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 would have a nice little nest egg by now. 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. 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.
So what does pain look like?
The descriptors people most commonly give for a pet in pain are not ‘loud’ but this: tired, mopey, crabby, tired, ‘old’, cranky, fine.
Dogs 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.
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.
pets manifest pain through behavior, not noise. Some pets don’t manifest it at all.
If you’re a veterinary professional, stop making pain medications optional for painful procedures. That implies pain control isn’t just as vital as every other aspect of your medical management.
The safety issue: Which is worse? Pain meds or pain itself?
Now that we are all in agreement that painful conditions are often underdiagnosed, we come to the next problem: 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 incumbent on 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 can be mitigated:
- If owners are aware of the potential side effects and discontinue the medication if any symptoms arise, the chances of long term problems are usually minimal. In my own experience, the vast majority of patients have an excellent experience with NSAIDs* 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.
- There are other drugs out there besides NSAIDs. 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.
Educated owners make good decisions. We all want that.
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.
*This message has not been brought to you by a sponsored shill.
Having had more than a few pets get to the geriatric state – our one Golden was just under 17 years when she passed – I can tell you that you CANNOT ignore the POSSIBILITY of pain in your friend. When they get old and slow and cranky, that’s when you owe them the VERY BEST care and attention – get them help – you wouldn’t let your grandmother be in pain; don’t let your best friend try to endure it – and they will try.
I lost my Scully almost 2 years ago, and she was 18 at the time. The best thing I ever did was ask my vet if she had slowed down, stopped jumping and started sleeping a lot because she was old, or was it possible that she had arthritis. She was a curious little cat and she was always into whatever I was doing, but she gradually began to slow down and eventually spent most of her time sleeping. I put her on Cosequin twice a day, even though I was told that it only seemed to make a difference in about 50% of the cats that were on it. A few months later she was much more alert and active and social. She still couldn’t jump up on counters, but she would certainly demand to be lifted up onto the sink so that she could help me get ready in the morning. It made a huge difference in her quality of life the couple of years. The heated bed was also her happy place in the winter time. Little things can make a big difference.
And it’s not just in senior pets or for medical procedures. My Oscar just turned 6 but I noticed a few months ago that he wasn’t getting on the furniture as much (in “his” spots), was slower getting into the car, and sometimes kept his back legs together while running across the yard. Now, he has arthritis. At 6. When he was young we did the PennHIP test and surgery to decrease his chances of dysplasia, and the orthopedist assured me that his arthritis would probably be worse if we hadn’t done that. So he’s on NSAIDs and walks – feeling much better. I shudder at the thought of his living several more years in more and more pain, so I’m all about treating it any way that works!
Adaquan kept my old dog mobil for 2 years before she finally gave up.
Is aspirin truly bad? Until someone educates me otherwise, I am skeptical about lumping aspirin in with Tylenol. I do not think of Tylenol as a ‘good old days’ approach, and don’t even take it myself, although I do take aspirin sometimes.
Great post! We are in our first days with a Senior pet and I’ve been learning about all the things you mentioned!
Applawse! Applawse! We hear this over and over again when dogs or cats are either awaiting amputation or recovering from it. Pet parents need more education like this so that old myths about pain and pets go away once and for all. Thank you so much, we will put this in our Discussion Forums and refer to it often.