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It was only 22 years ago that scientific consensus concluded non-human animals experience pain. Since September 2002, there have been tremendous advancements in our understanding of pain. Unfortunately, there continues to be significant disparity between knowledge and practice.
Ensuring our furry friends are pain-free is central to animal welfare, but it remains a challenging goal. Join me over the month of September as I, • Revisit basic pain science to refresh your memory. • Delve into new info & ideas for guardians interested in a proactive pain approach. • Reveal a continuing education opportunity for dog professionals. By the end of this series, I aim to empower you to advocate effectively for your four-legged friend and inspire hope for their future. Discovering your dog’s pain can be distressing, but knowledge gives you power to positively impact their well-being. The fabulous & formidable (instagram handles): @dogminded @up_2_snuff @dog_atheart @katieleedvm @graceful_strides_gait_analysis @gentlejourneyvetcare @the.speed.of.hound @camppawsible @muttlifedogtraining @kamloopsurbantailz. #ImageDescription Slide 1) Pain Awareness Month 2024. Why do We Need Pain Awareness? Behind text is a photo of Darwin, a 13 year old long haired, dapple Dachshund. Darwin is standing on the rocky shore of Lake Superior, looking over the edge, his butt in the air. Darwin has multiple degenerative musculoskeletal conditions, but continues to enjoy an active, adventurous life thanks to palliative care. Slide 2) “Despite the current standard of veterinary care regarding pain recognition and treatment in our patients, many veterinary professionals are inept in pain identification and management.” Slovak, J. E., Turbeville, C., & Grubb, T. (2020). Assessment of veterinary students’ responses to questions regarding small animal pain recognition and analgesic treatment options. Journal of Veterinary Medical Education, 47(4), 482-487. Slide 3) “As veterinary health professionals, we have a moral and ethical duty to mitigate suffering from pain to the best of our ability. Despite advances in the recognition and treatment of pain, there remains a gap between its occurrence and its successful management.” Monteiro, B. P., Lascelles, B. D. X., Murrell, J., Robertson, S., Steagall, P. V. M., & Wright, B. (2023). 2022 WSAVA guidelines for the recognition, assessment and treatment of pain. Journal of Small Animal Practice, 64(4), 177-254. Slide 4) “We must switch our focus from damage control pain management to proactive pain management. This philosophical shift is particularly relevant to handling chronic pain, in which problems are not quickly resolved and must be managed over the long term.” Gruen, M. E., Lascelles, B. D. X., Colleran, E., Gottlieb, A., Johnson, J., Lotsikas, P., ... & Wright, B. (2022). 2022 AAHA pain management guidelines for dogs and cats. Journal of the American Animal Hospital Association, 58(2), 55-76. Slide 5) Who is pain aware? Check the caption to discover the fabulous & formidable professionals ahead of the curve!
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I want to be clear, I am in no way broad strokes, shitting on supplements. My own dogs take supplements. However!
In a multi-modal + evidence-based approach to managing joint pain, supplements come last. First and foremost, of the limited evidence supporting supplements, none of it is for pain relief. If you are struggling to financially or logistically manage your dog's joint pain, you should confidently skip supplements. The limited evidence for supplements like omega-3 fatty acids or glucosamine & chondroitin are functional benefits. They are in no way replacements for NSAID's, even if they confer some anti-inflammatory effect. Additionally, these possible benefits can take months to happen. Caregiver placebo effect is when dog guardians AND vets perceive a dog benefitted from treatment, when there was no measurable change. The widespread failure to identify dog suffering until they’re in agony, casts doubt on our ability to detect changes from supplements. Finally, they're only slightly more regulated than dog behavior professionals. Quality, evidence-based service/product is a crapshoot. So, if you have the financial means & you aren't replacing evidence-based interventions with supplements - by all means! Otherwise, there's better ways to spend your hard earned money. 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. Conzemius, M. G., & Evans, R. B. (2012). Caregiver placebo effect for dogs with lameness from osteoarthritis. Journal of the American Veterinary Medical Association, 241(10), 1314-1319. Retrieved Sep 29, 2023, from https://doi.org/10.2460/javma.241.10.1314 McCormack, S., & Capon, H. (2020, January 24). CAM Live: Joint Supplements Part 1. Canine Arthritis Management. https://www.youtube.com/watch?v=5Awzsfu0L0A McCormack, S., & Capon, H. (2020c, January 24). Cam live: Joint supplements Part 2. Canine Arthritis Management. Youtube Video Unlisted. Roush, J. K., Cross, A. R., Renberg, W. C., Dodd, C. E., Sixby, K. A., Fritsch, D. A., Allen, T. A., Jewell, D. E., Richardson, D. C., Leventhal, P. S., & Hahn, K. A. (2010). Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. Journal of the American Veterinary Medical Association, 236(1), 67-73. Retrieved Sep 29, 2023, from https://doi.org/10.2460/javma.236.1.67 Learning about neuroplasticity was a canon event in my behavior consultant origin story. Knowing that the experiences my dogs have - the experiences I expose them to - change their brain was an "aha!" moment.
Using punitive methods when chronic pain and stress cause literal brain damage is unhinged. Equally insidious, is proceeding with behavior modification when pain has not been investigated and managed. Chronic pain, whether from disease or our own doing, makes dogs less trainable. Everything from motivation, to attention regulation, information processing and memory are impaired by pain. According to Dr. Kathy Murphy, chronic pain will cause deficits in cognition before physical lameness or mood disturbances occur. One of the primary signs she draws attention to is frustration. Frustrated dogs are easily distractable and overstimulated. They engage in jumpy, barky, mouthy and even humpy behaviors. Dogs experiencing chronic pain become frustrated because they cannot learn and behave as needed to function in their world (and meet our lofty demands). However, neuroplasticity does not have to be our nemesis. The relationship between pain and cognition is not one direction. We can use cognitive processes to alter our dog's perception of pain. Environmental enrichment (EE), where animals can meet their needs at will and exercise control, has been show to decrease pain sensitivity. Additionally and dog specially, engaging our dog's sense of smell can have powerful impact on their pain state! EE isn't just having some dog toys scattered around the floor. Environmental enrichment for dogs are opportunities to… • Engage sniffing, foraging, shredding, digging, etc without having to go through you. • Use their behavior to manipulate the enviro (control). • Choose from a variety of ways to meet the same need. • Interact with (individual appropriate) novelty. • Use all their senses to explore their world. It's not just your home, it's your dog's home, too. It is long overdue that we normalize homes that look like dogs live a full life in them (not just exist in them). Ambron, R. (2022). The brain and pain: Breakthroughs in neuroscience. Columbia University Press. Doidge, N. (2017) Chapter Seven - Dark Side of Pain. In The brain that changes itself: Stories of personal triumph from the frontiers of Brain Science (pp. 177-195) Costandi, M. (2016). Neuroplasticity (The MIT Press essential knowledge series). MIT Press. Heath, S., & Capon, H. (2020, April 28). CAM Live: Pain & behavior. Youtube (Unlisted). Canine Arthritis Management. Jarcho, J. M., Mayer, E. A., Jiang, Z. K., Feier, N. A., & London, E. D. (2012). Pain, affective symptoms, and cognitive deficits in patients with cerebral dopamine dysfunction. PAIN®, 153(4), 744-754. Kimura, L. F., Novaes, L. S., Picolo, G., Munhoz, C. D., Cheung, C. W., & Camarini, R. (2022). How environmental enrichment balances out neuroinflammation in chronic pain and comorbid depression and anxiety disorders. British Journal of Pharmacology, 179(8), 1640-1660. Moriarty, O., McGuire, B. E., & Finn, D. P. (2011). The effect of pain on cognitive function: a review of clinical and preclinical research. Progress in neurobiology, 93(3), 385-404. Murphy, K., & Capon, H. (2021, November 17). Pain and neuroscience. Canine Arthritis Management https://www.facebook.com/CAMarthritis/videos/361425985734208 Solberg Nes, L., Roach, A. R., & Segerstrom, S. C. (2009). Executive functions, self-regulation, and chronic pain: a review. Annals of Behavioral Medicine, 37(2), 173-183. Tennant F. Brain Atrophy with Chronic Pain: A Call for Enhanced Treatment Pract Pain Manag, 2009:9(2) The most effective pain management plan for canine osteoarthritis (OA), is the plan that starts before the dog is symptomatic. This is because OA is a degenerative condition and pain damages the nervous system.
When you intervene earlier: • More treatment modalities are available. • Available treatment modalities are more effective. When should you implement lifestyle and environmental changes for joint health / canine osteoarthritis management: • Any dog (of any age) with developmental joint disease. • Any dog (of any age) with history of joint injury (eg: CCL tear). • Any dog (of any age) showing joint laxity (too flexible). • Any dog (of any age) who's training plan is not progressing as expected. • Any dog (or any age) with an unusual gait or posture. Canine osteoarthritis is The Most Common pain condition. Ø Impacts as many as 40% of dogs under 4 years old. Ø Impacts 90% of dogs over 8 years old. Ø Leading cause of early euthanasia because most cases aren't caught until 8- 13 years old. Ø It is safe to assume osteoarthritis impacting your dog is a matter of "when", not "if'. Canine osteoarthritis is a bummer to talk about because we've normalized waiting until the disease and pain have progressed. Early intervention is hope. https://caninearthritis.co.uk/managing-arthritis/what-can-be-done/ Dycus, D. (2020, April 28). Cam live: Identifying arthritis earlier and taking a preventative approach. YouTube. https://www.youtube.com/watch?v=uFOyqCFyDlw Lascelles, D., & Capon, H. (2020, November 13). Cam live: Canine arthritis myths. YouTube. https://www.youtube.com/watch?v=M_adx3azXT0 Perry, K., & Capon, H. (2023, August 14). Catching arthritis cases earlier. YouTube. https://www.youtube.com/watch?v=z6sz-DkpDlA&t=18s Trey Cutler, J. (2022, February 21). Osteoarthritis staging tool for dogs now available. Today’s Veterinary Practice. https://todaysveterinarypractice.com/news/osteoarthritis-staging-tool-for-dogs-now-available/ When a dog is in pain, they are at increased risk of using biting to communicate. This is why the first step of pet first aid is always to muzzle your dog. Even the friendliest, gentlest dog will escalate to biting when they're in pain.
While this is technically aggression, Dr. Sarah Heath prefers to call this behavior "repulsion". The function of the behavior is to make a person or dog gtfo. Of course, it would be wildly unethical to slap a muzzle on a dog in chronic pain. So how can we help our dogs? One of my go to behaviors to add to a dog's repertoire is "touch". This is when a dog boops their snoot against the palm of your hand. • It is incredibly easy behavior to teach. Not only does this make it accessible for you, but it means your dog gets "easy wins" that promote cognitive welfare. • "Touch" can be used as a way to move a dog without any physical contact. Or you can use it as an opt-in behavior before a potentially painful event, like picking up your dog to put them in the vehicle or put on a harness. • "Touch" is a question. How reliably, how quickly, and how enthusiastically they "touch" givse us answers about our dog's pain. Abnormal dog gaits (patterns of locomotion) have become normalized, instead of being recognized as subtle signs of pain. This has led to limping being held up as The Sign of joint and muscle pain. However, limping is a last resort.
• It is incredibly inefficient, uncomfortable and vulnerable way to move through the world. • Since dogs have 4 legs, they have a myriad of other ways to compensate before needing to limp. • Limping is more closely associated with significant, acute pain (eg: cruciate ligament tear, broken bone, open wound). • When limping presents in chronic pain, it is because the dog can no longer compensate in other ways. • Compensatory movements cause tissue damage and pain. Gait and movement changes related to chronic musculoskeletal pain are often much more subtle. Too subtle to identify while observing a dog in real-time. Most early signs of discomfort need to be recorded the rewatched in slow motion & frame-by-frame. If you are concerned your dog is experiencing chronic pain, schedule a behavior & wellness consultation at the 🔗 in my bio. • Deep dive into your dog's physical wellness, behavioral history, enrichment, environment and routines. • You will get wellness tips and training advice that prioritize proactive pain management. • You also leave with a "Suspicion of Pain" document that details signs your dog could be experiencing pain to help you advocate for your dog. Disclaimer: I am not a veterinarian. I cannot diagnose or treat your dog, nor am I replacement for veterinary advice. My professional wheelhouse is careful, time intensive observation of dog behavior. Limitations on observing dogs is a significant barrier to vets identifying chronic pain in your dog. Canine Arthritis Management > Managing Arthritis > Owner Identification of pain. https://caninearthritis.co.uk/managing-arthritis/owner-identification-of-pain/ Hodson, G., & Bell, N. (2021, March 16). Cam live: Posture, gait analysis and free work with Gemma Hodson. YouTube. https://www.youtube.com/watch?v=-FftK1SYWys McKenzie, B. (2022). Is aging a disease? DVM360, 53(3), 25. https://doi.org/https://www.dvm360.com/view/is-aging-a-disease- 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 Pain is not just a reaction to an injury, but a conclusion drawn by the brain, from a multitude of incoming signals.
This is why pain is subjective and fluctuates. The brain doesn't just process signals from injured tissues, but also processes info from the environment and the state of the rest of the body. Factors that can influence pain include: 1) Cognitive function - as dogs age and become more frail, they may become less resilient to pain. 2) Emotional states - anxiety can heighten a dog's sensitivity to pain. 3) Physical & social environment - loneliness and boredom can lead to emotional pain, which can exacerbate physical pain. 4) Neurobiology - due to neuroplasticity, each dog's brain is unique, affecting their perception of pain. 5) Past experiences - previous encounters with pain can shape a dog's current perception. Just like us, our furry friends experience pain as a complex emotional and sensory experience. Understanding your pet's pain is the first step towards helping them live a happier, healthier life! Ambron, R. (2022). The brain and pain: Breakthroughs in neuroscience. Columbia University Press. https://caninearthritis.co.uk/ Cell Press. (2016, October 11). Why naked mole rats feel no pain. ScienceDaily. Retrieved September 13, 2023 from www.sciencedaily.com/releases/2016/10/161011133636.htm Eckman, D. (2022, September 15). Chronic pain in pets part 1: Causes, symptoms, and prevention. VMBS News. https://vetmed.tamu.edu/news/pet-talk/chronic-pain-part-1/ Green, H. (2015, February 13). The nervous system, part 1: Crash course anatomy & physiology #8. Crash Course. https://thecrashcourse.com/courses/the-nervous-system-part-1-crash-course-ap-8/ Green, H. (2015b, March 2). The nervous system, part 2 - action! potential!: Crash course anatomy & physiology #9. Crash Course. https://www.youtube.com/watch?v=OZG8M_ldA1M Green, H. (2015c, March 10). The nervous system, part 3 - synapses!: Crash course anatomy & physiology #10. Crash Course. https://www.youtube.com/watch?v=VitFvNvRIIY Hill PB, Lo A, Eden CA, Huntley S, Morey V, Ramsey S, Richardson C, Smith DJ, Sutton C, Taylor MD, Thorpe E, Tidmarsh R, Williams V. Survey of the prevalence, diagnosis and treatment of dermatological conditions in small animals in general practice. Vet Rec. 2006 Apr. https://ivapm.org/ 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 . Molony V, Kent JE. Assessment of acute pain in farm animals using behavioral and physiological measurements. J Anim Sci. 1997 Jan;75(1):266-72. doi: 10.2527/1997.751266x. PMID: 9027575. 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 O’Neill et al. (2021) “Epidemiology of periodontal disease in dogs in the UK primary-care veterinary setting”, Journal of Small Animal Practice. First, These lists are not exhaustive. They are merely to demonstrate the subtle constellation of chronic pain indicators. Second, few of these only indicate pain. Similar to body language, the signs need to be contextualized.
Finally, no. I don't know if your dog's behavior is a sign of pain. If you are worried your dog is experiencing chronic pain schedule a Behavior & Wellness Consultation. • In-depth assessment of your dog's behavior history, lifestyle, environment, and body appearance. • Video Consult to discuss assessment findings & ask clarifying questions. • Collaborate on a non-pharmacological approach to pain management. • Edit videos to maximize usefulness for vets & spreadsheet of what signs were observed in each video. • Create concise document organizing signs of pain. Disclaimer: I am not a vet. I cannot diagnose or treat your dog. I can identify if your dog is in pain and recommend evidence-based, non-medical interventions for improving welfare. Burton, B., & Fraser, S. (2020 July). The Sticky Interaction Between Medical Issues and Behavior with Dr. Chris Pachel (Episode 12). Dog Unknown. Canine Arthritis Management > Managing Arthritis > Owner Identification of pain. https://caninearthritis.co.uk/managing-arthritis/owner-identification-of-pain/ Dycus, D., & Capon, H. (2020, April 28). Cam live: Identifying arthritis earlier and taking a preventative approach. YouTube. (Unlisted). Canine Arthritis Management. Heath, S., & Capon, H. (2020, April 28). CAM Live: Pain & behavior. Youtube (Unlisted). Canine Arthritis Management. Hodson, G., & Bell, N. (2021, March 16). Cam live: Posture, gait analysis and free work with Gemma Hodson. YouTube. The International Veterinary Academy of Pain Management (IVAPM). https://ivapm.org/animal-owners/animal-pain-awareness/ Lopes Fagundes, A. L., Hewison, L., McPeake, K. J., Zulch, H., & Mills, D. S. (2018). Noise sensitivities in dogs: an exploration of signs in dogs with and without musculoskeletal pain using qualitative content analysis. Frontiers in Veterinary Science, 5, 17. Mills, D., & Capon, H. (2021, March 31). CAM Live: Pain and behavior in dogs. YouTube. 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 St.Clair, J. (2023, June 20). Dog splooting: Cute dog stretching or cause for concern?. TopDog Health. https://topdoghealth.com/dog-splooting/ Johnny Knoxville and Steve-o made a career out of getting seriously, even traumatically injured, for fun. Lots of sports are people voluntarily getting the shit hit, kicked, and choked out of them, for fun.
Even you and I have decided to forge ahead with an activity knowing damn well it's going to hurt, for fun. Getting tattoos and piercings. Hang overs. Hiking on a sprained ankle. And we have advanced cognitive processes. Dogs do not share these cognitive abilities. • Moment-by-moment pain is a competing motivator. Bend neck to drink water or stay thirsty. Seek social contact on the couch or stay alone on the floor. Basic needs will supersede avoiding pain until they're in severe pain. • Pain and dopamine have a complex relationship. TLDR; dopamine plays a pivotal role in motivation. Dogs are going to do The Thing if it leads to dopamine. Over time, chronic pain leads to decreased dopamine activity. When a dog loses interest in an activity, the value of it is unchanged. Their motivation system to do things is dysfunctional. • Stress Induced Analgesia - under stress (a trigger or from high impact exercise like fetch), the brain releases cortisol and adrenalin. These brain chemicals temporarily decrease pain sensitivity. • The painful consequences often don't rear their ugly head until hours later. Far too disconnected from the activity for the dog to make an association. • Humans train their dogs to hide pain. As evidence-based professionals we're familiar with pseudoscience practitioners using prong, choke, and shock to shut down dogs. However, using positive reinforcement to teach a dog to hide pain is every bit as sinister. For example, reinforcing a picky eater for eating, without thorough investigation into pain. Your dog's willingness to participate in an activity is not a reliable indicator of their pain state. Ambron, R. (2022). The brain and pain: Breakthroughs in neuroscience. Columbia University Press. Heath, S., & Capon, H. (2020, April 28). CAM Live: Pain & behavior. Youtube (Unlisted). Canine Arthritis Management. Jarcho, J. M., Mayer, E. A., Jiang, Z. K., Feier, N. A., & London, E. D. (2012). Pain, affective symptoms, and cognitive deficits in patients with cerebral dopamine dysfunction. PAIN®, 153(4), 744-754. Murphy, K., & Capon, H. (2021, November 17). Pain and neuroscience. Canine Arthritis Management https://www.facebook.com/CAMarthritis/videos/361425985734208 Murphy, K., & Capon, H. (2019, September 19). The issue of ball throwing!. Facebook. https://www.facebook.com/CAMarthritis/videos/490402398182831 Murphy, K., & Capon, H. (2019, September 12). All about dopamine!!: “they wouldn’t do it if it hurt..” yes they would!! and this is why! Facebook. Canine Arthritis Management. https://www.facebook.com/watch/?v=622331888174881 Taylor AMW, Becker S, Schweinhardt P, Cahill C. Mesolimbic dopamine signaling in acute and chronic pain: implications for motivation, analgesia, and addiction. Pain. 2016 Jun;157(6):1194-1198. doi: 10.1097/j.pain.0000000000000494. PMID: 26797678; PMCID: PMC4866581.  Text across top: When pain is overlooked in a dog using aggressive behavior. Image: House with his head cocked to the side, with side eye and sarcastic open mouth expression. Text across bottom: Treating for wrong diagnoses can have side effects… like death Diminished quality of life is not the only way pain can lead to a dog's death.
Pain can: 1) Cause aggression directly, 2) Exacerbate existing aggression, 3) Make it difficult to tease apart the function of aggression in different contexts. Dogs who repeatedly use aggressive behavior are more likely to be: 1) Rehomed or surrendered. 2) Subjected to abusive training methods. 3) Subsequently euthanized for too many bites. Pain undoubtedly contributes to negative emotional states. However, irritability is not the primary cause of aggression in painful dogs. Aggression is like limping: • Pain exists to tell the body something is wrong, do something about it to prevent it. • Aggression prevents pain caused by people and other dogs. • Preventing pain is important, therefore sensitization is fast. - You only need to step on a sprained ankle once or twice, before you limp without thinking about it. - A painful dog only needs one or two exposures for aggression to happen earlier in a situation & with less cognitive effort. • Engaging in compensatory behaviors long-term leads to additional suffering. It would be cruel to force someone to walk on a sprained ankle without limping - even if you used positive reinforcement. And if you talk to people who refuse to adequately care for sprained ankles, we will tell you they're permanently fucked. It's equally cruel to approach pain related aggression with training, even if you use positive reinforcement. Additionally, long-term you a creating a ticking time bomb. Dogs cannot suppress their pain forever. |
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