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

How Do We Tell If A Loved Dog Is In Pain?

Updated: February 10th, 2020

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.”

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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:


ready-to-rupture hemangiosarcomas

very inflamed mast cell tumors

solid tissue sarcomas that are about to split

larger bladder tumors, usually transitional cell carcinomas

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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


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  1. 5 Symptoms & Signs a Dog is Dying of Cancer | For All Your Dog Needs on February 19, 2019 at 1:15 am

    […] Animals are specialists at hiding their ache, however typically it’s obvious that they are hurting. […]

  2. Kay Holmes on November 26, 2018 at 6:29 pm

    My 11 1/2 year old English cocker has advanced melanoma of the mouth. I have twice had a thumbnail sized tumor removed from his lip, in oct, 2917 and in aug, 2018. His lymph node under his chin has gotten huge and the mouth melanoma is now the size of a small apple. Hanging out of his mouth.It bleeds some and smells horrible. He has been on pain medication and antibiotics for over two months. We opted against cancer treatments because his mother had lymphoma and the treatments were so horrible.He still runs in yard, wags his tail and eats like normal.
    We have an appointment to debulk the mass..this husband said that we had to do that or put him down.
    It’s so sad….I can’t put him down when he still seems happy. Do you think the surgery will kill him.? Do you think We should put him down?
    I’m so he ready????.

    • Dog Cancer Vet Team on November 27, 2018 at 7:43 am

      Hello Kay,

      Thanks for writing. We’re not veterinarians here in customer support so we can’t offer you medical advice. However, we can provide you with information based off Dr. Dressler’s writing 🙂

      As Dr. Sue writes in the article below, if a lump is 1cm or larger, or has been there for over a month, get it checked by a vet ASAP. This might mean getting a fine needle aspirate (or a biopsy in some cases) to determine what the lump is– it’s better to know sooner rather than later. Here’s the link to the article where Dr. Sue goes into more detail on this:

      You know yourself, and your boy the best, and there are a number of factors that you have to take into consideration (finances, your dog’s personality, your personality, treatment options, age, etc) before making a decision as each dog and their health situation is different– there is no one right fit. This is where Treatment Plan Analysis can be really beneficial. Here’s an article on how to end treatment plan analysis paralysis

      You also have to factor in your guardian type– do you want your dog to be as comfortable as possible? Are you okay with handling the side effects of particular treatments? How important is quality of life? Do you think he would be the same after surgery? It’s a lot of questions, but you have to ask yourself these and many more when making a decision. Here’s a link to an article on guardian types that you may find helpful:

      You should also ask yourself, how is your boy’s quality of life? Is he still happy? As Dr. D says in the article below, Life quality is a critical part of your dog’s care. Nobody wants to have a longer life if the life gained is a bad one. So, when a dog’s Joy in Life is taken, life quality goes down. Here’s the link:

      In the Dog Cancer Survival Guide, Dr. D writes that there are a number of treatment options (besides surgery, chemo and radiation) in the Full Spectrum Cancer Care that you could consider, under your vet’s supervision– Nutraceuticals, Diet, Brain Chemistry Modification, and Immune System Boosters and Anti-Metastics Here’s an overview article on Full Spectrum Cancer Care that may be useful:

      We can’t tell you what the right choice is because we’re not vets, each dog and their situation is different, and we don’t know your boy. But you do, and once you figure out what is most important to you both, you can then make a more informed decision 🙂

      We hope this helps!

  3. Brenda on January 22, 2018 at 1:02 pm

    Yesterday we said good bye to Rex, our beautiful 7 year old German Shepherd. He was diagnosed with lung cancer one month ago and although he had responded well to meds, (was eating well and was happy and mobile) we knew that his time with us was limited. Yesterday morning he declined steadily and we rang the vet to let him know we would be bringing Rex in for the last time. Shortly after Rex passed away in his own time on his favourite doggy bed in our arms. We are devastated but feel privileged to have had him as part of our family since his puppy-hood. I am writing this because I have been comforted by the information I have read which others have posted, and, to people whose pets are unwell, my advice is to treasure your final times with them. Brenda

  4. Kim Farley on November 9, 2017 at 11:35 am

    I have a little dog mixed breed we have been told she has lung cancer …She also having tummy trouble swelling up and getting small back and fore …drinking alot of water had a x-ray done showed noting…wrong with tummy…But lung cancer.. She still eating popping ,peeing, but when her tummy get bloated… she is miserable…should we stop her from drinking so much water or what…

  5. Susan Kazara Harper on June 16, 2015 at 7:58 pm

    Dear dear Sarah, I know how your heart aches, truly. Don’t you dare regret the decisions you made for Lily. Your love for her, and hers for you is a bond that no one else can touch. I know without a doubt that Lily loved you as unconditionally as only our wonderful animals can, and all your decisions were right for both of you. You chose based on your love, and that is never wrong. Lily will be with you always, and believe me, the time will turn the ache into sad smiles, and then into happy ones. The final days were but a small drop in the bucket of abundance you had together, so please don’t focus on those final times. Remember her with the joy she brought to your heart. It’s a rare gift. One day there will be another set of eyes looking to you, and your heart will fill when you know Lily has sent that being to share the home she had. Take care my dear.

    • disqus_KKB0snvAU9 on February 8, 2016 at 10:16 pm

      Beautiful words Susan Kazara Harper and much deserved sarah wilson dont you ever doubt it

  6. Susan Kazara Harper on June 1, 2015 at 4:13 pm

    Dear Rose, Panting usually relates to discomfort at some level. I hope you’ve been able to consult with your vet as every dog truly is an individual and there may be other factors at play. Have you discussed an action plan for her? You may be able to make subtle adjustments related to her eating or timing of any meds which may have a positive effect on the night-time panting. Work with your vet and really connect with your Yogi. Your instincts are very important here. Good luck to you both.

  7. sarah wilson on May 27, 2015 at 11:47 am

    hi there.
    sitting at home and
    very much alone after having to have my best friend put down yesterday! have spent all day today just driving anywhere to avoid coming home and not being greeted by her.
    Racked by a miated on her quality of life.xture of anger and guilt so thought I’d tell my story.
    Lily was a rescue dog and had a character of her own which included doing dressage when she wanted something and was loved very much. so,,,,,,,,,did I do right by her?
    I took her to the vet a few months ago when she developed small lump on her teet. the vet was very abrupt and said she had cancer and would need an operation, chest xrays etc etc. At forteen I was very concerned about the outcome of an operation but obviously did not want her to suffer either. she was behaving normally, still going for and enjoying going for walks, eating and drinking well and seemed her normal self so I made the decision to leave things alone for now, not wanting to risk spreading te cancer by invasive surgery.
    Three months later the tumour had trebled in size and I knew I was going to loose her but concentrated on keeping her pain free. she was, until two days ago, very active and showing no signs of distress. However yesterday she had a bout of diarrohea and was not her normal self so I took her to the vet who advised that I should have her put down. Neither of us were prepared and the whole experience has been awful with the vet almost accusing me of being selfish for not having the operation done. Yes I was selfish at wanting as much time with her as possible but responded the minute I knew she was not feeling well. had she been younger I would not have hesitated to have the operation and equally had she shown signs of pain I would have ended it sooner but when is the right time? Can’t stop crying now as I feel I let her down even though I know in my heart I did my best for her.

    • Josi on February 3, 2020 at 7:25 pm

      My dog has cancer he lost weight a lot not eating when he does he throws up15years old a beagle he’s my world but I know nobody can help us he pee a lot of blood. I need to be strong for him to put him asleep am I doing right for him to take him out of suffering

      • Dog Cancer Vet Team on February 4, 2020 at 8:56 am

        Hello Josi,

        Thanks for writing and we’re so sorry to hear about your boy. It sounds like he has an amazing guardian and is well-loved Unfortunately this moment is a reality we’ve all had to face at one point or another here, so we really understand what you’re going through.

        There is a chapter in the Dog Cancer Survival Guide on how to “know” when the time is right — so if you do have a copy of the book, you might want to re-read that Truthfully, it’s different for everyone, and there’s no way anyone (us, your veterinarian, your best friend) can tell you when it’s time to let him go. The best way we can describe it is that something clicks inside, and you just plain old know that it’ time.

        And sometimes, dogs find a way to take the decision out of our hands, which can be helpful if we’re resisting doing something we can’t fathom doing.

        Your dog, even in the end, only wants your companionship and presence — so being fully with your boy during this time will not only help you to understand what he needs and when he needs it but also give him what he most desires — you.

        There are a couple of articles on End of Life Care on the Dog Cancer Blog that you may find helpful at this time <3

        Sending lots of warm wishes to you both

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