How Do We Tell If A Loved Dog Is In Pain?
ByPain. 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:
osteosarcomas
ready-to-rupture hemangiosarcomas
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.
Pain assessment is very tricky.
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,
Dr D
About the Author
Dr. Demian Dressler, DVM is known as the "dog cancer vet" and is author of Dog Cancer Survival Guide: Beyond Surgery, Chemotherapy & Radiation. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://DogCancerBlog.com.
21 Comments
August 4th, 2009 at 9:07 am
Thank you so much for your comments regarding how to detect pain in dogs. I had to put my 11 year old Welsh Corgi down last night due to all that you have described. It was probably the hardest thing I ever had to do and I have lost many loved people that I knew, including my husband, to hardship and death but none who loved or was more loyal to me or I loved more. I appreciate all of your help and comments thoughout his illness. You are truly a caring Dr. and person. Please keep up the good work for others who need you. Sue
August 4th, 2009 at 3:52 pm
Dear Sue, I’m so sorry for your loss. I know how hard it is having been in your position. I’ll keep you in my thoughts. margaret and the shih tzu boys.
August 4th, 2009 at 4:59 pm
Thanks for the reassurance, I lost my Pheobe (a Rat terrier mix) on 8-1-09. She had been diagnosed with a hemangiosarcoma on her Spleen on Christmas Eve 2008, and had it removed New Years Eve the following week. During the operation the Veterinarian had found the Cancer had spread to all of the adjacent organs except the G.I. Tract. She was given a week to a month to live. She was quite a fighter and with the help of K9 Immunity (Feb-June) and Apocaps The last three weeks of July she survived 7 months after the operation. Perhaps if the Apocaps had come out sooner mabey she could have survived longer or been cured. Her Tumor had begun a rapid growth right before she started taking the Apocaps (July 12 2009). (It was about 10 pounds half her weight). She stopped regular eating about 3 days before the Apocaps arrived. July 29 2009 she started eating normal again, but the tumor had grown so much that she was having trouble breathing. I believe the tumor ruptured somtime during the night of July 31 2009. She would not lay down or sleep (Pheobe slept in our bed with us since birth), in the moring her tongue was pale, and she was hesitant to walk. She took her Apocap that morning but we brought her to her Vet for an evaluation to confirm her condition. It was the so hard to let her go after trying for so long to help her get better. Thankfully I have no regrets, because she’s been spoiled rotten. I will never get over her, but knowing she is no longer suffering must become my consolence. I am now the one in pain for her loss, but with time hopfully only the happy times will haunt my memories.
August 5th, 2009 at 7:57 am
What is Apocap? I had two dogs die from cancer and we used the K9 but I have never heard of Apocap. Could you please let me kno what it is. Thanks.
August 5th, 2009 at 2:15 pm
Apocaps may be a revolutionary step in helping dogs. These capsules are a novel way of helping the body turn on genes that allow deranged cells to be recycled into healthy, normal, young cells.
If you would like more information, go to http://www.apocaps.com, and fill out the information request sheet.
Best,
Dr D
August 5th, 2009 at 2:17 pm
Aubrey,
take comfort knowing you did all you could, and that your Pheobe shared a great life with you during her journey here.
May your sadness during this time of departure be replaced by memories of the love you shared,
With sympathy,
Dr D
August 5th, 2009 at 2:20 pm
Sue,
I am sorry to hear this sad news. I am thinking of you during your sad days. May you always be comforted by memories of your time together with your Corgi.
Best,
Dr D
August 6th, 2009 at 6:28 am
We just lost our wonderful Jazzie on July 22 due to hemangiosarcoma diagnosed in May. I purchased the book Dr dressler wrote and it was so helpful getting through this difficult time. I did all the things in his book BeyondSugery, Radiation and Chemo and so Jazzie had a great last couple of months. I considered chemo but after reading about hemangiosarcome, I believed it was best for him that he had a good quality of life. We all miss Jazzie. I am using some of the things i learned in the book to work with dogs who have been given to a sanctuary who had once been used in research. The dogs love the massages!
August 14th, 2009 at 5:29 am
I feel for all of you, it is so hard to lose a baby,,,especially from something like “cancer”
i am writing this in hopes of broadening everyone’s horizons.
I can not promote this way of medicine enough,,,
HOMEOPATHIC MEDICINE,,,,,this stuff is amazing!!!!!!!!!!!!!!!
We lost our baby back in april,,,not from the “cancer”
but rather, her stomach [IBD] another AUTO-IMMUNE disease, caused her too many issues.
There are NO side-effects of HOMEOPATHY,,,,only HEALING-EPISODES.
So if a CONVENTIONAL VET says chemo/radiation,,,,or even there’s nothing they can do,,,,,,,PLEASE,,,,look at HOMEOPATHY!!!!!!!!!
we lost our baby, but she was NOT in pain!!!!!!!!!
August 20th, 2009 at 2:47 am
i lost my dog tazz to cancer above the eye and then a short time he was blind then we had to put him down
September 1st, 2009 at 6:07 pm
O lsot my dog blue 8 years old to cancer august 279th. She had a tumor removed last november, she was okay until this month when her leg swollen. and she was always in the closet and would not greet me anymore, or just sit in the same spot and would sit sit and look I think she was letting me know its time. I took her to the vet and he said it might have spreaded and may need to be put to sleep. It turned out it was spreaded but my vet who had known my dog cremated her for free that I thak him so much for his support for me and my husband. i will miss him derly, it seems like I just cant get over this. time will heal
September 1st, 2009 at 6:09 pm
i am sorry for my wrong spelling of words
January 19th, 2010 at 1:46 pm
My dog wasn’t sleeping anymore, most of the time. Laying with his eyes open! However he was still eating, walking outside, making his welkom dance when I came home. But even when he was sleeping (and snoring) mostly his eyes were open.
He was also a bit restless, looked worried…..
Are these also signs of pain?
January 22nd, 2010 at 10:14 pm
Dear Reader,
we need more info here. Does your dog have cancer?
Is there swelling of the eyeballs (glaucoma or some other problem causing protrusion)? Have you taken your dog to the vet?
If not, get a vet’s input as there may be things going on that you are not yet aware of..we need more information for your dog.
Best,
Dr D
January 27th, 2010 at 1:51 pm
My dog had cancer(mct), yes. We went twice a week to the vet. Was treated with Masivet (kinavet), lomustine and vinblastine.
Even on pain mediation (tramadol) he remained restless and most of the time his eyes open…….
There were no signs of pain, but these worried open eyes made us suspect that he maybe was in pain????
January 31st, 2010 at 3:27 pm
Dear Reader,
I am not sure. Perhaps not pain, but I wonder whether there was some discomfort of some kind going on? Perhaps acid stomach, or excess histamine from the mast cells? Both of these could explain a vague discomfort, or perhaps it was due to something else entirely. Certainly famotidine (antacid), misoprostel (helps with the intestine), and benadryl (antihistamine) would be easy enough to try out if they were not part of the protocol.
Hope that helps,
Dr D
February 6th, 2010 at 8:44 pm
Hello, I just found this site a few minutes ago. I was looking up how to tell if a dog is in pain because my 9 year old border collie has (probably) lung cancer. She got pneumonia last June 0f 2009 and was on antibiotics and lasix (sp)for about 2 weeks. Unfortunately, we didn’t have a follow-up x-ray done afterwards because we were tight on money.
Throughout the rest of the summer and into fall, I kept feeling that she wasn’t fully recovered. She kept her tail tucked a good deal of time, but no other signs. Then in October our other border collie broke his elbow; a compound fracture that required 2 surgeries. That made things more than just “tight” for us.
It took until Christmas for things to get back to normal. That’s when I noticed Tara (the female 9 y/o bc) was getting very picky with her food. Then came the dry cough again and her tucking her tail more and more. We finally took her to the vet on January 11th and had a chest x-ray done and blood work. Very high white blood cell count and numerous fibrous looking things in her lungs. She was also lame on her left hind foot and had a fever.
The vet said it was either primary lung cancer, or possibly Blastomycosis. We had a urine test done for the blasto and it came back negative. She was put on Baytril and lasix, with a re-visit 2 weeks later.
He took another x-ray on January 25th and her lungs were 3-4 times worse! We were told that unless we did a lung biopsy or that bronco-lavage wash to confirm what type of cancer it is, there would be nothing they could do other than continue lasix and keep her comfortable.
We didn’t do either of those things because just with the few things I stated above, our vet bill is 627.00. The surgeries for Ace’s elbow cost us 6700.00!! We’ll be paying that one for the next 5 years! But what else could we do? How could we put a 6 year old dog down because of a broken elbow?!
Anyway, sorry I got off the subject there. My main concern is that Tara does not suffer. Monday will be another 2 weeks since the 2nd x-ray. Sometimes she seems worse and sometimes she gives us glimmers of hope. Mostly, she is only eating enough to not starve to death. Maybe 3 tablespoons of rice and 4 bites of chicken for breakfast and dinner. She refuses any and all kinds of dog food now. She lays on her side alot, is very quiet, stares at me alot, wants to be petted alot. Her respirations are about 45 per minute, she sounds congested when she breathes sometimes, yet she is not coughing as much anymore. She changes positions several times if she’s not laying on her side, and is kind of just laying on her haunches with her head slightly off the floor over her front paws. She’s probably lost close to 10 pounds by now. Her collar looks like it was borrowed from a Mastiff!
I need some help with deciphering these signs and knowing when enough is enough. I could send you the 2 x-rays if you would like. I just don’t want to put her down if it’s a fungus and there’s still time to save her! Not knowing for certain that it’s cancer, is really making this whole thing much more heart breaking.
Please help! (Sorry for this being such a long post!)
Thank you in advance,
Jeanine Collins
February 7th, 2010 at 8:22 pm
Dear Janine,
I believe you are asking about life quality assessment. Since you know your dog best, I would take some time to sit down for a few minutes without interruption and do a really honest evaluation of life quality. Pain is only one of the various negative life quality elements. I have discussed this area of life quality assessment in detail in The Dog Cancer Survival Guide. You should also read these blog entry to get you started in the right direction:
http://www.dogcancerblog.com/pain-in-dog-cancer-and-life-quality-part-2/
http://www.dogcancerblog.com/life-quality-in-dog-cancer-dr-dresslers-joys-of-life-scale/
I hope this helps,
Dr D
February 10th, 2010 at 7:14 pm
Dear Dr Dressler,
Thank you for answering my post and pointing me in the right direction.
After reading the “joys of life scale” and some of the blogs related to it, I was able to think more clearly. I called the vet early Monday afternoon and had them come to our home late in the day. Tara was euthanized in our living room, on her own bed, with her family gathered round, at 5:00 pm on Feb 8, 2010. She looked so beautiful and so peaceful, for the first time in weeks and weeks.
We were probably a week too late in doing this but at least we didn’t take any longer, thanks to you and the people who post on here. My thanks to all of you.
She is missed terribly, our house feels empty and very quiet now without her, but I know it was the right thing to do.
I have one more question for you; How long will Ace (Tara’s son) grieve for her? He is laying curled up right now, on the very spot she was laying in until our vets came to the door on Monday. My heart aches even more when I see him laying there and when he looks back for her every time I send him out to go potty. Seven years old and he never spent a day in his life without her.
Jeanine
February 15th, 2010 at 8:34 pm
Dear Jeanine,
It sounds like you made a very good, kind and compassionate choice. As hard as it was, you must feel this!
Ace’s mourning is difficult to predict. These beings are all different, as are we.
If it continues for a long time, a new canine family member might help, with your permission, of course, at some point in the future.
Best
Dr D
February 24th, 2010 at 8:02 am
I am a young woman who has had both parents leave and the one thing i could not let go were my two dogs. one of them (lucky) has had a tumor that has grown so large we made a brace for it. i am concerned because i just took her to the vet for the first time in a while and they said she can get surgery but will eed xrays first to see if it is even worth it. unfortuantely the surgery is something i am unable to afford so my options are to let her live out a natural death and hope for the best or put her down. I cant imagine doing it and it brings tears to my eyes even thinking about it. I have been trying to look for signs of pain but she eats alot and drinks alot and with her brace on she is able to run a few feet. when the brace is off she licks the tumor alot, she pants quite a bit and is always rubbing herself accross the ground.
im basically curious what the best advice would be. i have grown up with her and cant imagine putting her down but i dont know if im being selfish. everyday i would ask myself if i did the right thing and i just dont know when the times is really right. if anyone can help it would be amazing.
thanks, anne