Chapter 25
Recognition and Assessment of Pain in Dogs
How do I know if they hurt?
Jo Murrell
School of Veterinary Sciences, University of Bristol, UK
- Q. Why is it important to recognize and assess pain in dogs?
- A. Recognition and assessment of pain is pivotal to effective pain management. Unless pain is accurately assessed there is the danger that either pain will go unrecognized and inadequately treated, or that dogs will receive too much analgesia and drug side effects as a result of over treatment of pain will occur. Only with assessment of pain can analgesic administration be titrated to meet requirements for analgesia, ensuring optimal patient wellbeing.
- Q. How is pain recognized in dogs?
- A. Changes in behavior are currently considered to be the most reliable indicator of pain in dogs. Assessment of behavior can inform about both the sensory component of pain (where does it hurt and how much does it hurt?) and the emotional/affective component of pain (fear, anxiety, pain unpleasantness) and it is important that both of these aspects are considered when carrying out pain assessment in an individual patient. Changes in behavior associated with pain may either comprise the expression of “new” pain related behaviors, or the absence of “normal” behaviors, for example reduced interaction with the owner. Therefore a reduction or change in an animal’s normal behavioral repertoire must not be overlooked as it could be a sign of pain.
- Q. What is the main difference between acute pain and chronic pain?
- A. Acute pain is typically pain of short duration that does not outlast the period of tissue healing. Chronic pain is commonly defined as pain that persists for longer than three months. Chronic pain may be associated with ongoing tissue injury, for example in the case of osteoarthritis, but chronic pain may also continue despite healing of the original injury that initiated the pain. It is maladaptive and serves no useful evolutionary purpose to the animal [1].
- Q. What are typical behavioral signs of acute pain in dogs?
- A. It is difficult to be prescriptive about changes in behavior associated with pain in dogs because there is a large amount of individual variability. Table 25.1 lists some behaviors that are commonly associated with acute pain in dogs and the types of circumstances in which they occur.
Table 25.1 Typical behavioral signs of acute pain in dogs.
Behavioral change
Notes
Unwillingness to interact with people
Postural changes
Abnormal posture, or lying in an abnormal position, inability to rest easily, hunched up position or guarding of the abdomen or another body part
Adoption of the “praying position”
This describes a standing position of the dog with the head down, abdomen stretched and the hindlimbs extended. It is typically adopted in dogs with cranial abdominal pain
Sitting at the back of the cage
Aggression
Dogs that are not normally aggressive can show signs of aggression when in pain, which abate when pain is adequately managed
Exaggerated pain response to palpation of a wound or painful area
This phenomenon is described as hyperalgesia and accompanies upregulation of pain pathways
Painful response to stimuli that are not normally painful such as touch
This phenomenon is described as allodynia and accompanies upregulation of pain pathways
Unwillingness to move
Vocalization
Some animals may be silent, others whine, scream, whimper, bark (more or less) growl, attempt to bite
Absence of normal behaviors
Failure to do normal things such as stretch out, less vigorous shaking etc, less playful/curious, appetite changes 
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- Q. What is the main difference between acute pain and chronic pain?
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