Part 1: How We Recognize Pain in Pets
I graduated veterinary school in the decade of disco and Dynasty.
Wasn’t I lucky that the intense life of veterinary school gave me no time to watch TV, buy clothes or get my hair permed?
The veterinary world has changed a lot since the days of The Dukes of Hazzard. Now we’re watching Madmen and The Walking Dead (not sure if that’s a good or a bad thing) — and we’re doing a much better job controlling pain in our pets. That’s a good thing, for sure.
On Mother’s Day, I returned from a great continuing education conference in DC, and I’m savoring the updates and the new knowledge. From safer anesthesia to advanced geriatric medicine, cancer treatments to intensive care success, cardiac to kidney disease, hip replacements to cataract surgery, veterinary medicine continues to improve.
But no matter how much we learn, a pet’s quality of life depends on how well we can control their pain, no matter what the cause.
When your pet is suffering, it can be more frustrating than when a person is in pain. At least your daughter or son can TELL you “where it hurts, Mommy.” But think about the infant or toddler who can’t communicate yet.
Does that finger in the ear mean something, or is Jake just pretending his thumb is a Q-Tip?
Is Fifi standing funny because she’s scared, or does her tummy hurt?
Why is Jo-jo following me around with his head down? Is he depressed or in some kind of pain?
Pain Assessment — Not an Easy Thing
Gauging an animal’s pain can be extremely difficult, for owners and veterinarians alike.
Pain varies greatly among species and from animal to animal. A rabbit can “mask” pain up to a few moments before death. A Border Terrier can undergo an abdominal surgery and be running around two hours after surgery.
But say your next patient is a Greyhound with an infected canine tooth. Touch it and she screams for five minutes.
Does the Greyhound have intense pain or intense fear — or a little of both? Has she been in chronic pain for so long that the thought of you touching the tooth sends her reeling?
How about the terrier? Is he actually feeling pretty good, or is this dog driven by instinct to act normally while experiencing considerable pain?
We now know that a dog may even wag his tail and seem okay when he is actually in a great deal of discomfort.
And cats! Oh, boy, they exhibit pain in very subtle ways. You need your cat-whispering hat on your head front and center when trying to figure out what Puffers is trying to tell you when she’s ADR (ain’t doin’ right).
Recognizing Pain Matters
Most pets admitted to a vet clinic are out of their comfort zone (and fearful). And these patients may well be due for surgery.
The thing is, vets care a lot about whether their patient is in pain or not. Now, more than ever, we have an armory of drugs that can give effective pain relief, so there’s no need for dogs or cats to suffer discomfort.
However, all drugs have side effects, some more than others. In an ideal world, we want to control pain but avoid unnecessary medication. So with the right tools for the job, vets can control pain in cats — but first you have to recognize there’s a problem.
When your buddy cries out, you take notice.
If the sound of their whimpering or purr has changed, if it’s a frightening yelp or a dull moan, it’s time for action.
Same goes for no sounds. Where is the happy yip or any purr at all? Your may need your veterinarian to determine the meaning of the vocalization, but don’t ignore it.
Let’s start with our incredible canines. Many owners bring a dog in because “he has yelped in pain.” In my opinion, yelps that come intermittently from a dog, with normal behavior between the yelps, is frequently caused by neck or back pain.
Think of it as an acute spasm.
Many clients think this is abdominal pain, but that’s not usually the case. Rarely does a dog in abdominal pain scream out and then go back to what they were doing, like eating.
Cats do not give us as many clues as dogs do when it comes to vocalizing. Lack of happy purring and meowing is an obvious clue, but cats purr for many reasons, even stress or pain.
Low growls are usually significant and mean something is wrong. Excessive vocalization, as I’ve mentioned before, is not always pain but needs to be addressed with your vet.
How your dog or cat is standing, sitting or resting can give you subtle hints that they may be experiencing pain. If their stance is off, they probably ARE “off”!
So many sources of pain are obvious in a dog, it’s simply common sense.
A limp, licking a particular paw, scratching an ear: It’s almost as if your dog can talk to you in these instances.
But if your dog is standing in one position without moving, tucking in his abdomen, hunched, holding his head down, walking gingerly, these are all signs that should not be ignored.
If they could talk to you, they would be saying they are in pain.
Changes in posture are so subtle in cats, but this may be one of the only ways you get a clue that something is wrong.
When cats are in pain, they tend to be reclusive and stay in one position for extended periods of time.
Paws tucked, hunched, eyes half closed: They may not be telling you what it is, but they are telling you to get them help.
When cats are in pain, they frequently retreat. It’s upsetting when I hear clients say they let their cat “stay under the bed, not moving for two days.” This is not cool!
Cats don’t hang out under the bed because they’re playing “hide and seek.” They’re hiding because they feel like crap. Getting them from under the bed and out to the vet may save their liver, stop pancreatitis from becoming life-threatening, or relieve their dehydration — whatever the reason.
In the comfort of your own home, a cat in pain will act differently. They may:
- Hide away
- Not come to greet you
- Refuse to eat
- Be unusually grouchy
The list of what may be wrong when a cat is hiding is extensive. You need to find out what’s up with a downer cat.
To reiterate, you know your pet best of anyone. Except, perhaps, your vet.
If you’re lucky enough to have a long-standing relationship with your vet, it can be a great help.
An owner may bring in a pet I’ve been seeing for years, and be unaware that there is a change in demeanor, particularly if the change is subtle and slowly progressive. This is especially true with geriatric pets, who may be in some form of chronic pain, which brings me to my next point.
What Is Normal?
When pets are brought in to my hospital, it’s a huge help if I’m familiar with the pet before they’re sick, or before they are about to undergo a surgical procedure.
Knowing the normal helps to understand the abnormal.
If they’re admitted for a routine or more involved surgical procedure, assessing the animal before the procedure is essential to controlling their pain after the procedure. At the CVC conference, the pain experts spoke a lot about this. Seems like common sense, but attention to an animal’s demeanor can get lost in a busy hospital setting.
A dog simply LOOKING at her flank after a spay can mean she is in pain. Licking or bothering an incision usually means the dog is not just bothered by the sutures; it can mean his pain is not controlled. If we only walk by a patient every hour, we may not pick up on the subtle cues the pet is exhibiting.
My post-op patients are right out in the open, so we can be continually monitoring them.
Reducing Stress for Cats
No one wants to cause unnecessary stress to their patients, so vet staffs go to great lengths to make their inpatients as stress-free as possible. To reduce a cat’s stress, the vet tech may give the cat a box to hide in. This gives the cat a vital coping strategy, which is to conceal themselves.
Clinics use strategies to reduce stress such as:
- Keeping cat and dog inpatients in different wards
- Using reassuring cat pheromones
- Playing soothing music
- Providing boxes for cats to hide in
Clinical staff must also up their game and spot subtle signs of pain.
To do this, many practices now use the Glasgow Feline Composite Pain Scale (GFCPS) method — a bit of a mouthful. This is a method where we look at the bigger picture and give each cat a pain score out of 20. The higher the score, the more discomfort the cat is in.
The Big Picture
In good clinics, the hospital displays a Glasgow chart on the cattery wall, listing each item to be checked. Each cat has a clipboard on their bed where their individual score is recorded. Reviewing the scores helps clinical staff spot trends and when extra pain relief is needed.
Here are some of the factors constantly being checked. Each action has a prescribed “score,” and they’re all added together at the end of the assessment.
1. The Cat in Their Bed
- Meow or growl: When a cat is left alone, then “stress” noises such as growling, crying or groaning can indicate pain.
- Relaxed or hunched: If the cat is hunched and miserable, then this can reflect discomfort.
- Ignoring the wound or licking: Paying attention to a surgical wound may mean something has drawn the cat’s attention to it, such as pain.
- Pricked or flat ears: Agitated cats flattened their ears. So what caused the agitation? Is it pain?
- Muzzle shape: A squishy, tense muzzle reflects inner tension — caused by pain, perhaps?
2. Response to a Fuss
Does the cat enjoy a fuss and press in for a rub (good), freeze (not so good) or become aggressive (pain)?
What is the overall impression of the cat on a scale from friendly to depressed and grumpy?
3. Assessing the Sore Place
Is the surgical incision causing the cat pain? This is tested by gently touching the area around the incision and comparing their reaction with touching a non-sore place.
Here’s a little more information about cat pain:
How the Pain Score Is Used
The total pain score helps the vet decide if extra pain relief is required. Then, once the cat has received treatment, we can monitor them to see if it worked and when the effects start to wear off.
All cats are individuals. Some may be hissy and spitty by nature. But the beauty of this scheme allows for the cat to be given a score when admitted. If that score goes up after surgery, it’s likely the cat is in pain. Armed with this information, we can then give pain relief to alleviate their discomfort.
As you see, this is far from an academic exercise because it allows cats to be given the right level of pain relief for them as an individual. All of which goes to show just how far veterinary medicine has come. As a clinician, it’s wonderful to have medications that are safe and effective for cats, which means we’re much better able to manage their pain.
Part 2: How We Control Pain in Pets
Pain, how it works, and new drugs to manage it, is an amazing field, improving by the minute. The advances in human medicine, and now veterinary medicine, are astounding.
In my own life, I watched close family members suffer incredible pain after surgeries and traumas in the 1960s and ’70s. Today that pain in humans would be better controlled. This goes for animals as well.
Veterinary medicine mirrors pediatrics in many ways, because our patients are not communicating with words. What was considered acceptable in neonatal units 30 years ago would be considered malpractice today. Same goes for our furry babies.
A Cat Is Not a Small Dog
Differences in species make pain control difficult for the small animal veterinarian.
Never assume anything.
What works in a dog could be bad in a cat, for instance. Morphine and similar drugs are very effective in dogs, much as in humans. Not necessarily so in the cat. And wouldn’t you think you would treat a rabbit like a tiny pup or kitten? You would be wrong.
Of the few pain meds that are safe and effective in bunnies and other small mammals, you often need to use much more of the drug than you would in a dog or a cat to achieve proper analgesia.
Never, ever give your own pain meds or OTC meds to your pet without checking with your vet first. It’s hard enough for us to have the right answers, because many drugs have not been properly tested in dogs, cats, rabbits, etc.
And dose ranges are not the same. A dog is not a small human. A cat is not a small dog.
Don’t listen to your pharmacist either. They may be great resources for humans, but many pharmacists give out wrong advice about pets.
Not to beat a dead horse (what an expression for a veterinarian!), but my “Incredible” Dr. Pol article raised a bit of controversy, and pain control was an issue in that debate. With so much cutting-edge research in the pain management field, we need to stay current.
Proper pain control does not have to be expensive. Many newer pain drugs are already generic and can be very helpful in chronic or acute pain conditions. Combinations of drugs may be warranted, and veterinarians need to be thinking outside the old-fashioned pain box, both in how we assess pain and in how we treat it.
This article did not touch on many other advances in pain control such as acupuncture, laser therapy, local analgesia and anesthesia, and physical therapy, to name a few. Lifestyle, weight management, nutrition…
The answers are not just in the pillbox.
Just goes to show you how exciting my job is, and how life continues to get better for your pets!
This pet health content was written by a veterinarian, Dr. Debora Lichtenberg, VMD, with contributions from Dr. Pippa Elliott, BVMS, MRCVS. This article was reviewed for accuracy by Dr. Elliott and was last updated Feb. 4, 2019.