Pain management

Long term (chronic) pain is as debilitating in dogs as it is in people. Constant pain significantly reduces your dog’s quality of life. Amongst other things, it may cause interrupted sleep, reduced appetite and an inability to exercise or play properly. Taking measures to control even mild pain can result in a happier and healthier dog.

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Animals, like people, are prone to many different forms of pain. All types of injury including surgery can cause pain. There are times when pain can be anticipated, such as immediately following surgical procedures. In these instances, your veterinarian will probably prescribe your dog pain relief before and during surgery and then ask you to continue this at home. Adequate pain relief has been shown to improve recovery after surgery.

In dogs, long term (or chronic) pain is often caused by arthritis (joint pain) or cancer. When managing dogs with these conditions, vets aim to give your dog the best quality of life possible and pain control is an important part of management.

Animals in pain can show a variety of signs, some, like lameness, are obvious. Other signs in dogs with acute pain include whining, howling and restlessness. However, reduced activity, poor appetite, an increased breathing rate and altered sleeping patterns can also indicate discomfort. Animals with a painful focus may chew at or continually lick the sore area. Some animals in pain become reserved and unresponsive but others may become aggressive, as they may be scared of being touched.

It can be easy to attribute signs of pain, eg poor appetite, stiffness and reluctance to exercise, as signs of old age rather than pain. Dogs can be very stoical, particularly with common issues like chronic joint pain. Dogs may not cry out or yelp, as this type of pain has crept on gradually over time. They may have adapted their movements and behavior to try and cope with it.  You may be surprised at how much happier your dog is once their pain is relieved. If you are concerned that your dog may be in discomfort you should discuss this with your veterinarian as there may be a lot that they can do to help.

Pain is much more difficult to control once it is well established, so it is far better to treat it as soon as it is recognized. There are many different types of drugs used in the management of pain, and each has different benefits and potential side effects. Your veterinarian will initially prescribe what they think is the best drug for your dog. However, they sometimes need to try a number of different drugs, for the treatment of a dog in chronic pain, before the best treatment for that individual is found. Never give your dog pain relief medication not prescribed by your veterinarian – medicines that are safe and effective in humans can be dangerous in dogs. If you are worried about your dog, or they develop signs such as vomiting, diarrhea or bleeding, whilst on pain relief medication, always contact your veterinarian and do not give any more medication until you have done so.

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs that reduce inflammation. These drugs block the action of some of the messengers of pain and inflammation in the body (prostaglandins). Commonly used NSAIDs in dogs include carprofen, ketoprofen, meloxicam, deracoxib and tepoxalin but there are many more and more are being produced all the time. Depending on the type used, NSAIDs can be given as tablets, liquids or by injection.

When used carefully NSAIDs are relatively safe, and most dogs respond well to them. One of the most commonly reported side effects is stomach upset, such as diarrhea or vomiting. If your pet has these side effects, your veterinarian may prescribe some additional drugs to help protect the stomach or it may be necessary to change the type of pain relief your pet receives.

These drugs are removed from the body by the liver or kidneys and therefore should not be used in animals with damage to these organs. It is recommended to check liver and kidney function in animals receiving long term NSAID treatment.

Opioids

Opioids are drugs, such as morphine and methadone. They are some of the most powerful forms of pain relief available. Methadone is commonly used in veterinary hospitals to control severe pain after surgery but there are other types of opioids which are used in dogs too. These include buprenorphine which might be used in less severe forms of pain or for routine procedures.

Fentanyl may be used in animals. It can be administered via a drip or in the form of a patch. Fentanyl patches are a type of transdermal treatment that can be applied to dogs to provide them with continuous relief post-surgery. Some dogs can continue to wear them at home after being discharged from the hospital. However, they can pose a significant risk to patients if the patch is removed and eaten by your pet. Care must be taken to prevent access to the patches – also not recommended if there are young children in the pet’s household.

In recent years, Tramadol has become popular with veterinarians for managing chronic pain in dogs. There are few serious side effects with this drug although it has been reported to cause vomiting and sleepiness in some patients. It is often used alongside other medications.

Dogs receiving opioids do not appear to suffer as many side effects or hallucinations (highs) as people do. One of the side effects in pets is that these drugs can sometimes cause constipation.

Extreme care must be taken to keep all opioid medication out of the reach of children and pets.

Opioid medication is tightly regulated and recorded, which means that your vet may only be able to dispense a certain amount at any one time.

Alternative pain relief drugs

Gabapentin is a human drug that is often used in dogs, especially to manage chronic or nerve-related pain.

Paracetamol may also be prescribed for some dogs but must be used carefully to avoid overdose.

Ketamine has been used in sedation and anesthetic protocols for years, but many vets are now also administering it to help dogs struggling with chronic pain. As with opioid medication, some of these drugs are regulated and their use is controlled.

All these medications are often used alongside other drugs as part of a multimodal approach to pain management.

Monoclonal antibodies are also gathering favor in pets with arthritis, due to their lack of side effects and the fact they can be used in animals with other underlying diseases. These are administered as a monthly injection and help to stop signals from getting through to pain receptors.

Some lifestyle changes can help to reduce pain experienced by dogs. If your dog has joint pain your veterinarian will advise that they have controlled exercise, so that they don’t overdo things, and their weight should be kept to a minimum healthy level – to reduce the strain on the joints. Ensuring that your dog does not have to climb stairs or jump into the car can reduce back pain and the pain associated with hip disease. Hydrotherapy or physiotherapy can be helpful for these animals too.

Nutraceuticals such as glucosamine and chondroitin may help to improve joint health when given regularly. Omega 3 fatty acids may be helpful for dogs with arthritis.

With so many pain relief options available, your vet is on hand to ensure that your dog stays happy and comfortable throughout their life.