How Do We Tell If A Loved Dog Is In Pain?
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
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.”
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
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Ny dog has lympnode cancer I recently found out last week she has two large lumps on her neck and on the back of her legs are swollen she does not eat very much but does drink a lot which the vet said of that is normal for live lympnode cancer I don’t know what to do she is my baby and I had her for 11 years she just turned 11 on valentines day she doesn’t seem to be in pain but she’s always panting and can’t settle down she is constantly moving and can’t get comfortablethe vet gave me a steroid for her she said it would help her breathe betterand give us more time I dont wanna b selfish if she is in painbut I don’t know she also gave me antibiotic but I just don’t know if it’s timer nah I don’t want her to suffer I just want her to be happy
Oh, we also did a scan of her lungs in June to see if the cancer had spread and at that point it had not!
Rachel
Dr. D,
I have a golden retriever mix named Sandi and she is approximately 11-12. We have had her for 8 yrs. In Sept. of 2010 I noticed a lump on her left hip. She was due for her check-up in Jan 2011 so I waited until then to get it checked. The doctor thought it was a fatty tumor but did a needle aspiration to make sure. It came back as non cancerous. Well it continued to grow and in June of 2011 I took her to another vet (because we had moved to CO) and it was diagnosed as a soft tissue sarcoma. The vet referred us to a specialist and they were very business like and no compassion and basically said they could do it but could not guarantee anything. They also said they could amputate the leg. It was also going to be around $4,000 either way!! So I talked to my vet for advice and she said that since Sandi was already an older dog that recovery for either surgery would be hard on her, plus, removing the tumor would be hard because of placement and size (softball at this point) so her quality of life may not be so great afterwards. Well, I still wanted to get my baby the care she deserved but could not afford it so I called Golden Retriever Rescue of The Rockies and told them of the situation and wanted to know if I could surrender my dog because I could not pay for the surgery and they get her the surgery and readopt her. They told me that if their vet could do it that they would just pay for the surgery and I could keep her!!! I was ecstatic. So we payed a visit to their vet and he said that he did not recommend the surgery for the same reasons my vet gave. I felt so hopeless. So I just decided to let it go and use pain management until it was “time.” We have since moved again to SC (my husband is military and I moved to CO to live with my mom while we waited for our house to sell in NE) and before we left CO I saw our vet one last time and loaded up on the meds. She is currently on 100mg of Rimadyl (1/2 pill twice a day). Her tumor is now cantaloupe size. She seems to be doing great!! She runs with the other dogs in the backyard, she jumps on and off the bed multiple times a day, she chases her tail, she plays like a puppy with our lab, she humps our lab, she goes up and down the stairs, she still runs to the door when we get home. She pretty much does everything she did before.
When I touch or mess with her tumor she does look at me (like you mentioned) but doesn’t snap. Although, she does the same thing if I touch her other hip the same way. She does sometimes just look at me and paint for a few minutes (but she looks as if she is just relaxed and happy). So my question to you is… do you think she is in pain? We only started her on pain meds in Dec. because of the size and I wanted to be safe. Should I take her to another vet soon for evaluation?
I am so distraught over the whole situation. I wish I would have just put the $4,000 surgery on my credit card and now I would not have been going through this (even though 2 vets recommended against it). I just feel helpless.
Are there any signs of change in the tumor I should look for beside growth?
Thanks in advance and sorry my post was so lengthy.
Rachel
Dear Rachel,
this sounds difficult. As to pain, this is a question your vet should be answering as I cannot ascertain this over the internet. I am wondering however, about the fact that you have not mentioned any of the steps available for dogs other than surgery and Rimadyl. Have you read the Guide? Apocaps? Neoplasene? Diet? Immune support? Antimetastatics? Brain chemistry modification? Deliberate steps to increase life quality daily? Touch therapies? How about low dose Palladia? All of these are in the book, so its time for some self-education so you can be the most effective guardian for your dog.
I hope this helps
D
My dog is 9.5 and she is a very energetic dog. She was diagnosed in December with lymphoma and has been on high doses of prednisone since then. She is still fairly active during the day, happy to see us, eating, running around in the backyard. However, when night time rolls around she is very restless, and is panting. She is also on tramadol at night to help if she is in pain. We are also trying melatonin. I hate to put her down when she stills seems happy to be with us but I hate to have her struggle at night.
Thoughts, anyone have similar experiences and expert opinion.
Ps. I just had to put my 13.5 year old love down because he was bleeding internally which was very sudden and shocking.
My 9 yr old dog (Lab/Great Dane Mix) has Osteosarcoma and was diagnosed about 6 wks ago. The tumor has increased in size since he was diagnosed. He is favoring the front right leg which is where the tumor is but still is the happy, playful dog he has been. He is taking Tramodol and Rymadyl for pain which seem to help but I want to know what signs to look for pain wise and when will I know its time to put him down. He eats like crazy and is drinking water like normal. I dont want to put him down for selfish reasons but I dont want him to be in pain so I need some advice. What should I look for and will he let me know he is in pain and what will it look like? Any advice will be helpful.
Thank you!!
Thank u for the infomation. I am comfused with my dog.. He seems to be lame.. He was doing fine, but stayed outside alot, he’s had some skin problems abt a year, ask a vet, she said probally allergies. but large patches of hair would just pull out. he was heavy set in the hip area, don’t know if he over ate, unless, he took the other dogs food, never saw this., but I only fed them 2 cups a day each. abt a month ago I noticed he was week in the front legs, than last week, he layed down and never got up. the second day, we held him with a blanket under his chest and walked him slowed, he hadn’t urinated in 2 days, but did after we walked him. that was his last walk, he refuses to stand for more than a couple of mins. Been using pee pads under him. noticed to day, that left foot he consitantly lays on is really swollen. can’t get him to shift to other one.. we now have to move him by a halter collar and than a soft rope under his back end. he never makes a sound like it hurst.. still growls at the other dogs if they come near, he eats good, but refuses to drink, so I put boost in his can food to get him some liquids. I give him antibiotics, and qluesomine, advil, even nexium every other day with advil. I aso add some whey protein. he never yelps, or anything. this is a vocal dog, and a biter if he’s hurt, but he doesn’t even attempt to bite us when we move him. very unusual for him. Thought of putting him to sleep, but it just breaks my heart. and I cannot afford a vet. any ideas. could he be paralysed and not feeling anything. His bowel movements are regular now that he’s eating soft foods, he urinates. he will yelp for us when we first come in, but other than that pretty quite and sleeps. I’ve left a camcorder on him for hours to make sure.. nothing, no movement, just sleeping like he always did. so puzzled.
We are so confused and torned apart. Our 13 year old yellow lab has lymphoma. We are giving him half a tablet of pridnosone everyday and 2 Lukeran (2mg) every second day. He still enjoys very slow walks in the woods, but mostly, he just lies there. He no longer can go up the stairs which means he spends a considerable amount of time alone. He has lost a lot of weight, has problems getting off the floor but maintains a reasonable appetite due to the pridnosone.
We are assuming either he has degeneration of the spine or the cancer is in his bones We don’t want to submit him to more tests as this would be stressfull.
How do we know if he is in pain? How do we know it’s time to let him go.
We just don’t know what to do.
Thanks
Dear Muriwca,
I am so sorry. You should pay attention to the whole life quality. Being in pain is only one type of bad experience. I think maybe these would be helpful posts that will give you some insights in this very personal decision..
https://www.dogcancerblog.com/blog/life-quality-in-dog-cancer-dr-dresslers-joys-of-life-scale/
All my best
Dr D
Hello.
My Zoey is a Boxer and was just diagnosed with Lymphocarsonoma. Her lymphnodes by her neck were so swollen on both sides. I kind of figured that was what it was when I found the lumps. The specialist we took her to said it is in other parts of her body. According to what I have researched and read online I have decided it best not to proceed with the chemo. I have contacted the specialist to ask them a question and they just want me to come in for another appt. We are a one income family right now because I’m in school and they know this. We have spent alot of money lately on her and would gladly continue to do so if it meant we would have several years with her (she is only 5). He has not told me how long she may have, what to expect, etc. He did give her a shot for chemo and prednisone until we decided what we were going to do. I want to put her down before she starts to suffer but don’t want to do it to early. She is still eating and drinking but has lost weight. She still plays with our other boxer, Maggie, once in a while. She does shake like she is scared once in a while and last night she started panting and then stopped. She is still having bowl movements and has frequent urination. She has stopped vomiting since being put on the on the prednisone. She was laing on the floor and urination without even realizing it yet again. I thought it had stopped. Does this mean she is near the end? SHe was just diagnosed last week.
Thank you
Dear Jennifer,
just to reiterate the facts, this cancer is one of the best responders to chemotherapy, with about 80-85% of dogs getting better and living for a median survival of 12-14 months. I hope you have gathered this information and that you are clear on this data since online information is not always reliable (sort of funny I am writing this here online..)
I do not believe that urination on the floor nor the signs you mentioned means she is near the end right now. It is probably caused by the prednisolone. Please discuss this with your vet and have the urine checked at the minimum.
Also don’t forget about diet, apoptogens, immune support, and the other steps you should be taking with your dog’s cancer in the Guide. Don’t give Apocaps on same day as high dose prednisolone (again, have veterinary supervision).
A post that may help: https://www.dogcancerblog.com/blog/life-quality-in-dog-cancer-dr-dresslers-joys-of-life-scale/
All my best
Dr D
hi there, my dog Cassie had a op in March this year to remove a Cancer lump whiles she was under they did an xray of her lung which showed a small dark shadow. yap lung cancer, over last 7 weeks she has been couging alot, so 3 weeks ago i took her to my vet, they said its the cancer getting worse, she looked so sad, i was in tears, i just cant see her looking sad, so vet gave me antibiotics, said there might be an infection, and the antibiotics would act as a pick me up, they work for the first 2 weeks, now im back to where we where 3 weeks ago, Cassie over the last week, as been having mishaps in the house, and we take her out alot, her eyes have alot off sleep in them, and are very weepy, and i have noticed in this last week her back legs are not as steady, can i ask, im i thinking right, is it time that i made the hardest choice im ever gonna made, or am i jumping the gun, i just cant see her suffer plz i need some advice 🙁
Dear Lyndsy
you need to weigh life quality- here is a post that I think will help you sort it out:
https://www.dogcancerblog.com/blog/life-quality-in-dog-cancer-dr-dresslers-joys-of-life-scale/
and
https://www.dogcancerblog.com/blog/time-and-the-joys-of-life-in-dog-cancer/
I hope this helps
D
Dear Dr Dressler,
Our precious Maja, a labx and foxy x was diagnosed with Lymphoma on Friday…I was sort of prepared for the bad news, but putting her down is not happening right now as she is still walking, eating, wagging her tail, cuddeling with me etc etc, so I think for the time being she needs to spend her last few months with us being spoilt rotten! I am concerned though as she doesnt show pain….she did show pain when her lump on her neck was large, but after putting her on chlorella her lump on her neck reduced in size….anways i am trying to make her feel as comfy as possible….hard to do when she doesnt tell me if anything hurts! She lies down alot, she doesnt have lots of energy…but can manage a short walk. I looked at those Acocaps, but they are not available in NZ I dont think. Which sux as that may have increased her chances slightly, although she does have the worst type of Lymphoma so i guess nothing can cure that.