Managing Chronic Pain In Dogs
Dogs feel pain by the same pathways as humans. However, since they cannot “tell us where it hurts” it can take a little more investigating to determine where the pain is coming from. Dog also instinctively will try to hide pain as a mechanism of survival so it can be that much more difficult to determine where the pain is coming rom.
How can I tell if my dog is in pain?
The most obvious sign of pain would be limping because a leg hurts and they are shifting weight off the area. However, it is not always that easy to determine pain, but most dogs experiencing pain alter their behavior in some way. A dog may be reluctant to climb stairs, show decreased activity, or resist being handled or picked up. Subtle signs may be our only clue that the dog is hurting.
Arthritis pain is common in older dogs and is confirmed with radiographs. Anyone who has witnessed an older dog struggle to rise or be unable to stand after lying down can imagine the discomfort these dogs must endure.
Here are some other common signs of pain (but are not limited to):
- Less active
- More quiet or withdrawn
- Growing or aggressive when approaching them
- Licking the area of pain
- Eating less or not eating
- Slow to rise
- Personality changes
- Not wanting or tolerating the length of walks (stops or lies down on the normal walks)
- Not wanting to play
- Ears are down
- Unexpected reactions when you pet him
How is pain treated in dogs?
Let’s separate this into medication vs non-medication
Medication for pain management
Recent studies have shown that we need to be more aggressive about multi-modal pain management (blocking more than one pain pathway) when chronic pain (ie arthritis) is occurring (as opposed to acute pain like a procedure). My personal plan is typically to exhaust non-medication management and then use the medications as necessary when it is time.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – These medications block inflammation. They are highly effective, but pets are more sensitive to these medications than people which is why you won’t find them available over counter (at least not safe/effective ones). They must be monitored by a veterinarian and used with caution because there is the potential for liver, kidney, stomach, and/or intestinal problems. We monitor for anemia and liver and kidney changes frequently. Despite these side effects, they are typically the most effective at allowing your pet to feel ready for that walk again.
Neuromodulators – This includes our most recent favorite medication gabapentin. Gabapentin works on blockage of the pain pathway. It is most effective when given long term, but I will use it occasionally “as needed” for patients. It has other effects that are nice, sometimes sedation, anti-anxiety, and it is a mild anti-seizure medication.
Opioids – This category is mostly used for acute pain post-op in the hospital but occasionally we will use hydrocodone or tramadol which is opioid-like for additional pain control. Unfortunately, tramadol has very wide responses in pets so we use it sparingly at this point.
Corticosteroids – Cortisone and synthetic cortisone-like drugs (prednisone, prednisolone, methylprednisolone, budesonide and dexamethasone) are strong anti-inflammatory medications. They are often used to reduce arthritic, allergic, or dermatologic discomfort. We also use them for neck pain when NSAIDs are less likely to be helpful. They are most commonly used for immunosuppression instead of pain, but do have pain relief as a side effect (along with a lot of other long term side effects, this medication is monitored closely).
Non-Medication for pain management
Now this is my most exciting soap box. I am a big fan of multi-modal therapy but also I love to exhaust non-medications. They can be effective, can prolong the life of your pet, and post-pone the use of the above medications until necessary. This is not to say that I will not advocate for pain medications when it is appropriate, but just that I believe there are many ways to relieve pain
Weight loss – This is my number one go-to tool. I love to see skinny animals. They are at reduce risk for other health issues, they live longer and they have to see me less! Weight reduction reduces the forces on the joints that cause arthritis. It is in my opinion the number one most effective therapy that we can institute. I do this by first reducing the food by 20%. If that is not effective, then we will run blood work including a thyroid test and if that is all normal start a prescription metabolic diet or a prescription from just food for dogs.
Body condition scoring can be difficult. The main things I am looking for are if I can feel the ribs (I should feel them easily) and when I stand above the dog, I should see an hourglass shape. While this varies in different breeds, it is this I look for not a number on the scale.
Glucosamine-Chondroitin – This is one of the few things I reach for name brands. They are more effective and have a guaranteed analysis. While I usually a sceptic, my own clients started changing patients from over the counter to more high-end brands. I now sometimes can get pets off medication by being on a good supplement! I carry my favorite at the hospital because it includes collagen UC-II which has been show in studies to reduce inflammation.
Omega fatty acids – Omegas play a role in inflammation. The ratio of the 3’s and 6’s helps determine if we are up regulating or down regulating inflammation. For this reason, the same as above, I lean on the higher end omegas. I tend to start at the label dose and work our way up to about 3x the label dose. These help with skin, brain, kidney, and of course joint heath. I think they are a great addition to chronic management on pain but alone do not work very well. If you pet has severe allergies, there is a topical version that we can help you obtain for your pet to avoid stomach uspet.
Exercise – This is actually third on my list. If they are overweight or sore, they get injured easily. What I love to hear is I walk my dog around the lake for the same miles each day. Great! Slow and steady wins the race. This consistent methodical movement lubricates the joints and keeps them healthy. Again, better than medication in my opinion.
Chondroprotectives /restoratives – I suppose this could fall in either category, but since there aren’t really any down sides to using them I like to use these in conjunction with all of the above. This is neither a drug or a supplement. It is called a disease-modifying osteoarthritis drug (DMOAD) that inhibits cartilage loss in the dogs joints. The brand I use is called Adequan. It is a twice weekly injection at the start and then we taper to a once a month maintenance. The idea with this is it works better when there is still some healthy joint remaining. Think of it like a crack in a windshield, you have a time frame of when this is going to be most useful, so when in doubt earlier use is better.
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