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By Tari Kern, DVM, CCRP, CVMA, CVSMT

September is Animal Pain Awareness Month, established by IVAPM (International Veterinary Academy of Pain Management).  You might be wondering why the pain recognition in animals needs to have its own month?  The answer is simple – animals are extremely good at hiding signs of pain.  Some animals are very stoic and suffer in silence, especially cats.  Other animals may show signs of pain, but they can wax and wane which makes it confusing to know if they are in pain – an example is an on/off lameness.

How to do you know if your pet is in pain?

The signs of pain in pets can be variable and sometimes even absent.  Generally, we recommend that you watch for subtle such as changes in your pet’s behavior, activity level, and/or appetite.  Additionally, showing less interest in interactions that they usually enjoy, over-grooming (licking excessively in a particular area) or lack of grooming, difficulty walking or rising from a down, acting fearful, or limping should raise concerns for possible pain.  Please check out the link to the Pawsitive Steps Rehab Pain management webpage for more information.  IVAPM has also developed good tools to assess if your pet may be experiencing pain (Dog Pain chart, Cat Pain chart).  Finally, if you think that something your pet is experiencing might hurt you, it probably hurts them too.  Examples of this would include falling down stairs, etc.

Wouldn’t your veterinarian know right away if your pet was in pain?

Not necessarily, pets are often even more on guard at the veterinarian’s office.  Plus, many dogs in particular get excited for car rides, so the adrenaline of the adventure out of the house can mask pain too.  Cats get really scared at the veterinarian’s office and they often refuse to move at all at the clinic, so it is harder to assess them outside their own home environment.

These reasons prompt your vet and their staff to often ask questions to delve deeper into some subtle cues your pet provides or something that you may say at the office.  Always remember that you are a very important part of your pet’s health care team and your vet needs the best information that you can provide whenever your pet seems “off”.  Sometimes it would be helpful to take video on your phone or camera to help your vet see what your pet does at home.

So what can we do about pet pain?

The first step in making your pet become more comfortable is a visit to your veterinarian.  A physical examination will need to be done and possibly some other testing, like x-rays or blood work.  Once the source of pain is identified, a plan can be started to reduce the discomfort.  Pain medications (pharmacologic treatment for pain) may be started by your veterinarian either for a short trial period or longer depending on the cause.  Sometimes nutritional supplements may be recommended if your pet has joint pain.  Depending on the diagnosis of the cause of pain, referral to another veterinary specialist may be recommended, like an orthopedic veterinary surgeon or a veterinary neurologist.

Additionally, there are several other treatment options available to help pets in pain from other veterinary professionals who practice rehabilitation therapy, holistic and/or integrative veterinary medicine.  These veterinarians may use treatments that are more “outside the box” of traditional Western medicine.  These treatment options may include physical medicine modalities and exercises, acupuncture, massage, Veterinary Spinal Manipulative Therapy (VSMT aka “animal chiropractic”). Holistic veterinarians may use herbal therapies and Traditional Chinese Medicine (TCM) to help alleviate pain.  It is important to note that animals can respond differently to herbs than people and some things that are safe for us can be quite toxic to animals, so never try herbs or supplements that you might use yourself unless a veterinarian has indicated that a therapy is safe for your pet.  The treatments recommended will vary depending on the pet’s diagnosis, severity of pain and duration of the problem.

Why should we worry about addressing low grade pain in pets?

It is easier to address pain in its early stages, rather than after pain wind up has occurred.  Every joint has millions of joint receptors which send signals to alert the brain of a problem.  If there is long standing chronic pain, eventually the body can no longer compensate and the brain starts believing that the pain is unbearable.  Sometimes the nerve receptors cause the source of the pain to be mistaken as a different location than the original site too.  Imagine having a charlie horse in your calf which doesn’t stop or back pain that keeps you awake.  Our pets can experience the same types of things over time, which is sad because it can be helped…if it can be identified and treated appropriately.

So how would exercise help pets in pain?

Low impact exercise is one of the best ways to manage arthritis pain.  Seems a little odd, but keeping sore arthritis joints moving helps to spread the synovial fluid around and works the muscles.  When the muscles work more, they get stronger and support the joints better.  It is a win-win all the way around.

The difficult thing is knowing how much exercise and what types are best for pets who are dealing with pain.  This answer really requires the help of a professional, which is where veterinary rehabilitation therapy comes in.  Rehab vets can help to structure exercise programs which will be safe and comfortable for pets.  In many cases, using an underwater treadmill for hydrotherapy can be helpful (see our Hydrotherapy blog here).  However, learning safe exercises to do at home with guidance lets the family help out in the process too.

What else can help with pain management in pets?

A certified rehabilitation veterinarian will also have access to specialized equipment that can help relieve discomfort in pets.  Laser therapy, therapeutic ultrasound, TENS & NMES, Pulsed Electro-Magnetic Field therapy, Acoustic Compression Therapy can all be used for pain management depending on the pet’s diagnosis and combination of problems.