Suffering in Silence - Chronic Pain (Identification)
'I would know if my dog was in pain!'... Unfortunately, not all signs of pain are obvious and many dogs often try to hide long-term pain and just get on with life the best they can because they have no other option - they can't just open the cupboard and take some pain relief or call up their doctor. That's why it is down to us, as their owners to do best by them and learn to spot the low-key signs of pain to prevent suffering.
Acute Pain vs Chronic Pain
There are several classifications of pain, but for simplicity there are two key terms; acute pain, which is easily identifiable and chronic pain, which is not so easy to identify. Acute pain is a sudden, short-lived and intense feeling that has a self-preservation purpose, whereas chronic pain is a persistent long-lasting experience that does not have a purpose. Chronic pain is a major welfare concern that often goes undiagnosed, which can have a detrimental effect on the whole dog, affecting their overall physical and mental wellbeing.
Chronic Pain Indicators
Changes in movement and physical appearance can indicate the onset or presence of chronic pain and a wide range of medical conditions. Dogs struggling with chronic pain will adapt the way they move and may change their behavior, or they may even stop doing certain activities in order to reduce or prevent the pain and discomfort. These adaptations along with physical changes within the dog's body lead to external physical changes. The dog's physical appearance often slowly changes and over time their body shape and posture will alter.
The first commonly associated signs with pain in our dogs are changes to the way they move and their ability to do everyday things because they are often the most visible changes. However, the other changes, behavioural and physical, appear gradually and often a link is not always made to pain when these changes occur. This is especially true when looking at behaviour if the medical condition developed at a young age, thus, it may be assumed the behavioural issues are linked to psychological aspects.
Movement & Capability Changes
The way your dog moves is a key indicator of both acute and chronic pain. You may notice that your dog:
Trips over their own feet
Walks stiffly, unsteadily, slower or faster
Moves in a non-fluid, jerky manner
Skips, limps, bounces or hops when walking or running
You may also notice that your dog is unable to do the things that they once were able to do with ease. Often many owners believe the inability to do these activities is simply because their dog is getting older or stiffer... Yes, this may be the case, but generally there is also an element of pain with getting older and stiffer. Therefore, the following signs should be considered to be potential indicators for chronic pain and not just age or stiffness:
Inability to stand still when urinating/defecating
Making failed attempts or refusing to jump onto furniture or into the car
Unable to go up or downstairs
Struggling to sit, lie down or stand up, often making several attempts or refusing to do so
No longer stretching out their front and/or back legs when rising after rest
Remaining in a front down stretch for a long time
Incapable of walking as far as they used to, often sitting down or stopping more frequently
Note the movement of Tango's legs (forward movement of both left limbs, then forward movement of the right limbs) and the 'wobble' as he walks - this type of gait makes walking easier and less painful. Also, note the 'drop' down into a sit - this is indicating weakness/poor function in the pelvic muscles and/or a behavioural/movement adaptation that has occurred due to pain when sitting down the normal way.
Personality and Behavioural Changes
As a result of chronic pain, a dog's mood can change, which over time can alter their personality. Often, these changes are gradual, so you may not notice their personality change until one day, when they seem to have lost interest in you and you wonder what has happened to your dog. Pain causes a stress response that involves physical and chemical changes in the brain, which in the short term has minimal effect on the dog's overall health and welfare. However, with chronic pain, a constant firing of pain receptors occurs and it is this persistent pain that keeps the brain in a state of stress. Eventually this leads to poor cognitive ability and long-lasting emotional changes (depression, anxiety, aggression etc).
Behavioural changes are natural reactive responses to pain as a means of self-preservation. Some behavioural changes clearly indicate the presence of pain, whereas other are not so obvious, such as the development of a noise phobia. Noise phobias related to chronic pain occur due to the increased pain felt from tensing of aching muscles or the sudden abnormal movements that occur when the dog is startled by an unexpected noise. This can lead to anxiety and avoidance of areas where the loud sound has occurred in attempts to avoid the associated pain that came with jumping at the sound.
Behavioural indicators of chronic pain can include:
Increased amount of time sleeping or resting
Development of noise phobias
Changes in eating habits, e.g. eating faster or slower, lying down to eat
Excessively chewing or licking areas of their body
Constantly itching a certain spot on their body, particularly in the ears
Stopped or reduced time spent playing with toys & other dogs
Become fearful or anxious of other dogs, people or environments
Displaying signs of aggression towards people or dogs
Has become reserved, no longer wanting to interact with the family and has stopped wagging their tail
They groan when they lie down and find it difficult to get settled
Postural & Physical Changes
Dogs suffering from chronic pain will adapt the way they move or do activities differently and it is these adaptations that can lead to postural changes. Changes in posture are key indicators of musculoskeletal problems, particularly if other physical changes have arisen too. Physical changes affecting the skin and coat can help signal changes in the muscles and tissues in that area. With skin being the largest organ of the body, monitoring what is normal and identifying any changes can help monitor the health of the underlying tissues. External changes that you should look for in your dog include:
An abnormal/asymmetrical body shape
Low head/tail carriage
A curved back
Increased tension within muscles
Reduced pliability of the skin
Dull, messy & uneven coat
Excessively dry or oily skin & the dog may have allergies
Brown/dark pink stained fur, particularly on feet (from over-licking)
Uneven nail growth
A tucked in/hunched up body shape or they may look shorter
Note the wide stance of the back legs and the close positioning of the front legs - this stance allows Ralph to shift weight to his front limbs in order to reduce discomfort in his pelvic region and make standing still more comfortable. Also, note the particularly messy condition of his fur in his pelvic region (his coat is also very oily and his skin is flaky) - the coat and skin are indicating poor tissue health in this region.
Analyzing Your Own Dog
A key way to determine if chronic pain is present is to reflect on what your dog used to look like and how they used to behave. Sometimes, a dog may naturally look or behave a certain way, but if there has been a physical and/or behavioural change, then make a note of the changes and speak to your vet. If you would like help assessing your dog, please get in touch for a free comfort assessment.
This article not meant to cause shame, embarrassment or guilt if your dog is or has been displaying any of these indicators. We shouldn't blame ourselves for not knowing something, but now is the time to use your new knowledge.