Why is pain underdiagnosed & untreated?

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. 


​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