Six months ago I injured my back while attempting to train for a half marathon. I pushed through for a couple of months as I fell further and further behind my training buddies, until finally it occurred to me that needing to stop every couple of minutes to punch my fist into my left hip was probably not a normal thing.
As far as everyone in my everyday life knew, I was fine. I was still working and lifting things as usual, perhaps stepping a bit more carefully on uneven footing and pausing to brace myself before coughing. When I didn’t get better after a month of rest I wound up in a physical therapist’s office, where she figured out that my entire left pelvic wing was rotated out of whack. After a lot of therapy, ice, and Advil, I’m back on track.
I think about this a lot when I’m working with senior pets. One of the most common things people say to us when they bring in older pets is, “Oh, he’s just old and slowing down.” When we suggest that perhaps there is a painful condition, such as osteoarthritis, the client often replies, “Oh, he’s fine—he’s not crying.”
I would like to state for the record that for all the times I winced as shooting pain went up and down my spine, each gritting of the teeth and slow roll out of bed in the morning while I worked out the kinks in my pelvis, I never once cried out. The times I have cried out in pain? When I shut my finger in the car door and when I dropped the vacuum on my foot. That is the difference between chronic and acute pain.
Acute pain—that sharp, blast in the face sudden hurt—comes quickly and, usually, hopefully, also departs quickly. Chronic pain is any pain that persists past the normal expected point of inflammation and healing. While that is a somewhat simplistic explanation, it’s important to understand that pain is a very complicated phenomenon that involves many different pathways: the initial pain picked up in the periphery by a noxious stimuli, the part of the brain that recognizes the stimulus as pain, and the various places along the way where it can get tripped up, triggered, or amplified.
How do we know a person is in a state of persistent, low grade, chronic pain? They tell you.
How do we know a pet is in a state of chronic pain? They can’t talk, but they can tell us with their behavior.
These subtle indicators, when evaluated objectively and looked at in a sum total, are often striking. A dog who resists climbing stairs, jumping on the bed, tires after a short walk, doesn’t want to get up in the morning, those are all strong indicators of potential pain. Cats are even harder to interpret. Sometimes we only get one sign; the cat’s no longer on the kitchen counter, perhaps, or maybe the cat is urinating outside of the litter box because the edges are too high to climb over comfortably.
Why is this important? Because we can help, but only if you "hear" the pets ask.
The American Animal Hospital Association and American Association of Feline Practitioners just released the updated 2015 Pain Management Guidelines for Dogs and Cats, the most comprehensive and up-to-date recommendations for practitioners when it comes to recognizing and treating pain. Their number one recommendation? Realizing that behavior changes are a primary indicator of pain in veterinary patients.
There was a time, not too long ago, when pain medications were considered “optional” after a major procedure such as a spay or neuter. We’ve come a long way since then and we’re only getting better. There’s no need for a pet to suffer, not with the extensive toolbox all practitioners now have access to.
The best pain control in pets, as in people, comes with multimodal pain management: using more than one approach that addresses pain from multiple fronts. It’s good stuff. We’re blessed to be able to provide these comforts for our pets.
If your pet has any changes in behavior, from reluctance to eat to a change in exercise tolerance, give your vet a call. We’ve got lots we can do.
Dr. Jessica Vogelsang
Today's Daily Vet column was originally published in March 2015