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

Pain Management Update PLUS: Natural Pain Relief for Dogs

Updated: September 30th, 2019

Summary

Pain management for dogs should change based on what we know now. Dr. Dressler goes over his current pain control cocktails and natural pain relief for dogs.

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One of the most important questions I receive from dog guardians is, “Is my dog in pain?” And that is often followed by “is there such a thing as natural pain relief for dogs, or do we have to use meds?”

This article is long, but I hope it’s useful. I’m going to update you on changes in veterinary pain management (some of which haven’t been made yet on a broad scale), and also give you ideas for natural ways to address your dog’s pain.

Pain = Lower Life Quality

Pain, also called nociception, lowers life quality. This is true for any medical problem, including canine cancer. So of course, we must pay attention to pain to give our loved dogs good life quality. There’s a lot of discussion on pain and life quality in the Guide.

The old ways may not be the best ways, though, and we know more now than we used to about pain management. So today, I will update you on pain control in dogs with cancer, including important new information for both guardians and veterinarians.

We will look at these important topics for dogs with cancer:

  • The difference between pain and other bad feelings in the body.
  • Current information on how you can tell if your dog is in pain
  • Recent science showing how some of the most commonly prescribed dog cancer pain drugs may not work as well as we once thought.
  • What the best home pain meds actually are for canine cancer.
  • A selection of other Full Spectrum tools to provide natural pain relief for dogs with cancer.

Do Dogs Feel Pain?

The short answer to this question is YES.

In my opinion, anyone who says that dogs don’t experience pain is wrong.

I can’t believe that I have to start with this question, but it’s true: even in this day and age, some actually say (out loud) that animals don’t feel pain! Unbelievable. So let’s look at how we can be pretty darn sure that dogs feel pain.

Let’s start with how dogs have well-developed pain-sensing systems, similar to ours. These include:

  • similar pain-sensing cells
  • similar nerves
  • similar neurotransmitters and hormones that relay pain signals

These systems are activated in dogs in situations when a human would experience pain.

Also, when we give medications that remove pain (analgesics), dogs ACT like they are in less pain.

Dogs also move away from painful things. Have you ever seen a dog with a history of abuse cringe when someone lifts a hand? Move away from the oven door blasting heat? Hop over a hot sidewalk?

Dogs limp, vocalize, and their heart rate changes.

They act exactly like we do when we are in pain, AND they have all the same pain-sensing systems we have.

So, as far as I can tell, if you believe that humans feel pain, you should believe that dogs feel pain.

Okay??

Now that we have dispensed with that subject…onwards… to some details about pain versus other bad sensations, and why it matters.


There’s an entire chapter on pain management, plus a section on the Joys of Life, plus … basically, the whole book is focused on quality of life. If your dog has cancer, you should get it.

Make Pain Part of Your Treatment Plan Analysis

Decisions in canine cancer care are often a balancing act. Treatment decisions are not clear cut, and we have to weigh all the pros and cons.

This leads to what I call Treatment Plan Analysis, which is where we look at each treatment and decide if it is worth it. There is an entire section of my book dedicated to this subject.

Treatment Plan Analysis, defined: What does my dog get out of the treatment? Do the positives outweigh the negatives?

But make no mistake, one the biggest factors you need to consider is life quality.

And many guardians have the burning question, “Is my dog in pain?”

And they should! When we have a loved dog with cancer (or any other medical problem) pain matters.

Is It Pain, Or Is It Some Other Bad Feeling?

Sometimes we think a dog is in pain, but they actually feel something else. This is important!

Other bodily experiences can be negative, even if they aren’t quite painful.

For example, a loved dog who is throwing up may feel some pain, but probably feels other bad things as well, such as nausea and having no energy.

Many human people feel “sick” when they have cancer, and it’s not because of the treatments they are using. Cancer itself can cause fatigue, nausea, vomiting, diarrhea, and all sorts of other symptoms, including pain.

It’s important to figure out WHY your dog doesn’t feel well. Because if we assume it’s pain, and use a pain med to treat it, it might not work.

Pain medications don’t treat nausea, for example. If we use pain medication to treat nausea, we are not addressing the right thing, and the treatment will not work.

This is why your veterinarian probably asks you a LOT of questions about your dog when you visit. We have to differentiate between pain and these other bad feelings. We rely on you because you are the spokesperson for your dog.

So keep this in mind, as a vigilant protector of your dog:

Pain is only one of many negative experiences your dog may face. We have to treat the problem in order to succeed.

How To Know Your Dog Is In Pain

Pain is a perfect example of the mind-body connection, which I write about a LOT in my book.

The Glasgow Composite Measure Pain Score (CMPS), was developed at the University of Glasgow in 2007.  This Score uses canine behaviors (which start in the mind) to get information about pain (which usually starts in the body).

The CMPS is one of our best tools to assess pain in our dogs. That’s because this system can tell us not only IF a dog is in pain, but also HOW BAD the pain is.

The CMPS uses a questionnaire to track what happens when a dog is at rest, when she’s encouraged to get up and move with a leash, when pressure is applied to a potentially painful area, how his mood is, and what her posture is. Here is a link to the questionnaire. It’s pretty short, and you can probably get a good idea at how bad your dog’s pain is right now by taking it. Please review it with your veterinarian, of course.

In the meantime, here are some examples of canine pain signs listed on the CMPS:

  • Whimpering, crying, groaning, or screaming
  • Looking at, rubbing, licking or chewing the painful area
  • Limping, slow-moving, reluctant to move, or refusing to move
  • When pressure is applied to the area or around it: looking back, guarding, flinching, growling or snapping
  • Nervous, anxious, depressed or not responding to normal stimulation
  • Being unsettled, tense, restless, or having a hunched posture

As you can see, dogs in pain often show signs that we can see. Not every one of these is specific for pain (such as being “indifferent”), but the more we see in a given dog, the more likely we have true pain. Each sign is given a point score, and you add up all the points to get a total. If you have enough points, pain medication is warranted.

So how many points do you need before you ask for help?

Well, there are two different scores, one for dogs that can get up and move around, and one for dogs that are bed-ridden.

  • If your dog can get up and move around and scores 6 or more out of the possible 24 points, pain control is needed.
  • If your dog is bed-ridden and scores 5 or more out of the possible 20, pain control is needed.

Pain is real, and it’s a real bummer for dogs. So if you think your dog needs help, bring it up with your vet ASAP.

New Science for Older Prescription Drugs Shows We Might Be Doing the Wrong Thing

I’m gearing up for the comments, now, because once again I’m going to point out things that we veterinarians need to update. If this is new info, I’m sorry about that, fellow vets.

I’m guilty too, of course, because I’ve been using some of these drugs … but now that we know better, we should make better choices.

There is new information available that shows a whole bunch of drugs vets often use for pain do not work the way we thought they did.

Some don’t work well at all, and others do, but not the way we think they do.



Tramadol No Good for Pain, Maybe Good for Sedation

Sitting on my shelf is a bottle of a pain medication drug called Tramadol, or Ultram®. It’s been used for decades in veterinary medicine. I’ve even written about it.

Well … the days of Tramadol as a dog pain medication may be numbered, thanks to some new research on the subject.

In this 2016 study, Tramadol was used as the pain medication after a spay. The authors concluded that:

“Based on our results, the use of tramadol as a sole analgesic agent provides inadequate postoperative pain control…”

Uh oh. In plain English, this means Tramadol alone did not control pain after spay.

They did give the disclaimer that more work was needed to decide to stop using Tramadol altogether. That’s a typical disclaimer, but in clinical practice, their results should concern us veterinarians. Just based on this study alone, I’m questioning whether or not to use Tramadol to help dogs in pain.

So let’s look for more information. Oh, here: another study came out that looked at dogs with arthritis pain who were treated with Tramadol. It concluded:

10 days of treatment with tramadol … provided no clinical benefit for dogs with osteoarthritis of the elbow or stifle (knee) joint.”

Ouch. Literally. “No clinical benefit” basically means “did nothing for pain.” Another blow to Tramadol as a pain medication.

And finally, another paper looking at Tramadol as a pain drug after surgery. In this case, the surgery was the removal of an eye. This study compared Tramadol to carprofen (also called Rimadyl®) combined with a narcotic.

Tramadol lost again.

What’s the take-home message here?

If you are a veterinarian or a guardian don’t rely on Tramadol as an effective pain control drug by itself.

But hold on, don’t dismiss Tramadol completely. These studies did not look at Tramadol used as part of a pain control “cocktail” in combination with other medications.

Pain cocktails (combinations of multiple medications) are generally better at treating pain than single drugs are. So Tramadol may indeed still be effective as part of a cocktail.

Even so, I’m moving away from Tramadol for pain based on current data.

I do still use it to help with calming and relaxation because it does seem to have anti-anxiety effects, which can improve happiness and well-being in some dogs.

Acetaminophen with Codeine: Nope

Some vets, especially those of us who do a fair bit of surgery, have used acetaminophen (Tylenol®) with codeine. Well, in 2016, this combination was used in a study involving 6 Greyhound dogs.

The conclusion? A lack of pain control. Like Tramadol, Tylenol® with codeine didn’t work. Of course, the author included reasonable disclaimers that more study is needed.

Another study showed that acetaminophen with codeine did have some beneficial effects, equivalent to the effects of Percocet® in dogs.  However, the methods used were not as good as those used in the Greyhound paper.

So now I don’t normally reach for Tylenol® with codeine for pain control in my patients.

What About Narcotics?

What if we use a narcotic, hydrocodone, and combine it with Tylenol® (acetaminophen) in dogs? Seems reasonable.  Plenty of vets use hydrocodone and some of them use it in combinations like this. I’ve certainly got hydrocodone in my inventory.

Well, in 2015, this combination was shown not work either, at least not for pain from major orthopedic repair.  Tramadol was used in this research as a comparison group.  Here’s what the authors concluded:

“Overall, differences in pain scores between dogs that received hydrocodone-acetaminophen or tramadol were minor. The percentage of dogs with treatment failure in both groups was considered unacceptable.”

In other words, neither treatment worked. Too many dogs in BOTH groups “failed” treatment. That means they were treated for pain, and still had pain.

Tramadol = no good (again) and hydrocodone-acetaminophen also = no good.

And while we’re on the topic of narcotics, another paper looked at extended-release hydromorphone and found it no better for pain control than an anti-inflammatory medication.  So why use this narcotic at all?

In short, narcotics don’t look good either.

Fentanyl?

Yet another drug formulation that now looks destined for the grave is the fentanyl (Duragesic®) patch, which was still in vogue up until a few years ago for pain control in dogs. Many vets (including me) have used it, and some still do.

The problem with fentanyl patches in dogs, shown in this study, is that absorption through the skin is not very consistent.  Furthermore, there was a lot of difference between individual dogs, meaning it worked well in some dogs but not well in others.

And finally, heat has an impact on the delivery of the fentanyl through the skin. I’ve heard stories about dogs who were laying in one position (on top of the patch, on a soft bed) that were overdosed because of the prolonged heat in the area of the patch.  This is seriously bad news.

For these reasons, I’ve stopped using fentanyl patches altogether for pain in dogs.

Buprenex??

Veterinarians may also prescribe dogs the drug Buprenex® (buprenorphine) for pain control. But in 2007, in the World Small Animal Veterinary Association Congress Proceedings, a study showed buprenorphine worked even worse than Tramadol.

Ugh.

So Should We Give Up On These Drugs Altogether?

Generally, my opinion is that we should not rely on tramadol, Tylenol® with codeine, hydromorphone, extended-release hydromorphone, fentanyl patches, or buprenorphine as primary pain control meds for dogs with cancer. For that matter, we should avoid them for any painful situation.

However, I have to point out that there will be less-than-perfect situations where a vet may still need to use these drugs.

For example, if a patient has reactions to more-preferred pain meds, a veterinarian might reach for one of these tools.

Use other meds and methods before using tramadol, Tylenol® with codeine, hydromorphone, extended-release hydromorphone, fentanyl patches, or buprenorphine.

Read on for the medications I prefer to use in my pain cocktails, and also for the Full Spectrum tools that provide natural pain relief for dogs.

Anxiety and Stress and How They Relate to Pain

So, what DO I recommend? There are a few pain medication combos I feel are best for dogs, and I’ll go over them below. But to understand WHY I recommend what I do, let’s get a better understanding of what we know about pain.

I have over twenty years of clinical experience as a veterinarian, and I’ve treated lots of dogs for both cancer and other problems. I’ve also done a lot of research on pain.

I hate it when dogs are in pain.

Based on my research AND my experience, I feel that a lot of pain dogs feel is due to anxiety or stress. I’ll explain more on this in a minute, but first I’d like to unpack pain, as an experience.

Dogs experience pain in ways similar to humans, so let’s start there.

Nociceptors –> Nerves –> Brain –> Pain

A lot of pain starts in specialized cells called nociceptors.   These modified nerve cells can sense things like excessive heat, trauma, and chemical harm.  Nociceptors are all over the body, and they are found in humans, non-human animals, worms, fruitflies … in many living things.

Nociceptors connect to nerve cells that transmit the pain-related information to the spinal cord and the brain.

Once the pain information gets to the brain, the brain turns that pattern into an experience: pain.

Have you ever touched something very hot, like a pan on the stove, and drawn back instantly, and yet not felt the burning sensation for a few seconds? One set of nerves is responsible for that reflex, the drawing back instantly. The nociceptors, though, are responsible for the pain feeling. And the delay between jerking your hand back and feeling the pain: that’s the time it took for your nociceptors to notice the painful burn and transmit it to the brain so it could create pain for you.

It turns out that you can experience pain differently based on all those different steps in the process. The incoming pain signals and the actual experience of pain itself can be “reset” based on many factors.

When people talk about the “mind-body” connection as it relates to pain, they are talking about this system. It’s possible to interrupt the pain cycle, and therefore, diminish pain.

It’s also possible to increase pain, however. Sometimes pain gets worse as the nociceptors get ever more sensitive. For example, if you’ve ever had a headache and noticed that it feels worse with movement, it could be because nociceptors are more sensitive to the tiny little stiffness you feel in those tiny little movements. They get more sensitive and send more pain information, and the brain creates more pain.

Or, sometimes, nociceptors are damaged, and they send pain signals non-stop. This is a terrible experience, as you can imagine.

Different Bodies, Different Pain Perceptions

That cycle of nociception – nerve transmission – brain processing – pain experience sounds very neat and tidy, doesn’t it? But pain is anything but neat and tidy. In fact, it’s literally different for everyone. Different people perceive and experience pain differently.

Here’s a fascinating article that points out how genetics, culture, and even gender influences the way we experience pain. For just one example, the authors looked at heat pain. It turns out that Asian-Americans are more sensitive to heat pain than European Americans, African Americans, or Hispanics. Generally, the heat gets to them more. Meanwhile, European Americans have a higher tolerance for cold pain.

So there are differences in how we all perceive pain. What is painful to me might not be so bad to you. What is horrible to you might not bother me at all. (Think about that the next time you judge someone else for “being a baby” about something. Maybe the pain they feel is way worse than the pain you would feel.)

I’ve seen these differences among different dog breeds and personalities. We have pain-resistant breeds and pain-sensitive breeds. The individual dog’s temperament also seems connected with how much pain they feel.

Stress Can Lead to More Pain, Especially Chronic Pain

One well-documented reason some people feel more pain, especially chronic pain, is that they are under stress.  This is probably why it helps moms to do breathing techniques when they are giving birth, because breathing deeply reduces the stress response in the body.

This article about how stress can influence our perception of pain is fascinating, although I take issue with this idea found in the abstract summary:

“Peculiar to humans are additional factors that modulate pain that are experienced in times of stress”

I don’t think humans are alone in experiencing more pain during stressful times. No way. I disagree. Almost without fail, stressed dogs exhibit higher pain responses on the Glasgow criteria above, at least based on what I see in my practice.

And Frontiers in Bioscience agrees with the idea that animals feel more pain when they are stressed.

So now that we’ve established that dogs feel pain, that pain is a bummer, that many common meds we have turned to for decades don’t work, and we’ve got an idea of how pain works … let’s turn to actual solutions you can discuss with your veterinarian.

At-Home Pain Medication Cocktail Ingredients

If your dog is in the hospital, or even just at a regular veterinary visit, pain medications will be injected directly into their body. That way the pain meds get started and take effect much more quickly than they do when given by mouth.

But to keep up your pain control at home, you will be using at-home meds given by mouth.

And as we’ve learned, the best pain control is usually NOT a single drug, but a combination of medications, each of which does something a little different.

I’m a big fan of using “cocktails” of dietary apoptogens and anti-metastatics, as readers of my book know. When we use carefully balanced combinations of things, we often get a synergistic effect that is greater than the effect we get with each one individually.

We will go over natural pain relief for dogs below, but for now, let’s look at some of the better combinations of pain control medications you can give at home. These are all prescription medications, so of course, your veterinarian will decide which ones to use.

Note: when I say a “pain cocktail” I don’t mean that all the drugs are given at once, like a mixed alcohol drink. No, instead I mean that I may prescribe two or even three or four different medications, all carefully dosed and timed so that the maximum pain relief is achieved. I don’t just say “one and done” when it comes to pain relief. Sometimes one drug will be given just for one or two days, while others continue on for a while. Sometimes two drugs are given at different times of day. But they are all carefully thought through.

First, I think about an ingredient to control stress and anxiety and create relaxation. So let’s look at ways to reduce stress.

Start with Controlling Stress and Anxiety: Trazadone, Gabapentin, or Zonisamide

Because pain tends to increase with stress and anxiety, it’s always a good idea to consider antianxiety meds. These are not conventional pain medications, but using them is becoming more common in veterinary medicine. I generally like to include one of them in my pain cocktails.

Trazadone is an option to combat anxiety and depression and help reduce pain as a result.

Gabapentin is an anti-seizure medication, but it has also gained traction in past years for pain control. This is because it can treat nervous system pain, also called neuropathic pain.

Zonasimide is another anti-seizure medication that can be used for pain control cocktails.

You might wonder why progressive vets are using anti-seizure meds in their general pain control combos. The reason for this is that seizures are caused by excessive excitation in the brain cells, and gabapentin and zonisamide cause sedation, AKA less brain excitement.

In general, less brain excitement equals less pain perception. As a matter of fact, a study on gabapentin showed that dogs after mastectomy surgery needed less morphine to control their pain if they got gabapentin beforehand. And this paper showed that gabapentin could be relied on to control pain after surgery.

Note: the liquid gabapentin formulation sold under the brand name Neurontin® features very low doses of xylitol. Xylitol is potentially liver toxic and can create low blood sugar in dogs.  The doses in this type of gabapentin are low, but still, I usually avoid Neurontin® in dogs to be on the safe side. I use another gabapentin formulation in dogs.

Other Relaxation Meds To Consider

I wouldn’t use these as a primary pain medication, but on occasion, I will use cough suppressants with hydrocodone after surgery. This may sound weird, but cough medication with hydrocodone cause relaxation, and that is important immediately after a surgery when you need the dog to relax, rest, and not move around too much. Again, this is not a primary medication or something to give long-term, just one of the possible ingredients in my “pain cocktail” for an individual patient.

Muscle relaxers can also accomplish this, of course, especially if there is pre-existing muscle tension and stiffness.

And finally, there is the ultimate non-medical stress relief ingredient in our pain control cocktail: YOU.

You’ll also want an actual pain medication in your pain control cocktail. I often include an NSAID.

Add Pain Medications: Non-Steroidal Anti-Inflammatory Pain Drugs (NSAIDs)

NSAIDs are medications that help lower pain and lower inflammation.

Other drugs are good at controlling pain and inflammation: those from the cortisone family. These are steroids, and the most common one for us vets is prednisone. Steroids tend to have side effects.

NSAIDs are not steroids (it’s right in the name, non-steroidal). And they do not have the same side effects as the cortisone drugs.

Dogs seem to respond well to NSAID medications for pain, as long as they are already nice and relaxed. (NSAIDs do not address stress or anxiety.)

NSAID’s can be safely combined with all of the meds I recommend above for stress and anxiety.

So, if your dog is already chilled out, it might work to just use an NSAID by itself. But if your dog is stressed, or anxious, I recommend that cocktail of both an anti-anxiety med AND an NSAID.

I like the new drug Galliprant® (grapiprant) for the more frail animals who need a milder medicine.

I like meloxicam for general use.

And when we need a stronger NSAID, I like deracoxib.

Carprofen (Rimadyl®) is an older drug, and I still use it, because it is still pretty good in my opinion. It does, however, have a stronger association with liver injury (see below) than other NSAIDs.  But this might be for the simple reason that it was very popular at one point … and we vets have since learned the hard way that NSAIDs can cause liver and kidney problems. We may have over-prescribed it, and therefore seen more liver injury because of it.

That’s why I always advise checking liver and kidney function with blood labs before starting NSAIDs. I like getting that baseline reading of the health of the kidneys and liver.

Then I like checking again at 5-7 days, and then twice yearly when using NSAIDs.

Why so often? Because every once in a while, we see dogs with unique sensitivities to NSAIDs. Very rarely, those sensitivities can be quite serious. If you get the lab work done, you can monitor and quickly stop or taper if any problem shows up.

When used properly and monitored, NSAIDs are excellent drugs for canine pain control.

Other Newer Pain Medications: Tapentadol

We have some new prescriptions for pain control in dogs in those cases where we need something other than an NSAID.

One of the most exciting, I think, is tapentadol.  This is a new narcotic medication that is kind of like tramadol, except it is much better at controlling pain.

One of the problems with the narcotic family (morphine, hydromorphone, codeine, etc.) is that they aren’t well absorbed in the body. They also can cause slowing effects on both breathing and heart rate, which can be problematic in some dogs.

But tapentadol is different than its cousins. It is reliably absorbed by mouth, and its side effects are much less strong.

So if an NSAID is out, or isn’t cutting it, using tapentadol in your cocktail is something to consider with your veterinarian.

Older Narcotics Have Their Place

Sometimes nothing else is helping, or helping enough, and we need to pull out older narcotics with heavier side effects. Or maybe tapentadol is just too expensive. In these cases, some dogs respond well to narcotics like codeine.

Remember, I don’t make absolute rules about very many things, especially when we’re talking quality of life. Everyone is different, and some folks just do better on narcotics than others do. The same applies to dogs. Don’t fret too much about “putting my dog on a narcotic” if it helps your pup!

Don’t Forget Maripotant/Cerenia®

Maripotant is labeled for nausea, so you may wonder why I recommend it, or it’s brand name Cerenia®, for pain.

Here’s why: it blocks the effects of substance P, a chemical signal involved in both pain and inflammation.

This action makes it oddly effective in some cases of pain where there is inflammation involved.

This makes it an option for me when I’m crafting my pain cocktail.

It’s not my first choice, but I turn to it after I cycle through my usual go-to’s and realize that they are not adequate.



Full Spectrum Natural Pain Relief for Dogs

Pain of any kind and even pain from cancer can be managed with different combinations of the drugs above. However, I suggest looking at the following non-medication tools, as well.

De-Stress Our Mood and Attitude

As readers of The Dog Cancer Survival Guide are aware, our dogs pick up on OUR stress! I’m not going to go into it in detail here, but I consider chapters one and two of the book to be MUST reads. They explain in detail why our moods and attitudes influence our dogs, and how you can modify and cope with your own emotions. When you clear your mind, breathe and calm down, you can be way more effective.

And, I believe, by reducing your stress, you reduce your dog’s stress. And that can reduce their pain.

So take three deep breaths, and let’s look at other pain-reducing tools.

Massage and Acupuncture Therapies

Although there is nothing new about these tools, they deserve mention as their science keeps evolving.

Massage is getting more and more credence as a valid tool in pain control for dogs. Here is some information from Topics in Companion Animal Medicine on the subject:

“Recent studies have shown that massage therapy alters dopamine and serotonin levels, decreases noradrenaline levels, and modulates the immune system. Psychological effects such as reduction of stress and anxiety, with improvement of depressive patients, have been reported in humans.”

 Reducing anxiety is a top goal of mine in dog pain control, and the use of massage for this purpose makes a lot of sense, and this is why I specifically cover massage therapy in my book.  Here’s another point from the same journal:

“…massage has many effects on muscle, the circulatory system, the autonomic nervous system, and the mind. Various techniques are employed to achieve a desired effect in the treatment of many conditions..”

And if we combine acupuncture with massage, research shows that pain control gets better!

These days more vets include acupuncture in their pain control efforts, and with good reason.  Acupuncture works very well in certain circumstances. And even though this post is about new ways to combat canine cancer pain, people are becoming increasingly familiar with this ancient tool. Acupuncture is now part of modern scientific study and acupuncture techniques are still improving.

Acupuncture has been shown to help with pain and life quality in dogs suffering from various conditions.  Here’s a paper on neurological and musculoskeletal diseases.

Here’s a paper about how it helped dogs with hip dysplasia.

Here’s one on dogs with back pain.

And it’s even been found useful for anesthesia in dogs.

So how do these therapies work? Both massage and acupuncture can be tailored to focus on myofascial trigger points.  These are sensitive areas, usually felt in muscle during a massage or other similar practice, as a sensitive “knot.”

In trigger point therapy, acupuncture or massage techniques reduce those “knots.” Unfortunately, trigger point therapy has been put in a “psuedomomedicine” box by conventionalists. I think that attitude is a bit silly, since this is a very easy experiment to run yourself.

These points can be felt with the fingers, and you can feel for yourself that pain goes away when these techniques are applied.

Luckily for us, the rehab community is paying a lot of attention to “myofascial pain syndrome.” (That’s just another name for the pain in these knots.)

Dogs do indeed get these myofascial trigger points. They often start after chronic pain or discomfort, in my experience. (Just like they do in humans.)

And what’s interesting and useful is that they can be found and treated with things like massage and acupuncture.

For example, acupuncture treated limping dogs with myofascial trigger points at a whopping 60% success rate in this study.

And in this study, they charted the electrical signals and found acupuncture produced anti-pain signaling.

Dog Acupuncture and Massage at Home

So, how do you use acupuncture and massage at home?

Well, you want to find a vet who can do the acupuncture for you, of course. You don’t want to try to apply needles to your dog’s skin yourself.

However, massage is a different story. If you find a “knot” in your dog, gently and slowly work it out on a regular basis. Don’t try to do it all at once, because your dog probably won’t be able to tolerate that much.

Instead, on a daily basis, feel your dogs legs, neck, and back, and I bet your fingertips will pick them up.

Start by simply resting your fingertips on the knot. Don’t push, but instead just rest on it. In your mind, imagine it melting a little.

As you feel the resistance give way, gently go in little circles, very slowly and sweetly, and imagine it all just melting away, little by little.

Only go as deep as the tissue will allow you to. You want this to feel like gentle relief to your pup, not a forceful deep massage.

Address Bone Pain with Bisphosphonates

Dogs with bone pain, including osteosarcoma dogs, can really suffer. If this is your pup, consider bisphosphonates.

Bisphosphonates are meds that help build calcium in bones. You may have heard of pamidronate, or of the new version called zoledronate.

In humans, zoledronate seems to have fewer side effects. That’s important to me, particularly because one of the most common side effects is a headache. And a headache is really difficult to assess in dogs, so I’m afraid that if we give a med that can cause headache, our dogs just won’t be able to let us know they’re in pain.

That’s why if I were to pick between pamidronate and zoledronate for bone pain, I would go with zoledronate.

Homotoxicology

OK, stay with me. Homotoxicology is a “far out there” practice somewhere between homeopathy and pharmacology. That’s a sweet spot, in my opinion. Instead of relying on single homeopathic remedies that often take a long time to work and may or may not do the trick when you need them, homotoxicology uses low doses (like homeopathy) but in combinations. This gives a faster result, which is usually better, in my opinion.

One of these,  Zeel®, was shown to help dogs with mild to moderate pain and is still available over the counter (but remember to have your vet involved in all treatment decisions you make for your dog).

I use injectable Traumeel® on a daily basis in my practice. It’s related to over-the-counter Zeel®, and in my experience, it has the anti-inflammatory and pain-alleviating effects of a modest-strength drug, especially when administered in acupuncture points or as an IV injection.

Of course, not all vets want to hear about homeopathy or homotoxicology. But a good holistic veterinarian will be on board with these topics. And Full Spectrum veterinarians will certainly be open to at least considering them.

Future Natural Pain Relief for Dogs: Cannabinoids and More

I am excited to see research on cannabinoids over time. I’m not going to be writing in detail about them on this site until they are fully legal at the federal level, but the possibilities are exciting.

There are other natural pain relief therapies for dogs on the horizon, too. I’d like to see more work on electromagnetic field therapies, for example.

We need more work using lasers of different wavelengths.

I think vibration and/or high energy ultrasound have potential too.

My work with Traumeel in myofascial trigger points makes me want to understand more about how pain stores itself in body tissues. There’s a lot going on there and little is known on this subject.  I have theories but they will have to wait for now…

I hope you found this update useful. To be honest, there are still many more topics within pain control that could be discussed, but I’ve focused on the most practical and direct subjects that come up most commonly.

Below please find a reference list that can help if you would like to do further research.

All my best,

Dr D



References and Further Reading

Glasgow Composite Measure Pain Score Short Form

Reid, Jacky & Nolan, Andrea & Hughes, Lynne & Lascelles, B Duncan X & Pawson, P & Scott, E.Marian. (2007). Development of the short-form Glasgow Composite Measure Pain Scale (CMPS-SF) and derivation of an analgesic intervention score. Anim Welf Suppl. 1.

Fentanyl Patches

Kyles AE, Papich M, Hardie EM. Disposition of transdermally administered fentanyl in dogs. Am J Vet Res. 1996 May;57(5):715-9.

Tramadol

Goudie-DeAngelis, E. M., Woodhouse, K. J., Raffe, M. R., & David, F. H. (2016). Evaluation of analgesic efficacy and associated plasma concentration of tramadol and O-desmethyltramadol following oral administration post ovariohysterectomyInternational Journal of Applied Research in Veterinary Medicine14(1), 105-113.

Budsberg SC, Torres BT, Kleine SA, Sandberg GS, Berjeski AK. Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. J Am Vet Med Assoc. 2018 Feb 15;252(4):427-432.

Delgado C, Bentley E, Hetzel S, Smith LJ. Comparison of carprofen and tramadol for postoperative analgesia in dogs undergoing enucleationJ Am Vet Med Assoc. 2014;245(12):1375-81.

Acetaminophen with Codeine

KuKanich B. Pharmacokinetics and pharmacodynamics of oral acetaminophen incombination with codeine in healthy Greyhound dogs. J Vet Pharmacol Ther. 2016. Oct;39(5):514-7.

Chang AK, Bijur PE, Lupow JB, Gallagher EJ. Comparative Analgesic Efficacy of Oxycodone/Acetaminophen vs Codeine/Acetaminophen for Short-Term Pain Management Following ED Discharge. Pain Med. 2015 Dec;16(12):2397-404. doi: 10.1111/pme.12830.

Buprenorphone

Comparative Efficacy of Tramadol and Buprenorphine as Preemptive Analgesics for Ovariohysterectomy in Female Dogs World Small Animal Veterinary Association World Congress Proceedings, 2007 Amit Kumar Gupta; R.S. Bisla; Kuldip Singh; Ashok Kumar Department of Veterinary Surgery and Radiology, College of Veterinary Sciences, Chaudhary Charan Singh Haryana Agricultural University Hisar, Haryana, India

Hydrocodone

Benitez ME, Roush JK, McMurphy R, KuKanich B, Legallet C. Clinical efficacy of hydrocodone-acetaminophen and tramadol for control of postoperative pain in dogs following tibial plateau leveling osteotomy. Am J Vet Res. 2015 Sep;76(9):755-62. Heffernan AE, Katz EM, Sun Y, Rendahl AK, Conzemius MG. Once daily oral extended-release hydrocodone as analgesia following tibial plateau levelingosteotomy in dogs. Vet Surg. 2018 May;47(4):516-523.

Pain Sensation

Coghill RC. Individual differences in the subjective experience of pain: new insights into mechanisms and modelsHeadache. 2010;50(9):1531–1535.

Ahmad AH, Zakaria R. Pain in Times of StressMalays J Med Sci. 2015;22(Spec Issue):52–61.

Imbe H, Iwai-Liao Y, Senba E. Stress-induced hyperalgesia: animal models and putative mechanisms. Front Biosci. 2006 Sep 1;11:2179-92. Review.

Deracoxib (Deramaxx®)

Bakirel T, Alkan FÜ, Üstüner O, et al. Synergistic growth inhibitory effect of deracoxib with doxorubicin against a canine mammary tumor cell line, CMT-U27. J Vet Med Sci. 2016;78(4):657-68.

Neuropathic pain

Backonja MM. Use of anticonvulsants for treatment of neuropathic pain. Neurology. 2002 Sep 10;59(5 Suppl 2):S14-7. Review.

Moore SA. Managing Neuropathic Pain in Dogs. Front Vet Sci. 2016;3:12.

Gabapentin

Levendoglu F, Ogün CO, Ozerbil O, Ogün TC, Ugurlu H. Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury. Spine(Phila Pa 1976). 2004 Apr 1;29(7):743-51.

Crociolli GC, Cassu RN, Barbero RC, Rocha TL, Gomes DR, Nicácio GM. Gabapentin as an adjuvant for postoperative pain management in dogs undergoing mastectomy. J Vet Med Sci. 2015;77(8):1011-5.

Chang CY, Challa CK, Shah J, Eloy JD. Gabapentin in acute postoperative pain management. Biomed Res Int. 2014;2014:631756. doi:10.1155/2014/631756

Trazadone

Gruen ME, Roe SC, Griffith E, Hamilton A, Sherman BL. Use of trazodone tofacilitate postsurgical confinement in dogs. J Am Vet Med Assoc. 2014 Aug1;245(3):296-301.

Crociolli GC, Cassu RN, Barbero RC, Rocha TL, Gomes DR, Nicácio GM. Gabapentin as an adjuvant for postoperative pain management in dogs undergoing mastectomy. J Vet Med Sci. 2015;77(8):1011-5.

Tapentadol

Kögel B, Terlinden R, Schneider J. Characterisation of tramadol, morphine and tapentadol in an acute pain model in Beagle dogs. Vet Anaesth Analg. 2014May;41(3):297-304.

Acupuncture

Silva NEOF, Luna SPL, Joaquim JGF, Coutinho HD, Possebon FS. Effect of acupuncture on pain and quality of life in canine neurological and musculoskeletal diseasesCan Vet J. 2017;58(9):941-951.

Teixeira LR, Luna SP, Matsubara LM, Cápua ML, Santos BP, Mesquita LR, Faria LG, Agostinho FS, Hielm-Björkman A. Owner assessment of chronic pain intensitioty and results of gait analysis of dogs with hip dysplasia treated with acupuncture. J Am Vet Med Assoc. 2016 Nov 1;249(9):1031-1039.

Fry LM, Neary SM, Sharrock J, Rychel JK. Acupuncture for analgesia in veterinary medicine. Top Companion Anim Med. 2014 Jun;29(2):35-42.

Still, J. (1989), Analgesic effects of acupuncture in thoracolumbar disc disease in dogs. Journal of Small Animal Practice, 30: 298-301.

Massage

Formenton MR, Pereira MAA, Fantoni DT. Small Animal Massage Therapy: A Brief Review and Relevant Observations. Top Companion Anim Med. 2017 Dec;32(4):139-145.

Lane DM, Hill SA. Effectiveness of combined acupuncture and manual therapy relative to no treatment for canine musculoskeletal pain. Can Vet J. 2016;57(4):407-14.

Corti L. Massage therapy for dogs and cats. Top Companion Anim Med. 2014 Jun;29(2):54-7.

Myofascial Trigger Points

Desai MJ, Saini V, Saini S. Myofascial pain syndrome: a treatment review. Pain Ther. 2013;2(1):21–36. doi:10.1007/s40122-013-0006-y

Wall R. Introduction to myofascial trigger points in dogs. Top Companion Anim Med. 2014 Jun;29(2):43-8.

Janssens LA. Trigger points in 48 dogs with myofascial pain syndromes. Vet Surg. 1991 Jul-Aug;20(4):274-8.

Srbely JZ, Dickey JP, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010 May;42(5):463-8.

Pamidronate, Zoledronate

 Yang L, Du S. Efficacy and Safety of Zoledronic Acid and Pamidronate Disodium in the Treatment of Malignant Skeletal Metastasis: A Meta-Analysis. Medicine (Baltimore). 2015;94(42):e1822.

Homotoxicology

Hielm-Björkman A, Tulamo RM, Salonen H, Raekallio M. Evaluating complementary therapies for canine osteoarthritis–Part II: a homeopathic combination preparation (Zeel). Evid Based Complement Alternat Med. 2009;6(4):465–471.

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  1. Tripawds on August 14, 2019 at 6:34 am

    SUPER helpful information here, Dr. D. Thank you for taking time to publish such a comprehensive overview of the status of pain relief meds for pets. It’s our greatest wish that more vets would get on board with the same school of thought. Too many still don’t give enough pain control after amputation and other surgeries. We’re sharing this with our community.