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Pets' Pain Often Goes Undiagnosed

How acute and chronic pain can contribute to behavior problems.

Key points

  • Recent research found that at least a third of all referred cases to veterinary behaviorists are diagnosed with some sort of painful condition.
  • Research has even shown that pets can even develop noise phobias as a result of underlying pain.
  • Once diagnosed, treating the underlying disorder and initiating adequate pain control is imperative.

By Amy Pike, DVM, DACVB

Image by Candace Bailly from Pixabay
Dog lying down with cast on hind leg.
Source: Image by Candace Bailly from Pixabay

Dogs and cats with behavioral problems often have undiagnosed acute or chronic pain. One recent study, by Mills, et al.,1 reported that at least a third of all referred cases to veterinary behaviorists are diagnosed with some sort of painful condition that is contributory to the behavioral diagnosis. The researchers also suggest that this may be a conservative estimate, and as many as 80 percent of referred cases may involve pain in some way.

Acute and chronic pain from dermatological, gastrointestinal, and musculoskeletal disease processes often manifest to the owner as behavioral changes in their dogs and cats. The most common manifestations seen in my clinical practice are house soiling (in a previously house-trained dog), inappropriate elimination (in cats who previously used the litter box consistently), and aggression. Research has even shown that noise phobias can develop as a result of underlying pain.2 It is imperative that clinicians be able to recognize, diagnose and treat painful conditions in practice, in order to alleviate the patient and family’s emotional and physical suffering and improve the quality of life for everyone.

Image by lhlaponina from Pixabay
Cat in cone
Source: Image by lhlaponina from Pixabay

Diagnosing Pain

Diagnosing painful conditions, like musculoskeletal disease in our patients that display aggression and fear in the veterinary setting can be difficult, at best. There are many tools available, including client questionnaire pain indices3 and facial grimace scores4, to help us. Owners can also simply video the pet at home doing normal activities such as walking, running, playing, going up and down stairs, and jumping on and off furniture. When watching the patient ambulate in its comfortable home environment, you are able to see even the most subtle of gait abnormalities and lameness. In a clinical setting, the pet is likely to hide gait abnormalities when experiencing a high level of fear, anxiety, and stress. Diagnosing pain will be made easier in the future with exciting tools like the Pain Trace.

Once diagnosed, treating the underlying disorder and initiating adequate pain control is imperative. Appropriate pain control must be multi-modal, including everything from supplements, medication, rehabilitation, to Eastern medicine interventions, just to name a few. Without addressing the underlying medical disorder and using adequate pain control, the behavioral concern will not resolve. This will leave owners frustrated and their pets suffering.

Pain is an insidious problem resulting in behavioral changes in our companion animals. It is difficult to diagnose but, thankfully, a good number of options are available for treatment (both with and without empirical evidence supporting them).

Clinicians and owners desiring to learn more can watch the webinar I presented for the American College of Veterinary Behavior, “How Pain Contributes to Behavior and Current Treatment Options”.

Lance and Lili Pet Photography
Dr. Amy Piike
Source: Lance and Lili Pet Photography

Dr. Pike graduated from Colorado State University in 2003. After graduation, she was commissioned as a Captain into the Army Veterinary Corps where taking care of the Military Working Dogs returning from deployment spurred her interests in behavior medicine. Dr. Pike completed a Residency program under Dr. Debra Horwitz, DACVB and became board certified in 2015.

References

1. Mills, Daniel S., et al. "Pain and problem behavior in cats and dogs." Animals 10.2 (2020): 318.

2. Lopes Fagundes, Ana Luisa, et al. "Noise sensitivities in dogs: an exploration of signs in dogs with and without musculoskeletal pain using qualitative content analysis." Frontiers in veterinary science 5 (2018): 17.

3. Hielm-Björkman, Anna K., Hannu Rita, and Riitta-Mari Tulamo. "Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis." American Journal of Veterinary Research 70.6 (2009): 727-734.

4. Mogil, Jeffrey S., et al. "The development and use of facial grimace scales for pain measurement in animals." Neuroscience & Biobehavioral Reviews (2020).

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