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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


Leave a Comment

  1. Don Dressel on February 26, 2014 at 8:47 pm

    Just to let everyone know what my wife and I went through with our 10 year old collie a few years ago. He was diagnosed with lymphoma and we put him on chemo. He was dead within 3 months as the vets office overdid him on chemo. If we were to go through that again we would have put him on prednisone and let it go at that. A co-worker who’s golden lab came down with the same disease put her dog on prednisone and the dog lived 3 more years.

  2. Kellie Esarey Lucas on January 20, 2014 at 4:34 pm

    I have a 3 year old female rat terrier , 4 days ago she started acting as if she scared, shivering, panting, clinging for dear life. She is well taken care of and loved very much. Heres the strange thing she seems to only do this at home. Anywhere else she is fine. Nothing has changed at home she still eats and is going to the bath room. Dont know what to do can anyone give me some answers please i desparate

    • Susan Kazara Harper on January 21, 2014 at 4:38 am

      Hi Kellie, This is unusual. A couple things could be going on. She could be ‘masking’ when she goes out… our dogs instinctively do not show weakness outside their home environment. Such an extreme reaction at home must indicate though that something has changed. Really go over every possible situation…. has there been a new visitor, is anyone in the home stressed, was there a storm or anything else that could have made a scary noise, any new cleaning products (including laundry detergent) ??? Is it even POSSIBLE that something happened in the home, maybe when you weren’t there, that could have set her off? Is she more scared in certain areas of the home? Was a package delivered? Please also give her a really good check. Does she have any areas that are sensitive when you touch them? Is her tummy tender? If you absolutely certain that the answer to it all is no, I recommend you get a vet check done to rule out any physical problems. How is her poo? In the home, take the focus off “what’s wrong with her” (what’s her name by the way)? Walk with her or carry her through each room and in and out of the doors, being very calm and happy the entire way. Let her know that you know everything is OK. Something has spooked her, and you’re lucky that she loves you enough to show you. I hope this helps. Good luck.

  3. christine handy on May 30, 2013 at 5:17 am

    Dear Dr. Dressler, I have a 9 year old, male, mixed breed neutered dog. He was diagnosed in April of this year with amelanotic melanoma. The tumor in his mouth was removed. I do not plan to have radiation or chemo. I am trying a few holistic herbs and veggies. Sometimes he will vomit all of his meal. He is spending more time under the sofa. He eats, plays and goes for walks. Do you know how much the vaccine costs? Do you think my dog is in any pain? I have read that this cancer is very aggressive. Do you have any idea how much time I have left with him? What symptoms should I look for when the cancer gets worse? Or will it be obvious? I feel so impotent. Is there anything I can do for him? Should I continue to give him his monthly Trifexis? I would appreciate any info/guidance/advice you can give me. Is it my fault that he has cancer? I did have his teeth cleaned when needed but maybe not enough. Thank you. Christine.

  4. Sanser Meitou on May 27, 2013 at 11:06 pm

    My dog Cosmo, an American Staffordshire bull Terrier mixed, diagnosed with cancer three years ago. He is now fourteenth and half. I have the priveleged to own this loving creature since he was four months old. I know he is in pain, his vet said there is nothin more he can do. Cosmo has his better days and a bad days. He is taking short walk, sometimes he will just laydown for at least 25 to 30 minutes then try to get back up to walk home. Inside me is dying and numb. Tears pouring down my cheeks and trying to control myself around him. He does manage to stop and look straight up at me. I will try to pretend everything its ok. What next. The question is am I gonna be able to handle when it’s time for him to go. My mom just passed away 7 months ago, but never like this how I feel about my mom like how feel about my Cosmo. He does climb into bed with me, so I have to make a bed on the floor so both of us can share. He is used to sleep right by my side and so do I. Any suggestions please it will be very much appreciated. Thank you for the love of Cosmo.

    • Dr. Demian Dressler on May 28, 2013 at 11:18 am

      Dear Sanser,
      I would like to help but am having a little trouble figuring out what information you need….are you asking about ways to cope with pet loss? Can you please clarify the question, thank you very much!
      Dr D

  5. Noud Durnez on February 6, 2013 at 10:05 pm

    Hi Dr,

    I have a 7 year old Female chow, who has always been very relaxed and loving (Similar to your profile picture i noted). Last week we noticed she had broken teeth and we got those extracted. When investigating the chipped canine tooth, the doctor noted that she had what seemed Melanoma in her mouth. This was the reason for her teeth needing to be extracted. He took an X Ray of her chest and noted some lumps in her lungs too.
    From what he told us, and from reading up on this, I assume this is stage 3 Melanoma as it has spread already. (Samples have been sent to the lab to be tested to confirm this).

    The vet informed us that we should look out for bleeding, and that that would be our que to say goodbye.

    The thing I am trying to find out is, “is having the cancer in her mouth and lungs painful to her?”

    She has always been relaxed, so playfulness is difficult to use as a gauge. She’s still eating enough, plays with her brother a little bit, so things don’t seem so bad. But her mouth is swollen (because of the cancer) and she is continuously licking her mouth / rubbing her tongue against the area where the teeth were removed.

    Would you say that the cancer is causing her pain?
    Is there anything else we can do to ascertain when its time to say goodbye?
    We are having difficulty waging up her level of discomfort to the joy she has of being with us for these final days.

    I would appreciate some assistance with this difficult situation..

    (Cape Town SA)

  6. Maria on December 7, 2012 at 4:24 am

    I’m so sad. my dog started having diarrhea a few weeks ago. the first days we thought it was somithing she ate got her discontrolled. After a few days we took her to the vet, after a full examination he gave her subcutaneous fluidsand send me home with antibiotics and to cook rice and chicken for her.we also did blood work they said everything looked normal but the protein and calcium were low. I went back with her they put her special diet and prostora max. within this process we start noticing that her stomach was swelling up, she never stopped doing diarrhea, drinks water and pees a lot, lot i mean. i’m so scared she might be very sick, it’s hard to know it she is pain she doesn’t complain she seems happy most of the time can someone give me a word of advise? tanks to all of you animals lovers out there.

  7. Amanda on November 30, 2012 at 4:59 am

    I have 110 pound pit bull named Gorgeous. She weighed more then that when we got her 2 yrs ago. She is approx 7 years old. She was a rescue dog. She recently has been jerking away when we pet her right shoulder and upper back area. After further inspection she seems to be rather sensitive in her leg also. She is so fat I know that has to play a part in her pain. She struggles to walk and run. The day we got her we went right to petsmart to buy her collar and basic nessecities and if we stood still in an isle for more than 30 seconds she would plop down and lay down on the floor panting. We thought it was funny then. Now I am truly concerned for her health. I don’t know if her new pain is weight related or if there is something more serious going on with her. She is such a good girl. She has lost about 5 pounds since we got her but does anyone know anything else that can be wrong? Do these symptoms fit any specific illness? I plan to take her to the vet next week but I can’t afford hundreds and hundreds of dollars in tests.

  8. Adam on November 26, 2012 at 6:12 pm

    this person has clearly put a lot of effort into their dog. they can’t help where they are financially. please think before you put someone down like that. it’s wrong.

  9. paige on November 9, 2012 at 6:10 pm

    my dog is limping sevrely and have big lumps the size of pennies to quarter size could yousay whats wrong? if you can thx cuz shes a friend i had sceince i was 5 and she is about…9 or 10 plssss help

  10. justine on August 13, 2012 at 11:28 am

    Today my 9 year old chocolate lab has been acting odd. She has not eaten her food and will not get up or even move. I tried giving her some water and she only had a little. She doesn’t have diarrhea, but has thrown up a little bit. Can you help me and tell me what’s wrong with her and how can I help her? does she have cancer?

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