The two main issues with pain in dogs are recognizing pain in your dog and what should be done about it.
“What can I get over the counter to help my dog’s pain,” is one of the most frequent questions on dog forums. And yet, that’s not what we’ll be talking about today.
Two main types of pain
Pain falls into two main groups. Pain from damaged tissues and neuropathic pain. Pain from tissue damage is self-explanatory. Neuropathic pain results from damage or dysfunction of the system that reports pain to the brain, the nervous system.
“This is the difference between engine trouble and trouble with that light on your dashboard that claims there’s engine trouble.” ~PainScience
Isn’t the above the best explanation ever? I wish I came up with it. If your dog is in pain, it is most likely the first type that is caused by damaged tissues or tissues in trouble. There can be a combination of the two.
There are other pain categorizations, but understanding that feeling pain is both a function of damage and communication is enough for our purpose. In other words, a pain source and pain perception.
Acute versus chronic pain
Dr. Huston explained the difference very well:
Chronic Versus Acute Pain In Dogs: What Is The Difference?
If you want to understand the difference, go check it out.
Purpose of [acute] pain
[Acute] pain has a very clear purpose–to alert to an injury and promote avoidance. If you put your hand on a hot stove, the pain will make you quickly pull away and, hopefully, not do that again. Without that, you could let your hand burn to coals without even noticing. If you broke a bone, without pain, you’d keep using the limb, and it would not get a chance to heal.
Where there is tissue damage, there will be inflammation. Inflammation is the body’s response to damage. It recruits immune cells and repair crews. Tissues swell to allow easy access to the emergency teams and their equipment. Imagine a bad collision on a highway. You will see police, firetrucks, ambulances … Everything else needs to get out of the way until the problem is taken care of.
Inflammation and the resulting pain remains until everything is repaired. Or it should. Conditions where damage is chronic, such as arthritis, or situations where the immune system keeps on bombarding perceived enemy forces, resulting in chronic inflammation and pain that no longer serves any purpose.
Anti-inflammatories work by reducing inflammation at the affected tissues. Those can include corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs). These medications douse the pain-causing fire.
Corticosteroids are a synthetic version of a natural hormone, cortisol. They are extremely good at reducing inflammation and generally making anything feel better. Cortisol, however, is a stress hormone, facilitating the body’s response to danger or crisis. Which means that while they reduce inflammation, they also generally turn off the immune system and maintenance. Since the goal through all that is healing, this can be quite counter-productive. The only time I agreed to use steroids for Jasmine was after her neck injury.
The downside of using steroids was the reason behind the development of nonsteroidal anti-inflammatory drugs (NSAIDs). The effect of NSAIDs is more selective; they don’t take out the immune system and maintenance. They are not as targetted as one would wish but more so than steroids.
The way they work to manage pain is by reducing inflammation. With chronic inflammation that is absolutely what you want. With a fresh injury or trauma, you want the analgesic effect but how much do you want to knock down the inflammation? That is the question, and it is argued both ways.
Given enough pain, though, I can guarantee you, nobody cares about the potential downside of the resulting pain relief. Either way, the question remains how much inflammation is too little or too much. And whether a safe dose of NSAIDs would ever be able to stop the inflammation completely–not likely.
Turning off the pain perception
While opioids get a bad rep, they are the cornerstone of [acute] pain management in veterinary medicine. The way they work is by turning off the transmission and perception of pain. They don’t affect the site of damage but make the brain not care. It’s like when your smoke detector goes off, and you yank out the batteries. There is definitely a time and place for that, not exclusive to surgeries either.
There are many drugs in this class with various uses and applications. Some are only used by your veterinarian, say during surgery, some come as pain patches, some as pills.
The latest thinking is that a multi-prong approach going after both inflammation and pain perception yield the best results.
That’s why your arthritic dog might be prescribed both NSAIDs and say Tramadol or Gabapentin. Though recent research seems to prompt skepticism about how effective Tramadol for pain management in dogs really is.
Pain Management in Veterinary Patients