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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. Rose on May 10, 2015 at 4:24 pm

    My yogi is 8 us old. She has cancer and at night in bed she also is starting to pant really fast? Don’t know what us happening? Need help?

    • Mary on March 12, 2017 at 2:47 pm

      I was told by the ER Doctor that panting is a sign that they are in pain and also can be anxiety

  2. Susan Kazara Harper on October 23, 2014 at 7:46 pm

    Laura, I hope you’ve taken your girl to the vet to have her checked. This could be a variety of things, but your vet will be the one to diagnose. Good luck.

    • laura on October 23, 2014 at 11:39 pm

      Thank you susan for getting back to me..we had to say goodnight to my belle on monday she had a mass under her belly i felt it but didnt wont to hurt her so i wasnt sure ? The vet was very good and got straight to the point and said shes not well he didnt need to say anything really i new in my heart that she was ill. She was my beautiful,bouncy, wet nose,sparkly eyes,energetic, slightly clumsy, strong, brave, resilient girl…

      I will never forget you and i will alway miss and love you my daring you was my brightest star in my life..

      Thank you for this article my advice to everyone who has an inkling to your dog being in pain go to the vets because i knew that she was in pain and if you know your dog as well as i did then you know…. but they are so resilient and try to hide it

      • Susan Kazara Harper on October 25, 2014 at 8:14 pm

        I’m so sorry Laura. Belle will always be with you my Dear.

      • Mary lister on November 16, 2014 at 2:30 am

        I’m so so sorry Laura, I am going through the same thing my boxer is 12, and has histeocytic sarcoma, she has huge tumors and can barely walk, but loves to be with me, and follows me wherever I go, and she still eats also and wags her tail, we have an appt tomorrow for the vet to say goodnight and I am having such a hard time with this and want to wait, I don’t want her to hurt, but I just can’t imagine life without her…

  3. Laura Crosland on October 18, 2014 at 8:18 am

    Hello we have a golden retriever she 11 years old and for the past few weeks started to drooling and seemed out of sorts today has had alot of trouble getting up her legs have been giving way a few time and she just looks so depressed its not like her. she has been eating and drinking fine i hope im wrong but she seem in pain and is very quiet any i thought

  4. Susan Kazara Harper on July 30, 2014 at 1:29 pm

    Hi Deano, Well it could be many things. Your pom may have gotten a scratch or a bite and the lump is a local response or even an infection. Equally yes, it might be something more serious. Let me ask you this. If you woke up one morning and had a golf ball sized lump suddenly appear on your body, would you go to the doctor? The best thing to do when your dog gets a lump is make an appointment with the vet. There is no reason to believe that if you wait, the lump will go away. It may be nothing, but if it’s “something” you will feel happier getting it checked out as soon as possible. Good luck!

  5. deano on July 29, 2014 at 11:57 pm

    My 10 year old pomeranian has just developed an almost golf size fatty lump/not quite hardened nodule overnight is it something to worry about as it was completely smooth on Monday

  6. lynsey on July 25, 2014 at 1:26 am

    Would really appreciate some help with my boxer. He is 9 years old and for the last 3 weeks has been completely lame in his left front leg. Won’t put any weight on it , just drags it along the floor and crys horrendously when he tries to get out of bed. At first the vet thought it was arthritis and started treatment for that with no success. He was then put on 40mg of metacam and 200 mg of tramadol 3 times a day with no change. They then added 800mg of gabapentin to the mix which still didn’t help. They have now done 6 x rays and blood tests that have all come back completely clear. He is now on 800mg of gabapentin 3 times a day and 50 mg of predisilone which still isn’t doing anything. They have said the only other option now is sending him for a scan which is going to cost £3000 and that still might not show what the problem is. I don’t know what to do next. He can’t carry on in this much pain I hate to see him like this. Would it be kinder to put him to sleep or would a scan find something that’s fixable? I know there is no definite answer but any feedback would be greatly appreciated x

    • Susan Kazara Harper on July 25, 2014 at 4:35 am

      Goodness Lynsey, this is distressing. Can you or your vet tell where the source of the pain is? Is your dog’s paw tender? The leg? The shoulder? Did the xrays go from foot to shoulder? There must be a way to isolate the source of the problem … it could be anything from a problem in the paw to something higher up. It could be an impingement in the spine that feeds the leg. This probably all sounds like old ground to you, but I suspect you need to be referred to a specialist. Ask your vet if there is an orthopedic specialist you can go to. It’s no reflection on your vet, and you have every right to ask for every way to determine what is causing this. I’m sure your vet wants to know as well, and should have no problem helping you find a specialist. Something major has happened to cause this. I suspect that if you let your boy go without knowing what it is, you will always be plagued by that decision. But I don’t know you, and you now your dog the best. There has to be a way to discover what is wrong. Once you know that, it may be serious, or it may be something that can be fixed. But at least you will know. Good luck from all of us on the Team. Let us know what you find out. Give your boy a gentle cuddle from us.

  7. Susan Kazara Harper on July 8, 2014 at 5:50 am

    You pose very valid questions, and they’re ones that we as dog guardians often face. So here are some thoughts. You and your vet know your dog best. If there is any evidence of heart or lung problems, or other symptoms that may make sedation a problem, it’s a matter of weighing those factors against the benefits of surgery. If sedation is not a problem, you may want to ask about the possibility of using cryosurgery to freeze the epulis. Even a de-bulking surgery, where the vet reduces but doesn’t completely remove the epulis may be worth considering if it’s a toss up between surgery and not being able to eat. If the epulis continues to grow there could be real issues of discomfort as well as inability to eat. Again, these are information points for you and your vet to work out together. To address fear of the vets, which won’t help any procedure, are you able to occasionally drive your boy to the vets, get out in the parking lot, walk around, and go home? Try it a couple times, then do the same, walking into reception, say hi to everyone, and go home. Use soothing words and treats and ‘good boy’s all along the way. This can all help desensitize him to the visit. I’m sure the vet staff will be happy to say hello and pet him, give him a treat etc. so it will become a good experience. It takes time, but all things that are worth it, do. Good luck!

    • PH on July 8, 2014 at 8:14 am

      Thanks for the reply. Our Vet is going to take him in for the surgery and see what can be done. Hoping de-bulking can help. As for conditioning Caleb, the funny thing is that he is never stressed in the waiting room. It’s that table and anyone other than me putting their hands on him. Oh well, at 15, we just have to manage through it. It has become worse with age.

      • Susan Kazara Harper on July 9, 2014 at 3:07 am

        Well, at 15 he certainly deserves to have his wishes fulfilled! Perhaps you can ask the vet to either treat him on the floor rather than on that table, or to come out of the practice room to look him over where he is more comfortable. Good luck!

  8. PH on July 6, 2014 at 4:54 pm

    We have a Corgi a week shy of 15. Relatively fit, rather deaf, and deathly afraid of the Vet (no trauma, just his quirk). He has a rather large Epulis on his lower gum, doesn’t seem to pain him, eats like a horse. I fear surgery of some sort is the next step before it gets much bigger, but I have to wonder if it will do much good. At what age do you say, no, I am not putting my dog under anesthesia? His Aunt was ill at 12, and went under anesthesia and crashed, we almost lost her. Several month later she was gone anyway. What to do? Is it the right thing to put him through the surgery? Am I doing it for him or for me?

  9. Susan Kazara Harper on June 1, 2014 at 1:46 pm

    Hi Nikki, We’ve had no evidence that Apocaps cause any growth to increase; they are designed to help do just the opposite. You’ve mentioned that this is a rapidly growing mass, and the vet hasn’t been able to get it out entirely. I’m a little confused why a fine needle aspirate was done. If 80% of the mass was taken there should have been plenty of tissue to do a proper biopsy. Have you been able to ask about being referred to a vet oncologist? With so much unknown, you may feel better having an expert, and that’s no reflection on your vet. No one can know everything. But you want to take the best care of your dog, and you have a lot of gray areas. Equally, there may be another specialist surgeon who could review the notes and determine whether closer work could be done. Please hang in there. Find out about specialists you can get to and put your team together. All vets want the best for your dog, and should have no problem with your requests. Give Bennie a big hug please.

  10. Nikki Landry on June 1, 2014 at 9:53 am

    Dr. D, I just started my dog on Apocaps for the first time. Is it possible, apocaps could enlarge his tumor? I’m not sure if his tumor is growing rapidly because of the apocaps or if it is because of the type of tumor it is. I have his test results, but the results of his tumor came our undefined. The vet did a fine needle biopsy and the results came back undefined. Basically, the vet knows it’s cancerous, but he’s not sure what kind of cancer it is. He did a chest xray of my dog and his lungs were clear. Here is what the results say based on the Fine Needle Biopsy. These results are from before he had the tumor removed. RE:2000 MICROSCOPIC INTERPRETATION MICROSCOPIC INTERPRETATION – malignant neoplasia, undifferentiated, type uncertain. Large 6x6cm rapidly growing firm mass caudal to the scapular spine. Excisional biospy some cystic necrotic tissue in center of mass. Relatively avascular. Two pieces.

    Ever hear of anything like this? The vet was able to remove 80% of the tumor because the other 20% is attached to muscle or nerves.

    Anything you can suggest to help my dog? He’s on pain meds, and apocaps, healthy diet, and he’s eating really well.

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