a consultation, so this allows us to see how your dog is doing over a longer time period.
- The first section deals with the level of pain your pet has been experiencing over the 7 days. Please score each question from 0 (meaning no pain at all) to 10 (meaning very severe pain)
- The second section deals with how this affects their day-to-day activities (general activity, being able to get up, walk, run, manage stairs etc)
- Please score each section from 0 (meaning does not interfere at all) to 10 (completely interferes)
- The third section is your general impression of your dog's quality of life, from poor to excellent.
There are no right or wrong answers to any of the questions, just go with the response that feels best to you. Try to answer as many of the questions as you can, but do not worry if you feel some do not apply to your pet.
We will use this information to try and determine if your pet is showing signs of arthritis and to see if further treatment is required. Please bring the completed chart to your next appointment.
What are the benefits of treating pain?
Treating pain has many benefits both in the short and long term. Pain is never beneficial and has a big impact on quality of life, we are all happier with a life free from pain!
Pain can cause behaviour changes such as depression, lethargy and even aggression. It also causes stress, which lowers the immune system and can cause delayed wound healing. Reduced mobility due to pain can lead to ulcers (bed sores) and urine scalding. An animal in pain is be less likely to eat, which can lead to weight loss, muscle wastage and electrolyte imbalances.
Acute pain when left untreated can develop into chronic pain, which can be more difficult to manage. Repeated painful experiences can cause 'sensitisation', which means that a normally non-painful event can provoke a pain sensation. It can also lead to long term behavioural changes.
Therefore, here at Maven we use a variety of techniques to reduce pain, both in the hospital and at home. We want our patients to have a positive experience when they come to us, which involves making their visits as comfortable and enjoyable as possible.
How do dogs show pain?
It can be hard to recognise the signs of pain in dogs, particularly in stoic animals. Chronic pain associated with arthritis or dental disease can sometimes be mistaken for 'normal old age', but when treated for these conditions the quality of life of your dog can be significantly improved. Not all dogs will express pain in the same way, so the list below is a guideline only. Pain can be caused by a wide variety of illnesses, trauma or following surgical procedures.
If you are concerned your dog is in pain, please DO NOT give any human medications (paracetamol, ibuprofen, naproxen) as these can be toxic to dogs.
If you have any painkillers at home from a different condition or a different animal, please contact the clinic for advice before using them as they may no longer be appropriate.
Signs of acute pain in dogs (e.g. after trauma or surgery):
- Agitation (restlessness/not able to settle, pacing)
- Vocalisation (crying, howling, growling)
- Behavioural changes (aggression, hiding or antisocial behaviour)
- Reduced appetite
- Excessive grooming (licking of painful area)
- Limping or reduced activity
- Rapid shallow breathing
Signs of chronic pain in dogs (e.g. osteoarthritis, dental pain, chronic illness):
- Reduced activity (slowing down on walks, reduced tolerance for exercise)
- Difficulty performing everyday movements (difficulty rising/standing, taking stairs or jumping up)
- Reduced appetite and weight loss (reduced appetite, especially with dry or hard foods can be a sign of dental pain, although many animals with dental disease will continue to eat)
What medical treatments are available to help manage pain in my dog?
Drug Therapies include:
Non-Steroidal Anti-inflammatory Drugs (e.g. Loxicom, Carprieve, Previcox)
These drugs manage inflammatory pain and come in injectable and oral forms. They are very useful not only as part of the treatment for acute pain, such as after trauma or surgery, but they are also very important in the management of chronic conditions such as osteoarthritis.
Precautions and possible side effects: The main side effects of these drugs are vomiting and diarrhoea, but in rare cases they can cause ulcers in the stomach or intestines. These medications generally must be given with food to reduce the likelihood of this side effect. If your pet is not eating, or develops vomiting or diarrhoea, please stop this medication and call the clinic asap for advice. These drugs must be used with caution in patients with liver or kidney disease, and we recommend animals that are on these medications long term receive regular health checks and blood tests to ensure that these drugs are still suitable.
Opioids (Methadone, buprenorphine, fentanyl, tramadol)
These are strong pain killers that are very important in the management of acute pain. They are generally available only as injections, but some oral or topical forms are available. All animals undergoing procedures at Maven Vets will receive a strong opiate, usually methadone, before surgery. They are frequently reassessed for pain during and after the procedure and additional doses are given as required. For more invasive procedures, such as orthopaedic surgery or major abdominal surgery, we often keep patients in for at least 24hours so that appropriate pain relief can be given. We also sometimes use long acting pain relief patches (Fentanyl patches) to give lasting opioid pain relief at home. The oral forms can be very useful for managing pain at home, either in addition to NSAIDs for severe pain, or instead of NSAIDs in patients that cannot tolerate them.
Precautions and possible side effects
The main side effects are sedation (sleepiness, wobbliness) and nausea or vomiting. We reassess our patients regularly in the hospital for this and adjust doses accordingly. These drugs are generally safe to be given to older patients and patients with liver or kidney problems.
These completely block all sensation including pain so are one of the most effective ways to manage acute pain. At Maven Vets we use local anaesthetic injected into the gum prior to all dental extractions, using long acting drug that lasts 4-6 hours. We also use local anaesthetic during invasive surgeries such as orthopaedic surgery and large lump removals. In some cases, we place an indwelling drain so local anaesthetic can repeatedly be applied to the painful area, providing long lasting pain relief.
Precautions and possible side effects: these medications generally have few side effects. They can cause transient irritation at the site of application, and in rare cases allergic reaction.
What non-medical treatments are available to help manage pain in my dog?
Non-medical treatments include:
Nutraceuticals (joint supplements e.g. Nutraquin, Nutraquin +)
Increasing intake of essential fatty acids, and supplements containing glucosamine and chondroitin have been shown to help support joints and increase comfort levels in dogs and cats with osteoarthritis. This can help to reduce the dose of drugs that are required to control pain, therefore reducing the chances of drug-related side effects. There are a variety of products available and we would be happy to discuss them with you at your next appointment should you have any questions.
Often animals that are experiencing pain will require additional TLC at home, such as extra padded bedding, raising food and water bowls to make them easier to access, and ramps or steps to help them into the car or onto furniture. In some cases, for example after fracture repair surgery, we may recommend restricting their movement by keeping them in a cage whilst they heal, or they may need to be on a special exercise program.
Therapeutic exercise can be used in cases of osteoarthritis or after surgery to rehabilitate the muscles and reduce pain. We refer our patients to Joanne Boddy Bsc MCSP SRP Category A ACPAT.
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There is growing evidence that acupuncture can be very useful as part of the treatment for chronic pain in both cats and dogs. At Maven we can arrange to refer your pet for acupuncture if this is appropriate.