19/09/2023
There are numerous barriers to diagnosing and treating pain in dogs, but they all have the same throughline:
Humans like neat & tidy boxes. We like clear cut binaries. We like simple, and chronic pain is anything but simple.
One of these boxes is how we expect dogs in chronic pain to present.
• Guardians and professionals alike demand dog's present with significant decreases in quality of life before investigating pain.
• Despite stress-induced analgesia being well-documented, dogs who still play fetch or present as "fine" in clinic are overlooked.
• We associate pain with the inevitability of aging and dismiss it as "slowing down."
The second box is the clear cut binaries people want out of diagnostics.
• "These aren't signs of pain, these are behavior problems. You need to train your dog better." Real words vets have said to my clients.
• Confirming the presence of pain is not the same as diagnosing the primary condition. Clean x-Rays and other physical tests do not rule out if the dog is in pain or determine severity of pain.
• Frameworks for assessing dog pain, such as the Helsinki Index, ARE behavior assessments. Pain medication trial is the tool to confirm whether a dog is in pain.
Finally, we have our rigid ideas about how pain should be treated.
• Veterinary medicine focuses on prevention in many ways (eg: vaccines, spay/neuter, anti-parasitic), osteoarthritis is not one of them.
• WSAVA recommends pain being treated as the 4th vital sign, investigated with the same regularity and consistent tool as heart rate, temperature or respiration. However, most people have never received a formal means of measuring their dogs pain.
• Pain medication is important, but it is not the end-all, be-all. Pain management must include strategies that not only reduce pain, but prevent further harm and improve other aspects of welfare.
Check out Divergent Dog Behavior's Behavior & Wellness Consultations to see how I can help you overcome some of these hurdles.
Slide 1) Animal Pain Awareness Month. Why is Pain Under Diagnosed & Untreated? Behind text is a photo of a black and white Border Collie running along a sandy shoreline.
Slide 2) The Dog.
• Cannot communicate directly that they’re in pain.
• “3 Legs and a Spare.”
• Hiding pain is a survival skill.
• Don’t know there’s another option.
• Stress-induced analgesia.
• Continue to engage in painful behaviors.
Slide 3) “There are no geographic limitations to the occurrence of pain, nor to the ability to recognize it. The only limiting factors are awareness, education, and a commitment to include pain assessment in every physical examination.” 2022 WSAVA guidelines for the recognition, assessment and treatment of pain. Behind text is a photo of a tan and white, young dog running towards the camera.
Slide 4) The Dog Guardian.
• Cognitive Dissonance.
• Believe their dog is “too young”.
• Believe “slowing down” is normal.
• Fear of NSAIDs & meds in general.
• Chronic pain often presents as significant behavior struggles.
• Lack of accessible education.
Slide 5) “Preventive and multi-modal analgesia should always be considered.
Pain perception is influenced by numerous internal and external factors including the social and physical environment.
Treatment of pain should always include pharmacological and non-pharmacological therapies.”
2022 WSAVA guidelines for the recognition, assessment and treatment of pain. Behind text is a photo of a white and tan fluffy dog in an orange harness, running towards the camera.
Slide 6) The Vet.
• Industry in crisis; time constraints.
• Lack of knowledge regarding pain & behavior.
• Unrealistic expectations of dog guardians.
• Difficulties educating guardians.
• Do not implement consistent methods for tracking pain.
• Conflate diagnosing pain with diagnosing disease state.
Slide 7) “Chronic or maladaptive pain can be associated with a primary condition, or it can exist by itself.” 2022 WSAVA guidelines for the recognition, assessment and treatment of pain. Behind text is a photo of a black, scruffy dog running through a dried, grassy field.
Belshaw, Z., Dean, R., & Asher, L. (2020). Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting. Preventive veterinary medicine, 185, 105198. https://doi.org/10.1016/j.prevetmed.2020.105198
Belshaw, Z., Asher, L., & Dean, R. S. (2016). The attitudes of owners and veterinary professionals in the United Kingdom to the risk of adverse events associated with using non-steroidal anti-inflammatory drugs (NSAIDs) to treat dogs with osteoarthritis. Preventive veterinary medicine, 131, 121–126. https://doi.org/10.1016/j.prevetmed.2016.07.017
Budsberg, S. C., Torres, B. T., Kleine, S. A., Sandberg, G. S., & Berjeski, A. K. (2018). Lack of effectiveness of tramadol hydrochloride for the treatment of pain and joint dysfunction in dogs with chronic osteoarthritis. Journal of the American Veterinary Medical Association, 252(4), 427-432. Retrieved Sep 18, 2023, from https://doi.org/10.2460/javma.252.4.427
Canine Arthritis Management Advocate Program
Dycus, D., & Capon, H. (2020, April 28). Cam live: Identifying arthritis earlier and taking a preventative approach. YouTube. https://www.youtube.com/watch?v=uFOyqCFyDlw
Mannion, P., & Capon, H. (2020, May 15). Cam live: The role of imaging in canine arthritis management. YouTube. https://www.youtube.com/watch?v=xx5P8pb5UVg
Mills DS, et al Pain and Problem Behavior in Cats and Dogs. Animals. 2020; 10(2):318. https://doi.org/10.3390/ani10020318
Mills , D. (2021). Pain & Problem Behaviors . Lemonade Conference .
Monteiro, B. P., Lascelles, B. D., Murrell, J., Robertson, S., Steagall, P. V., & Wright, B. (2022). 2022 WSAVA guidelines for the recognition, assessment and treatment of pain. Journal of Small Animal Practice, 64(4), 177–254. https://doi.org/10.1111/jsap.13566
Roberts, C., Armson, B., Bartram, D., Belshaw, Z., Capon, H., Cherry, G., Gonzalez Villeta, L., McIntyre, S. L., Odeyemi, I., & Cook, A. (2021). Construction of a Conceptual Framework for Assessment of Health-Related Quality of Life in Dogs With Osteoarthritis. Frontier.
St.Clair, J. The pain trial concept for dogs: What is it and why is it important?. Grey Muzzle. https://www.greymuzzle.org/grey-matters/common-health-issues/pain-trial-concept-dogs-what-it-and-why-it-important-dr-james-st