Pain. The very word makes us wince.
Same with the word cancer. A friend recently brought up the fact that some of us refer to cancer as “The C-word.”
So when we put these together and talk about cancer pain, we have quite a loaded topic on our hands.
Before I get into how to tell if a dog is hurting, let me give a quick word of caution. Since cancer pain is so important, we can get a little tunnel vision. The first question we want to ask is, “Is my dog in pain?”
Pain is a massive life quality destroyer. No question about it. The mistake is when we interpret no obvious pain as good life quality.
Absence of pain does not a good life make.
Other life quality negatives include nausea, loss of appetite, fatigue, disorientation, loss of social pleasures, loss of normal body functions, boredom, chronic stress, low self esteem, and more. Not just pain.
All must be factored in during life quality analysis. This topic is covered in some depth in The Dog Cancer Survival Guide.
In medicine, when we are talking about something we see in an animal we call it a “sign”. When we are referring to something we experience, we use the word “symptom”. In veterinary medicine, we talk about signs and in human medicine we talk about symptoms.
Some more common tumors that may cause pain, or at least discomfort, are:
very inflamed mast cell tumors
solid tissue sarcomas that are about to split
larger bladder tumors, usually transitional cell carcinomas
I would like to share with you some of the ways a clinician evaluates pain, based on a hand’s on approach. We go about it in kind of a technical way. Pain assessment can be accompanied by biting, so the safest option is have your veterinarian do it.
One of the most consistent signs of painful stimulus is called the withdrawal reflex. This happens when a painful area is touched, squeezed, or similarly stimulated, and the dog pulls it away. Oddly, this reflex is not connected to the brain but happens in circuit in the spinal cord.
Another useful sign is when pressure is applied to the painful area, the dog will turn and look at you. Sometimes they do a little more than that!
Sometimes pain can be detected when there is a body position shift to alleviate the discomfort. For example, if we exert gentle back pressure on a standing dog and this is a sore area, sitting quickly may be due to pain.
A painful abdomen can be detected by palpating, with flat fingertips, towards the middle of the dog’s belly. Veterinarians have to be cautious, as some tumors, like blood-filled hemangiosarcomas, may be on the verge of a rupture. We will look for what we call “splinting”, which is when there is a tensing of the muscles of the abdomen.
Almost 100% of the time, limping is due to pain. There are very few mechanical problems of a limb causing limping that are not causing pain.
Many sore dogs will pant when they are not comfortable.
Occasionally a dog will simply seem down, or just kind of off or lackluster. This can be a vague sign of pain too.
Often dog lovers in my examination room will point out that their dog is not vocal, and suppose that there is no pain. This is an error.
Recall times have we walked around with a sprain, a sore back, or some other injury that hurts? For what portion of this time were we exclaiming, “Ouch! Ow! Ow!?”
No vocalization means there may be pain, or there may be no pain.
We have to be careful when we use these physical signs. There can be what we call “false positives,” which means we have a sign which can mean there is pain, but not this time. If we take the sign to mean there is pain, this is a false positive…an error.
So when a dog yips every time we touch an area, probably it hurts. Some dogs will be vocal for other reasons though, such as fear. So it’s tricky.
Panting dogs can be hot. A positive leg withdrawal can mean the dog remembers having her nails cut. Splinting in the abdomen may mean the person doing the test is poking the dog with his fingertips. A standing dog who sits with back pressure my be just trying to please.
One way to increase the accuracy is by seeing if the response is reproducible. Do you get the same response every time?
Another way of increasing accuracy is by looking at multiple signs to get the big picture.
A rather technical way of doing it is by taking a heart rate (how many beats in a minute), then stimulating the area in question. Next, take another heart rate. The second heart rate should be higher if there is pain.
A lot of information can be gained by the use of pain medication. Sometimes after pain medicine is started, when we look for the same pain sign, it is gone. Usually the dog will be happier along with this. I have used this approach when the signs are very vague.
As you can see, the way a veterinarian assesses pain may be a little different from what one would imagine. Since your four legged family member cannot speak, we use other ways to try to make sure our patients are not experiencing any pain.
All my best,