Pain In Pet Dogs: The Secret Epidemic

separation anxietyHealth & behavioranxietyaggressionfear

Aug 14

Written By Gemma Maslen & Ingrid Komisar, CCPDT-KA

Imagine having a sprained ankle, then having to make it through the day's to-do list, being forced to attend a social event or an exercise class - doesn’t sound like much fun, right? You may find yourself struggling to be your usual sociable self with friends, or downright unable, to put in any effort at the gym.

Now imagine that this is your dog and they too have pain in their ankle, but they can’t tell you that it hurts.

What might that look like when we ask them to perform certain behaviors like sit, lie down, take them to a park to interact with other dogs, or march them around the neighborhood because “they need a walk!” You may have one unhappy pooch on your hands - and not unreasonably!

Pain is an often overlooked aspect of behavioral health in dogs, but more and more we are learning of its prevalence and impact. So let’s unpick this complex topic.

*Special thanks to Ingrid Komisar CPDT-KA (CCA associate trainer) for co-writing this piece.

Dr. Daniel Mills, FRCVS, a veterinary researcher and behaviorist at the University of Lincoln (England), suggests that a large portion of behavior problems are exacerbated or caused by physical pain, and that resolution of that pain can mitigate or even resolve the behavioral issue.

One study by Dr. Mills et al. (2020) reviews caseloads from several of the co-authors, and they found that the prevalence of pain in dogs studied ranged from 28–82%, and many of these conditions can be suspected from close observation of the patient.

And this isn’t just older dogs we’re talking about either, this study found that osteoarthritis (joint wear and tear) prevalence in North America is reported in 20% of all dogs over 1 year of age based on data collected from 200 veterinarians.

Sadly the effects of uncontrolled pain over time can be widespread, leading to changes in motor function, compromised immune function, slower healing, increased risk of complications post-surgery, and even increase risk of tumor growth!

Most Common Areas of Pain in Dogs:

The most common areas of pain for dogs are:

Joints - such as hips, stifles (knees), carpus/tarsus (wrist/ankle), spine, shoulders, and elbows
Ears
Dental issues
Gastrointestinal concerns
Dermatologic conditions

What to look out for?

Depending on the cause of the pain, there may be a WIDE range of signs that can indicate your pup is experiencing discomfort.

These can be subtle as dogs often suppress outward signs of pain, this can make it difficult for guardians to spot.

Often we don’t consider pain until we see the more severe signs, such as whining, yelping, crying, limping, etc. but dogs rarely express those behaviors unless it is REALLY BAD. Pain suppression is an evolutionary trait that dog’s developed to protect themselves from predators during times of injury or sickness, so this can make it extra difficult for us to know when our pups are in pain!

Some early signs to be aware of are:

Activity Changes: Reluctance to go on walks or an overall decrease in usual activity, stiffness, lameness, reluctance or inability to jump (as onto furniture), changes in gait such as a “skip” in one or both of the back legs, excessive sway or bouncy walk. A reluctance to walk on slippery surfaces. An unusual sit position, like knock-knees, or sitting on one hip constantly. Any changes to body positions that are “normal” for your dog could be worth noting. For example, do they usually sploot with their back legs out like a frog, but have stopped doing that

Decreased Appetite: The physical act of eating could be painful, or they do not feel well enough or have the appetite to make it to their bowl to eat
Tiredness: Your pet may tire more easily and need more time resting or are sleeping more than usual
Muscle Atrophy: Arthritic pets often develop muscle atrophy due to inactivity and decreased use of the muscles surrounding the affected joint. This may result in a visible or palpable difference in the size or shape of the affected limb
Aggression Related to Handling or Grooming: When a dog is in pain they may show aggression around grooming or handling procedures. They may snap and/or bite when approached or handled, particularly if the petting or handling increases their pain
Resource Related Aggression: This behavior can be associated with musculoskeletal or gastrointestinal pain. It’s theorized that this could be due to increased anxiety from the pain, leading to anxiety over resources in the environment also
Licking, Chewing & Biting: Dogs experiencing pain or discomfort may also lick, chew or bite at areas that are painful. These can sometimes be quick or sudden movements to bite at an area. This can lead to hair loss over the area and inflamed or infected skin, often referred to as “hot spots”
Changes in Behavior: A sudden change in general behavior, or an increase in anxiety, especially associated with a changeable temperament, like a “Jekyll and Hyde” personality

Changes in Learning or Performance: Dogs experiencing pain may suddenly show reluctance to perform behaviors they usually would with ease, like sit, down, or jump. This could even look like a reluctance to play tug or hold a toy when they usually would. Unfortunately, this can often be mistaken for “stubbornness” or “disobedience”

Noise Sensitivity: A sudden or increased sensitivity to noises around the home can also be an indication of pain
Body Warmth: Notice a certain area of your dog’s body feels warmer than others? That could mean there is an increase in circulation and inflammation there
Sudden house-soiling: A potential aversion to movement may lead to house-soiling problems
Connection Seeking Behavior: Comfort seeking, clinginess, or connection seeking are widely recognized behaviors associated with pain in dogs
Pain on Manipulation: Stiff body language, moving away from touch, and occasionally vocalizations on manipulation of a joint
“Compulsive” Type Behaviors: A potentially under-recognized manifestation of gastro-intestinal pain in dogs is “star-gazing” behavior. This is described as an upward raising of the head and neck extension followed by staring at the ceiling or sky. “Fly-snapping,” also known as “fly biting,” “air biting,” or “jaw snapping,” is a behavior in which dogs appear to watch or see something not visible to humans and then snap at it. Some dogs will extend their neck and raise their head prior to fly snapping. Excessive licking of surfaces has also been associated with gastrointestinal disorders
Pica (ingestion of non-food items): This unusual behavior can be associated with GI issues or even musculoskeletal pain!

Treatment Options:

Treatment recommendations to address pain are made based on individual patients and in discussion with the dog guardian and vet/ vet behaviorist. There are many things that can be done depending on the location or type of pain. This could mean taking pain medications, using cold or heat therapies, or physical therapy, etc. We’ll list some of the common areas of consideration for addressing varying types of pain:

Pain Control/ Pain Trial: If pain is a reasonable possibility but no cause is apparent after a physical exam or testing, Dr. Mills typically recommends a trial course of analgesics (pain killers), citing that many documented behavior cases have shown significant improvements or even resolution when treated with pain medication. In general, it is argued that clinicians should err on the side of caution when there is a suspicion that a patient could be in pain by carefully evaluating the patient’s response to trial analgesia, even if a specific physical lesion has not been identified. It may take a couple of trials of different analgesics in case the first was not right for that dog’s particular issue. Dr. Mills argues that the risk of side effects can be minimized and that the benefits of using pain medication will normally outweigh the risks, but it is important that any trial is done under veterinary supervision as over-the-counter medications for humans can be quite toxic to dogs
Activity Modification: High-impact activities such as running or jumping should be limited as they can cause more inflammation and pain. These activities should be replaced with more controlled activities like long line leash walks, sniffing, brain-games, training, etc. Adding in adaptations around your home can also help to reduce uncomfortable movements, such as ramps or steps for getting on or off furniture or beds as you continue to strengthen your dog’s muscles

Physical Therapy / Rehabilitation: Range of motion exercises, therapeutic exercises, and aqua therapy (underwater treadmill, swimming) help to improve joint mobility, increase muscle mass, and improve exercise endurance
Weight Management: Fat produces inflammatory mediators that perpetuate the inflammation process, and increased body weight puts additional stress on the joints
Joint Supplements: The exact mechanism of how joint supplements may help alleviate joint pain is not well understood. Chondroitin sulfate, glucosamine sulfate, omega-3-fatty-acid supplementation are the most commonly recommended joint supplements by veterinarians and are known to not have severe adverse effects. Always check with your vet before adding in any supplements to your dog's diet
Disease Modulating Agents: This can be given either as a muscle injection or injection within the joint (corticosteroids, platelet-rich plasma, hyaluronic acid, and stem cell). More research is necessary to ascertain the benefit of disease-modulating agents
Surgical Management: Surgery may be indicated in some instances and could include soft tissue, joint salvage procedures to remove the painful joint components, arthrodesis (fusion of joints), or total joint replacement surgery

So what does all of this mean?

This can all sound very worrying, but there are lots of options for treatment, management, and rehabilitation. Knowing that underlying pain may be the reason for your dog’s less desirable behaviors is the first step to addressing this.

Never forget, you are your dog’s advocate. Presentations of pain are not always straightforward, but addressing pain could be the missing puzzle piece you have been searching for. As Dr. Debbie Gross Torraca (Veterinarian and Board-Certified Orthopedic Clinical Specialist) says “Assume it is pain until proven otherwise."

“Assume it is pain until proven otherwise.”

— Dr Debbie Torraca

Want to Learn More?

Join CCA's Head of Training & Behavior, Karishma Warr, and Lead Veterinarian at Williamsburg Veterinary Clinic, Dr. Gina Rendon DVM, for a FREE one-hour webinar about pain in dogs and the effect pain has on behavior.

Topics we'll discuss:

How pain can impact behavior
How to identify pain in dogs
What to do if you think your dog is experiencing pain

Pain is an often overlooked aspect of behavioral health in dogs, but more and more we are learning of its prevalence and impact. Join us to unpick this complex topic!

When: Sun August 21st at 1:30 - 2:30 pm US ET
Where: Zoom

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Additional Reading:

Gemma Maslen & Ingrid Komisar, CCPDT-KA