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Featuring Demian Dressler, DVM and Sue Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide

Life Quality: Is My Dog In Pain?

Updated: January 28th, 2020

Physical comfort is very important for a dog’s life quality.  When it comes to canine cancer, life quality is a central topic that deserves much attention.

Since the systemic cancers are so formidable and resist successful treatment, often increasing life span and maintaining a normal life quality are main goals.

Life quality can be evaluated systematically.  I wrote about this in detail in The Dog Cancer Survival Guide as a part of overall treatment plan analysis.  You want to do what makes sense for your particular dog, and for you.

Basically, life quality assessment is done by looking at everything that makes your canine companion happy, and then asking how many of these things are now gone.  If most are gone, or the biggies are gone, life quality is probably not good anymore.

Being in pain is a major life quality negative.

So how do I know if a patient is experiencing pain? Well, the topic is debated a lot in veterinary medicine, since dog’s don’t have the means to tell us directly, and a lack of crying does not mean no pain.

Let’s look closer.  We can divide pain up into acute (sudden) or chronic (long term) pain. Acute pain is the one that is easier to detect since there is a sudden change to reaction.  The one that is harder to assess is chronic pain, which is more common in cancer patients.

Behavior, it turns out, can be used to assess pain. A dog will have different behaviors depending on where the pain is coming from.

Leg pain causes limping. Back pain causes a reluctance to go up or down, and less jumping. These dogs often yip suddenly for no apparent reason and may shift around a lot trying to get comfortable.

Neck pain often appears as a reluctance to move the head, such as difficulty dropping the chin to eat, or sudden yelping.

Mouth pain usually is seen as difficulty eating, or by dropping food from the mouth after it is taken from the food dish.

Pain in the abdomen often produces a “hunched” posture, where the front and back legs are brought a bit closer together and the back is slightly arched upwards.

Chest pain is usually seen as a reluctance to move, or sometimes by coughing.

Occasionally pain will be demonstrated by licking, scratching, or chewing at the painful area.

Bladder pain is seen as straining to urinate, urinating frequently with small amounts, and licking at the genitals sometimes. Colon pain is seen as straining to pass stool with little coming out, and the feces is usually soft or mucoid. Both bladder and colonic conditions causing pain can also cause bleeding.

One of the hallmarks of chronic pain is that the dog will become less engaged socially and just distance themselves, not wanting to be disturbed.  We have to be careful with this since this is not specific, but if it is occurring, we should question whether it is due to pain.

Chronic pain also can be seen by not wanting to do normal physical activities, like turning back during a walk to go home.

Chronic pain can be seen as less energy and appetite as well.

However, it may be that, since each dog is different, whenever there is tissue injury and inflammation, pain should be assumed.

An interesting fact is that a dog lover’s take on whether their dog is in pain is just as accurate as any clinical inquiry.  This is true when the person has been educated on what to look for.  Now, you have been educated and you can make the call!

Try to have your vet localize the pain to be sure (find it on the body), just for confirmation. When meds are used, often the result is a big change in demeanor, which gives us information that a problem is being taken care of.

When controlling pain, the best approach is to use more than one type of medication.  This usually has a higher effect, especially if the pain is difficult to control.

Life quality is so important for our canine friends, and it was this that prompted the development of Apocaps, which is designed to support normal life quality and life expectancy in dogs.

All my best,

Dr D

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  1. Lindsay Irwin on October 3, 2018 at 9:15 pm

    Hi Dr. Dressler,

    I have a 10 1/2 year old male Golden Retriever named Buddy who is 109 lbs and very tall. He has always been fed completely Organic food, vegetables and is gluten free since day one. I’ve had him since i was 12. Our vet diagnosed him with a slipped disc about a month ago and put him on Adequan. The shots didn’t work and he continued to have trouble getting up and panted constantly but once was up was full of energy. lately he still has a hard time getting up, continues to pant constantly, on Thursday last week he started whining recently a few times after coming in from outside playing and i thought he must of hurt his back worse or tweaked a leg muscle so we rushed him to the vet, (he eats, drinks, gets excited easily.) Before The vet made it seem like a slipped disc was no big deal and never told us to have him rest from a month ago. Everything I’ve been reading online says a slipped disc can be painful and requires the dog to rest in order to heal. Since he wasn’t resting over the last month because we didn’t know he should be, we assumed his recent whining meant he hurt his back worse from being active, so we took him into the vet again. She was concerned that the shots were not working and assumed maybe they just weren’t right for him. She now has him on Gabapentin and Tramadol
    hoping that will heal him, but the problem is is that on these medications at high doses he continues to pant and whine sometimes, she is worried why he may still be showing signs of having pain even being on a high dose of meds. His x-rays came back clear of bone cancer, no signs of any hip trouble, his blood work was good, he has some fatty lumps on his back legs but they are all clear as of a few months ago. Could these change and become cancerous and cause him pain and difficulty getting up? He has had some joint trouble but takes medicam for the last few years and that has always helped. So, now i feel at such a loss, She suggested an MRI at a specialist to investigate further, but i’m not sure if its needed, its hard to tell how he really feels being on these medications. Is he whining because he’s in pain or could he be anxious from the medication ( a common side effect) he was seeming so healthy and happy the night before he started whining beside for having trouble getting off our hardwood floors and all his panting. I’m a bit confused at the vets plan, i guess it’s to hopefully stop his pain currently and see if it was from his slipped disc pain or if its not then continue to research. The Gabapentin and Tramadol make him sleepy and less excited to get up as well as cause his legs to be weak.
    My question for you is our vet mentioned it could be a type of blood cancer that we cant see or i read that spinal tumors can cause difficulty getting up and rear leg weakness. Do these seem a bit drastic based on his symptoms could cancer really come on that quickly and the only symptom be panting and difficulty getting on the floor? He whined once or twice before we rushed him to the vet, but ever since then and he’s been on meds he whines a lot ( again not sure if its the meds or is he in such pain they aren’t working) but still he had/has such little symptoms of anything and all his blood work and x-rays are clear. Is there a possibility a cancer could be showing little signs like he has? In your opinion would any specific testing be beneficial to him? He seems worse the last few days, but i know its the medication side effects listed on the bottle, but i don’t want to jump to drastic decisions… but i also want an answer and cant help but ignore the vet who says she’s at a loss because he seems healthy but he’s still having pain? Im afraid it could be something worse and would love your expertise. I know that was a lot of info and handful of questions, we really Thank you for your time!
    -Lindsay and Buddy.

    • Dog Cancer Vet Team on October 7, 2018 at 10:40 am

      Hi Lindsay, unfortunately, yes, cancer can “come on quick” in dogs, because they hide symptoms for as long as possible before they get sick. This article can help explain: Since your veterinarian has not found a way to relieve the pain (and those symptoms definitely sound like pain) then further tests may be necessary, as your vet suggests. An MRI can show things that regular imaging techniques don’t. You might be doing a test just to find out the worst case, but at least you’ll know what you’re facing. Without a diagnosis, it’s difficult for your vet to know what to do. 🙁 We hope Buddy is feeling better soon.

  2. India Taylor on July 10, 2018 at 8:25 pm

    How do I find out what’s causing my dog pain?
    When she is laying down not moving she will start to scream for about 30seconds just laying there staring at me crying out in pain, I’ve examined her whole body and nothing seems to hurt her or cause any discomfort. It’s only on occasion when she’s laying down and starts screaming in pain. She’s 13 yr old blue chihuahua. In the past we found out with an xray she does have arthritis in her hips and she’s had surgery before for an emergency spay. She has a scar down her whole belly for that. I don’t know if any of that contributes, I just don’t know why she’s screaming in pain

    • DogCancerBlog on July 11, 2018 at 7:04 am

      Hello India, thanks for writing and we’re sorry to hear about your girl! 🙁 It definitely sounds like a visit to your veterinarian is in order as they may be able to provide suggestions as to what might be causing all of this pain–whether it is arthritis or something else. Dogs are very good at hiding their pain as they believe it is a sign of weakness. The only time we as guardians notice that our dog is in pain is because they can’t hide it from us any longer. We know it must be very hard to see your girl in pain and we hope that your veterinarian can provide answers on what might be causing it and what you can do to help manage the pain 🙂

  3. BnK on September 19, 2012 at 10:20 am

    Hi Dr. Dressler,

    Thank you for your reply. You’re such a good person to share your time with others unconditionally.

    Our beautiful Lucy has gone to Heaven. In the hope that all information may assist you in eventually finding a cure, I thought I would share her final battle details.

    Shortly after my last post, Lucy woke up one morning with an extraordinarily swollen mouth – too painful for her to lie on. We increased her Prednisone and it went down overnight and never returned.

    A few weeks later she woke up & was limping severely on her right front paw. The oncologist said she had cancer the size of his fist in her shoulder which was causing the pain. We did one treatment of Lomustine and saw an immediate decrease in all the lumps, but went for her check up a week ago. The day before her check-up, her eyes looked very red and irritated and we found dried blood on her bottom. Her Doctor said her lumps had increased, so further Lomustine would not be beneficial. He prescribed Prednisolone for her eyes, saying the cancer was blocking them from draining, and prescribed Metronidazole to reduce the inflammation in her bottom also caused by the cancer. I called a couple of days later saying I could see bloody flesh when she was trying to poop. He suggested Miralax to soften her stool. So at this point she was on 30mg Prednisone, 200mg Tramadol, 1000mg Metronidazole, Prednisolone drops morning & night, and Miralax once per day (and Apocaps, Calcium Citrate, Fish Oil & Digestive Enzymes…..).

    She was such a fighter and a trooper! Up until her last day. Sunday night overnight to Monday morning she woke me up several times to eat and go out, so Monday morning I held off her breakfast because she was resting, and I thought she could use it. Eventually she came to me and looked like she aged 100 years. The change was so dramatic and sudden. I immediately got her breakfast ready so she could have her pain medication. She didn’t come when I called her which was very unusual because she was ALWAYS in the kitchen if someone else was. I brought her bowl to her, and she wouldn’t eat. I gave her 2 Tramadol without the food in the hope they would kick in and then her appetite would return. I was in the kitchen again to feed my baby and she wanted to be with us, but it took her about 20 minutes just to come down the hallway because she kept stopping to lie down. I called my husband to come home from work, and when he got there, she collapsed on her side and struggled to breathe. Between not being able to walk, not being able to eat and not being able to breathe, we knew it was time. We had a Doctor come to the house and ease her from her pain and suffering.

    I’m sorry my story is long-winded. I’m just hoping that knowing these details may help you in your journey to understanding this awful disease, and eventually discover a cure to prevent future fur babies from suffering the same fate.

    I truly thank you and Dr. Ettinger for your guidance and wish you all the best. If I can answer any questions that may assist in any way, please don’t hesitate to let me know. Thanks again,

    • Dr. Demian Dressler on September 19, 2012 at 3:27 pm

      Oh- I am very sorry. i hope that she was able to have very little pain and that her time was happy and good. May your sadness soon turn to memories of the happy times you shared! Dr D

  4. BnK on July 25, 2012 at 6:04 pm

    Hi Dr. Dressler,

    Thank you for your information, your guidance & your time.

    This has been such an emotional journey for us. We found out we were expecting a baby last July, then found out Lucy had Lymphosarcoma in August. We have followed your Dog Cancer Diet, and opted for chemo treatment. We shared both the pregnancy and Lucy’s fight to remission (January) with her oncologist, who died suddenly in April and never met our newborn son :-O

    Unfortunately at the end of May, Lucy’s lumps returned 🙁

    Her new Doctor estimated 2 – 3 months and said if we do chemo again, she would be on it for the rest of her life. We don’t want to put her through chemo again, so we’ve started her on Prednisone instead. At 3 per day, the lumps reduced, but her appetite was insatiable!!! She woke me up every 2 hours for more food and gained a LOT of weight!

    Dr. reduced it to 1.5 every second day, but the lumps came back. Then we increased it to 1.5 per day, and I’ve since increased it to the original 3 per day in an urgent hope to reduce the lumps.

    It’s hard to find a happy medium … even if she’s not in pain, starvation seems a form of suffering. Other than the appetite, her energy and personality still seem herself – she doesn’t act like she’s dying.

    We have stretched our budget to its maximum after over $7,000 on chemo, plus top grade ingredients to home cook plus Apocaps & supplements for the past year … Our credit is all maxed.

    Do you have any suggestions on trying to achieve remission a second time without chemo? And/or any suggestions on how to appease her appetite? I am starting to accept that we can’t prevent the inevitable, but we want to afford the best we can to make her as happy and healthy as possible, for as long as possible.

    Any guidance is greatly appreciated. I read your book last year, and am re-reading now to refresh. Thank you! Thank you! Thank you!


    • Dr. Demian Dressler on August 1, 2012 at 2:07 pm

      Dear BnK,
      ugh. So sorry you are dealing with all of this, and for your dog too!
      Might try methylprednisolone, which in some dogs seems to have less increase in appetite than strait pred.
      I think Dr Sue will chime in on her chemo thoughts.
      Finally, consider Neoplasene orally. It certainly does not increase appetite (if anything kills it), if you decide to go off the pred. It has some beneficial effects and is not very expensive. Have your vet or onc contact Buck Mountain directly (don’t call as Terry gets grumpy with laypeople sometimes).
      Hope this helps
      Dr D

  5. Mark on January 19, 2012 at 5:27 pm

    Good article. Our dane just passed away 2 weeks ago.

    For the final week she was no longer the dog she had already been, even through all the chemo.

    She laid in bed, didn’t want to even go outside, then had trouble with simple stairs. Appetite decreased a lot as well. She didn’t even get eager to go for walks or car rides anymore. One week after those signs came on she had her last fight and it was time for her to go.

    So important for people to understand this article and what to look for.

  6. Sherry on May 20, 2010 at 6:01 am

    Our 6 year old mini schnauzer was diagnosed as having a possible meningioma. The vet specialist highly suspects it but no MRI has been done because we cannot afford it. We took her to the vet because she was lethargic and wouldn’t eat. After several tests that came back negative our vet said she suspects the meningioma. She put her on 10 mg of prednisone twice a day. She wants to eat everything in sight now and is a little more active. She wants to lay on the hardwood floor instead of her bed. Her abdomen is bloated and she pants alot. She is distancing herself from us. She doesn’t want to lay on the bed with us as much anymore. She is about 25 lbs. She has always been larger in frame than the others. We know the prednisone is causing some side effects and want her to be comfortable. I think she is in pain as far as laying on the floor instead of bed. She does seem to shift around alot like she is restless. What is the prognosis for meningioma? We started taking her to the vet about 4/4/10. Please email me at

    • Dr. Dressler on May 22, 2010 at 4:55 pm

      Dear Sherry,
      One approach that you may consider:
      Although meningioma and glioma are not the same cancer, we don’t know what type of cancer your dog has without advanced diagnostics. There are other types of masses in the brain other than meningioma. I believe at this stage giving time lines and survival times might not be that useful for this reason. If you feel that the therapy is causing side effects that are not tolerable, go back to your vet and discuss alternatives and perhaps consider other veterinary solutions or sources. Please get veterinary supervision when you are making treatment plan changes.
      There is a lot of information that might benefit your dog in The Dog Cancer Survival Guide too.

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