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Advice on Recognizing and Treating Pain

Our four-legged friends are good at hiding pain. From the evolutionary perspective, appearing sick or weak does not get you any pity points. Instead, it is common to see ill or injured pets being picked on or even attacked.

Pets who do not feel well tend to be more aloof and like to distance themselves or hide. In many instances, the only way pet owners know something is up is by observing changes in social behavior, or having to deal with various forms of digestive upset. Pain is stressful, and stress gives many pets stomach problems including GERD (heaving, grass eating, incessant licking of front feet), anorexia, vomiting, and diarrhea.

Joint pain is common in geriatric patients, but young ones are not immune from it either.  Have you ever seen a large dog tumbling down the hill at Fort Funston? Sure, she’s having a blast, but it does take a physical toll. Pain in limb joints is easy to spot; it typically manifests as some degree of favoring or lameness. Severe limb injury, like a cranial cruciate ligament tear, make dogs unable to put any weight on an affected leg. Injuries in elbow, ankle, wrist, and finger joints can present as swelling, and pets will often lick painful places to the point of creating a dermal ulcer (hot spot). Spinal joint pain is harder to spot, and it tends to manifest as on-and-off stiffness and a decrease in activity. Pet owners often report decrease in stamina on walks, reluctance to play, jump on the couch or into a car, or unwillingness to go up or down the stairs. On physical exam, spinal pain manifests as heat or sensitivity at the location of the injured disc. Oftentimes, I will find painful spasm or strong involuntary twitches as I pass my fingers down the top of the back (nerve pain). Many dogs and cats will chew on the rump or hind legs, making their owners think they have a flea problem, and creating painful hot spots, which require separate treatment.

Joints are slow to heal, so it is important to create a favorable environment for swift repairs. The longer it takes to heal a joint, the more scar tissue is created. This is called fibrosis, and it affects many types of tissue with poor regenerative ability such as kidneys, heart, and brain. As with human athletes, rest is the best. If you keep using the injured joint, it gets even more swollen and painful, and it will take longer to heal. However, resting the joint completely is not always a good idea either, as it can quickly lead to marked decrease in range of motion. Low-impact exercise like slow leash walking can help with healing by improving blood supply and preventing excess scar tissue build up. Physical therapy helps, too: massage, chiropractic, acupuncture, aquapuncture, laser, and other modalities are chosen based on type of injury and patients’ temperament.  Nutritional supplements containing glucosamine, chondroitin, and other connective tissue precursors supply necessary building blocks for joint repair. Anti-inflammatory herbs and medication help decrease pain and swelling and prevent excess scar tissue buildup. Analgesic herbs and medications control excess pain, which, as a type of stress, can lead to secondary inflammatory problems in the digestive tract.

The other most common type of pain I see in my practice is dental pain. We like to think of teeth as strong and resilient organs, but when injured or damaged, they cause significant discomfort, which often keeps pets from being able to eat and sleep. Dental pain usually presents as excess pawing or wiping of the muzzle, scratching at the chin, pawing at ears or eyes, or head shaking. It’s not always obvious which tooth is hurting, and patients experience general pain centered at the base of ear canal. It is why many pets will present with severe secondary ear canal infections (otitis externa), because they have been scratching at the ear to shake off unpleasant sensation. I have treated many dogs who woke up with ear pain symptoms, but by the time I see them a few hours later, the deep pain has subsided, but there’s a traumatized, infected ear canal that needs to be cleaned up.

There is no easy solution to dental pain, as it often indicates severe damage such as enamel damage/cavity, root abscess, or inflamed root canal. Anti-inflammatory or analgesic medications can be used for minor aches, but many pets will need antibiotic therapy to resolve underlying infection. There’s another twist: painful teeth do not always appear damaged above the gumline, and it takes dental X-rays to document inflammation of a root canal or an abscess around dental roots. Veterinary dental specialists offer endodontic procedures (root canal), but most painful teeth need to be extracted. Infected, painful teeth are a huge source of inflammation and stress and can lead to digestive upset and decreased immune function.

Dogs and cats can’t tell us where it hurts. It takes a keen eye to pick up on subtle changes in behavior, whether it’s changes in posture or gait or a funny way of picking a chew toy.  Consult your pet’s veterinarian if you suspect pain, before having to deal with secondary stomach issued, ear hematoma, or infected skin.

Adam Piaseczny, D.V.M, leads the team of Healthy Pets Veterinary Hospital,, a four-doctor integrative practice in the West Portal neighborhood of San Francisco. He lives in adjacent Sunnyside with his partner, daughter Sofia, two dogs (Ricky and J.J.), and two cats (Chica and Chala). He is a graduate of Cornell University College of Veterinary Medicine and has acupuncture certification from Chi Institute of Traditional Chinese.

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