The Subtle Symptoms of Chronic Pain

By: Dr. Kristi Sharpe

It is a common occurrence that during a physical exam I see things that signal the pet is having chronic pain issues. When I mention it to the owner they are in disbelief that their happy, healthy pet could possibly be in pain. The truth is animals do not exhibit pain like humans do especially when we’re dealing with more chronic pain like arthritis. Since our pets cannot talk and tell us things like “ouch, my back is so stiff when I get up” we have to look at subtle changes in their behavior to clue us in.

Pets are much more stoic when it comes to pain than most people realize. During acute pain, like from trauma, many animals will show signs of pain like vocalization and limping. That’s easy for us identify. However, chronic discomfort can have much more subtle presentations. The number one symptom I hear owners describe is decreased activity or a decrease in otherwise normal behaviors. For instance, if your dog enjoys jumping up on the couch to watch TV with you in the evenings and has recently seemed reluctant to make that leap onto the cushion that can be a sign that they’re feeling some discomfort. If your kitty usually is pretty spry and likes to leap from the cat tree to the kitchen counter but suddenly starts falling short, that can be a symptom of pain. Another common observation is that the pet is slow to rise. After an arthritic pet lies down it may be difficult for them to rise to a standing position. Their legs may tremble or it just may take them a minute to get up and moving. They may not tolerate as long of a walk as they once used to. So pay attention to subtle behavior changes that may indicate pain related issues.

Typically, owners will miss the cues that an animal may not be 100% but there are physical changes we can see to help us discern if our pet is feeling discomfort. Muscle wasting is probably the most common symptom we encounter and usually affects the rear limbs. A normal, active pet should have good muscle mass and tone around their bones. If they are experiencing any pain with a specific limb they will preferentially bare weight on their other limbs. Over time this leads to muscle loss on the affected limb or limbs. Another thing we commonly will detect on a physical exam is crepitus. Crepitus is a clicking or grinding that can be felt when flexing or extending a joint. A normal joint is well lubricated and should flex and extend smoothly. Any repeatable noise on manipulation of a joint is abnormal. The last thing that I’ll typically look for when assessing a patient for chronic pain is range of motion. Each joint has its own range of motion from complete flexion to full extension. If a pet has a decrease in its range of motion then that is usually a sign there are structural changes to the joint that are preventing normal movement. More often than not this is due to arthritic changes, but can also be a result of joint swelling. If there is any question as to what might be the initiating factor I may recommend radiographs (x-rays) to take a look at your pets bone structure.

Once we’ve identified patients with chronic pain we have to talk about what steps come next. There are many different ways we can approach chronic pain to help our patients function better and feel better. Most of the time I’ll recommend a trial of NSAIDs (non-steroidal anti-inflammatories) in the beginning to help with immediate pain relief. If they seem more comfortable and we want to keep them on the medications long term I’ll do blood work to ensure there are no underlying medical conditions that would cause us to adjust the dose or choose another type of medication.

Medications are not the only answer to chronic pain though. A multimodal approach, meaning treating the patient with different methods, is typically the best approach. Joint supplements are always a good option for dogs with chronic pain and can be given in conjunction with NSAIDs. Supplements help to protect healthy cartilage and slow its degradation overtime. Usually I’ll recommend a glucosamine/chondroitin supplement like Cosequin since it is readily available at most pest stores. I will caution owners to avoid human formulations as these have not been studied in dogs and cats. This matters because dogs and cats absorb oral medications differently than people. If your pet is overweight, I will usually discuss the importance of a healthy weight. Multiple studies have been conducted on the effects of obesity and arthritis pain. Those studies have proven that for overweight animals weight loss is more effective at controlling their discomfort than any prescription medication. Alternative therapies like acupuncture and shockwave therapy are also good treatment options to help with chronic problems.

It is important to be observant of any abnormal behaviors your pet may be exhibiting. Since they can’t talk to us we need to pay close attention to catch medical conditions before they become a major problem. If you’ve noticed any symptoms of chronic pain in your canine or feline companion it’s time for a check up to talk about treatment options.

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