If I had a nickel for every time a person said, "Oh, my dog isn't hurting, I can tell because he doesn't cry" I could retire. It makes me nuts, because it's not true, and pets suffer for it.
Have you ever been sore, or had a headache, or tweaked your knee? Did you cry every time you moved? Probably not, because there are different kinds of pain. Acute pain, the type you get when you stub your toe on the doorjamb or slice your finger cutting lemons, is sharp enough that you might cry out "Oh !@$@$!# that hurts!" And the people around you react with sympathy and bandaids.But chronic pain, that dull, throbbing, always-there ache of osteoarthritis or bulging discs, doesn't usually manifest with vocalizations. If you've ever spent time walking around a senior citizen center, you'll notice two things:
- they walk very slowly, probably because many of them are nursing sore bodies;
- they don't spend a lot of time screaming.
How Do I Know If My Pet Is In Pain?
They aren't yelping. Usually, it's one of these: tired, mopey, crabby, tired, 'old', cranky, fine.
It's not just joint problems, either: Pets with rotting teeth are in pain. They may not yelp when they eat, but they sure do eat less, or eat slowly. Most people don't even notice this until after the problem is fixed, when all of a sudden their pet has a voracious appetite.
Did you know 90% of cats over 12 have some degree of joint disease? Probably not because they are sneaky about it. Cats with arthritis in their spine are in pain. They may not yelp when they walk around, but they move gingerly. When their pain is treated, they start jumping back on counters again.
The best way to manage pain is to assume if a pet has a painful condition, it's probably there.
Veterinarians have a role here too. For years, we have undertreated painful conditions. As little as 15 years ago I would routinely see clinics where pain meds were optional after a spay or neuter. Ouch!! If your veterinarian offers 'optional' pain meds or no pain meds at all after a surgery, I consider that a red flag. We've moved beyond that. Adequate pain control should be part of the package.
But aren't pain meds dangerous?
Many people are under the mistaken belief that most pain medications are so dangerous it's better not to try them at all. Veterinary NSAIDs, the most commonly prescribed class of pain medications, are also the most indicted as a Bad Thing.Yes, NSAIDs can have side effects. All drugs do. Some of them are severe. It is vital for veterinarians to ensure owners are aware of that potential and educate owners as to safe administration. They are not an appropriate choice for all pets. However, this risk can be minimized:
- Owners: be aware of the potential side effects and discontinue the medication if any symptoms arise. If discontinued immediately, the chances of long term problems are usually minimal. In my own experience, the vast majority of patients have an excellent response to medications when given as directed. Most of the adverse events are related to people who either wait too long to report side effects, give more than the prescribed dosage, or refuse the recommended monitoring. In other words, most are avoidable.
- NSAIDs are not the only pain control options. There's tramadol, gabapentin, Adequan, just to name a few. We can also use adjunct treatments like acupuncture, laser, and physical therapy. The more combining of medications you do across categories, the less you need of any one and the better the overall pain control. This is called multimodal pain management, and it's the best way to deal with chronic pain.
- Those cheaper, OTC remedies you read about on the internet (aspirin, Advil, Tylenol)- you know, the 'good old days' approach- are not only less effective, but more dangerous. The worst pain medication reactions I've treated have all been to OTC human meds. And a reminder: one teeny Tylenol will kill your cat.
- When it comes to the pain of joint disease, the best treatment/prevention is free: keep your pet at a healthy weight.
Pain can be managed, even in very senior and frail patients. And yes, even in cats. We just need to acknowledge that it's there first. Don't wait for your pet to tell you- he can't talk, but we can see it nonetheless.
Dr. Jessica Vogelsang is an author and veterinarian specializing in senior and end-of-life care. She writes on pet topics regularly at her site pawcurious.com. You can learn about her bestselling book All Dogs Go to Kevin at drjessicavogelsang.com.