Would you know if your dog was in pain? Would you believe if your veterinarian told you? Many people are still denial about their dog’s pain.
I asked my veterinary friends how commonly they deal with denial regarding signs of pain in dogs.
Question: Do you often have difficulties getting clients to believe that their dog is in pain? How do you convince them?
Trying to convince owners that their dogs are in chronic pain and not just “slowing down” or “getting older” is a daily struggle.
One of the most effective methods of proving pain is to prescribe an effective pain reliever and watch what happens. If the dog starts “acting like a puppy again” with a pain reliever on board, you know they were hurting before.
I think the primary reason most dog owners refuse to acknowledge their animal is in pain is because of our stubborn refusal to accept guilt.
By housing a painful animal, especially one not showing obvious symptoms of pain, a dog owner must acknowledge a few things. First, they are powerless to prevent pain. Second, they are directly responsible for choosing whether or not to let another living creature continue living in pain. Third, they are similarly solely responsible (emotionally and financially) for any treatment of that pain, which might impact other areas of their life. Fourth, acknowledging pain, especially associated with senior health concerns, forces owners to consider their own mortality.
In short, most people get a dog thinking it will live its whole life pain-free and one day suddenly die in its sleep.
When pain complicates the relationship, that creates a cognitive dissonance that most owners have difficulty processing.
How does a veterinarian help a dog owner deal with pain? Gently, patiently, with the forgiveness of a priest and the acceptance of a zen monk.
People often underestimate the degree of pain or discomfort that their dog is experiencing.
While many dogs are very stoic, cats Re even better at hiding pain.
Owners will often come in with a limping dog or, even more dramatically, not using a limb at all. A typical response is, well, he’s limping, but at least it doesn’t hurt him. It takes patience to explain each time that that the dog is limping because the leg hurts. Dogs do not necessarily cry out or whimper when in pain.
Pain can cause even more subtle changes in cats. For example, behavioral changes such as reluctance to jump on furniture or changes in litter box habits can reflect a painful condition.
So dogs that are not acting well may be covering painful conditions and should be evaluated by a veterinarian.
Some dog parents who have had experience with dog pain are receptive to the evidence of pain.
They accept and believe there is pain present, and they are on board with the need to treat it.
Others, when shown the rotten teeth, stiff legs, muscles in spasm, inflamed ulcerated skin or ears, will say, “Well, he does not act like he is in pain.” All of these abnormalities are, of course, painful and need treatment.
Owners and veterinarians who are tuned into pain recognize it. But, unfortunately, others do not accept the presence of pain and treat it with denial.
Many confuse pain with aging.
Healthy aging is pain-free. Diseased dogs are painful at any age. Unfortunately, some (many) owners will ignore those abnormalities and someday will present a dog as not eating, moaning, gasping, and say “He must be in pain,” and he may be, BUT he is dying now as well.
Another piece of the puzzle is economics. For example, a dog in pain is still a companion, goes for his walks, and accepts the household’s attention. In other words, his pain does not affect his ability to do his job. Now consider a lame cow. A lame cow does not produce much milk or meat. Therefore, the farmer is economically punished for having a painful animal and will treat the cow.
A painful dog owner incurs no negative consequences related to denying the presence of pain.
However, if they accept there is pain, they incur an economic penalty in the form of paying for the needed treatments. The willful blinding of humans to dog pain problems because of the economic issues that it raises is one of the best reasons to have dog health insurance. It enables people to concentrate on the welfare of the dog rather than the cost of that welfare.
Clients fall on a spectrum ranging from intuitively perceptive about their dog’s discomfort to blatantly ignorant.
The most common scenarios where I have trouble convincing clients of pain are dental disease and lameness. However, both can be associated with chronic pain, which dogs learn to live with.
Studies have shown that dogs and cats have similar pain thresholds to humans, so we know from research and professional experience that these conditions can be excruciating. Yet in most cases, the dogs will keep eating, keep wagging their tails, and never whine or cry.
I’ve had very smart people escort a limping dog into my exam room and say, “It doesn’t seem to bother him.”
If it didn’t bother him, he’d be bearing full weight on the leg. Instead, he’s not using the leg because it hurts!
Animals mask pain. For a wild canine, it’s the prudent thing to do when trying to survive in a pack. Once I explain this to a client, often asking them to remember how their tooth abscess or sprained ankle felt, they come to understand that pain is real for their dog and undeniably decreasing their beloved dog’s quality of life.
However, the proof guaranteed to convince any skeptic is the dog’s new attitude and vitality when we resolve/control the pain. Witnessing that transformation is one of the most rewarding parts of being a veterinarian.
I think that many people get so used to seeing their dogs limping or stiff-gaited that this becomes normal for them.
Additionally, many people think that if there is no whining or whimpering, there is no pain. Therefore, I take the time to gently explain that lameness or stiffness implies discomfort and ask clients to try what I recommend for a period of two weeks to see if the improvement is recognized. This approach seems to work well for most folks.
I am very fortunate to be working with a group of clients who trust my advice and care deeply for their dogs.
Every patient that I see is asked a litany of questions about their dog’s full overall health. As a result, I spend a great deal of time in the exam room talking. We talk about everything from day-to-day activities, general health concerns, diet, exercise, mental alertness, and stimuli to any changes in behavior/activity or ambulating ability. I try to get a comprehensive overview of all aspects of the dog’s health and well-being and address any changes or needs.
All dogs that are considered geriatric, present with any degree of limping, or pre-op candidates receive a comprehensive exam from identifying any signs of pain or discomfort.
Every surgical patient is given pain medications for their procedure. To avoid any discussion of not wanting to provide pain medication, the cost of the medication is included and not optional for all procedures. In addition, the pain medication is listed as zero on the invoice to further remind our clients who important and necessary the pain medication is to our treatment plan.
For any patient that the owner is not convinced may be in pain, we often provide a trial (these are provided free by the drug company) size of pain medication for the client to use to see if they see “any response to treatment.” This works well for osteoarthritis or chronic disc disease dogs.
I spend a long time talking about the many different pain management options available, the range of affordable options, possible side effects, and long-term monitoring if they decide to continue the medication.
I have found that in almost all cases, if I can effectively communicate options and encourage trying, clients are very willing and happy to provide pain relief to their dogs.
The key to a successful pain management program is to talk openly and honestly about the many options available.
And to remind clients that there is a large range of medication options and prices. And I never withhold the fact that many of these are available generically and at significantly discounted “bottle prices.”
I am so fortunate to have clients that see their dogs as family members and understand that pain management is one of the most important hallmarks to a “good quality of life” for their dog and that, like every treatment option we try, we may have to try a few options before the ideal one is identified.
I think most dog parents I meet are aware of a dog’s ability to feel pain, especially when it comes to surgeries and post-operative pain control.
Recognizing dental pain is still a struggle that I regularly face. Dental cleanings are not inexpensive, and many dogs have very advanced periodontal disease by the time the dog parent agrees to or requests a dental cleaning. I ask them to think about how much a toothache pained them, and many people can then relate.
Others still deny the dental pain saying their dog still eats. I remind them if the dog doesn’t eat, they will die. I also ask about eating g behaviors such as excess drool, dropping food, or chewing on a preferred side. If they admit to any of these, I explain this as a result of oral pain.
I don’t often encounter challenges in alerting my clients to their dog’s painful conditions.
By discussing the characteristics of their dog’s mobility during my history-taking process, my clients come to understand that the dog’s difficulty moving up or down from elevated surfaces, decreased interest in playing or socializing with human or animal family members, or reluctance to being touched in uncomfortable areas are all potential indicators of pain-causing medical conditions (arthritis, intervertebral disc disease [IVDD], cancer, etc.).
Pairing these characteristics with the physical examination and observation of a dog’s ambulation increases my client’s awareness of their dog’s pain.
Increased awareness promotes their willingness to pursue a diagnosis through diagnostic imaging (radiographs, MRI, CT, etc.) and the most appropriate treatments for their dog’s particular condition (pain medication, nutraceuticals, acupuncture, dietary and lifestyle modification, etc.).
Fortunately, I do not often have difficulties getting clients to believe that their dog is in pain. Often it is the reason they are visiting.
If they need convincing, for example, with previously undiagnosed oral pain from dental disease or hip pain from osteoarthritis, I demonstrate for them during the physical exam – press on the sore gums or extend the leg of the sore hip.
Most dogs are sweet and will not bite when you do this (the sign I was taught to look for! Either dogs were grumpier, or we used to let pain get WAY too severe before we recognized it!) So I also tell clients how their dog is licking his lips or tensing up or turning when pain is elicited. I feel like a jerk for that few seconds, but it is worth the long-term benefit of getting clients to realize their dogs’ pain and getting the dogs the treatment they need.
If clients have any doubt, they believe 100% after their dog’s pain has been treated and relieved, and seeing the dogs at a late visit comfortable and pain-free is one of the most rewarding aspects of what I do.