By Dr. Karen Shaw Becker
The practice of scoring pain is almost exclusively a human medicine tool. A doctor or nurse asks a patient to rate the pain he or she is experiencing with a number, for example, 0 to 10, with 0 indicating no pain, and 10 signifying excruciating pain.
Sadly, the veterinary community has been slow to follow suit. In fact, I regularly have pet parents tell me their vets won't administer pain medications after surgeries or accidents, even when the client demands them. It breaks my heart that so many animals suffer needlessly, and it infuriates me that doctors who take an oath to relieve suffering fail to do so.
Assessing Pain in Canine Patients
In veterinary medicine, our canine patients can't tell us in words how much they're hurting, so pain scoring must be done primarily through observation. It can be used not only with dogs who've had surgery, but also any pet dealing with an injury or illness. Since every animal is an individual with a specific pain threshold, to use pain scoring effectively, we must observe the dog before painkillers are given and before any procedure is attempted, no matter how minor (e.g., a blood draw).
We also need to apply some science to the art of observation when determining a dog's pain score. We need to know average pain levels for the condition the animal has or the surgery about to be performed, and factor those into the equation. This is necessary because many dogs are stoic even when in significant pain.
Pet Pain Scales
Pain scales such as Colorado State University's (CSU) below are intended for use by veterinarians and their staffs, but they can also be helpful for pet parents who want to learn what signs to look for to determine if their dog might be in pain.1
Pain score: 0
No pain present. The patient is happy, acts normally, moves comfortably, has a normal appetite and (if applicable) does not bother the surgery site. TPR (temperature) is normal.
Pain score: 1
Mild pain present. This is usually displayed by a slight limp, difficulty getting up or down or a slight increase in TPR. The patient is eating, tail wagging and not depressed.
Pain score: 2
Moderate pain present. The patient shows sensitivity and may lick or chew at the surgical site or wound. The patient may refuse to eat and may seem depressed, and has slow, shallow respirations.
Pain score: 3
Severe pain present. Signs include depression, reluctance to move and sensitivity at the surgical site or wound. The patient will usually not eat, may vocalize and may lie down but not sleep.
Pain score: 4
Excruciating pain present. The patient shows all the signs described with a pain score of 3, in addition to intermittent panting, increased TPR — even at rest — constant vocalizing, profound depression, dilated pupils, aggressiveness and deep breathing.
To view the full detailed CSU pain scales, which include rough drawings of how your dog might appear with a pain score of 0, 1, etc.: Canine Pain Scale.
Signs to Watch for at Home
Determining if your pet is hurting is all about picking up subtle cues. Generally speaking, a cat in pain will make herself scarce, whereas a hurting dog is often a dog with a sad or tense expression. Canines don't typically whine or cry unless they are in tremendous pain, so here are some other signs to keep an eye out for:2
Lack or loss of appetite
Not greeting you as usual
Not bearing weight on a leg
Taking longer than usual to urinate or defecate
Reluctance to climb up or down stairs
What to Do if You Think Your Dog Is in Pain
How your canine companion's pain is managed depends on what's causing it, so it's crucially important to make an appointment with your veterinarian for a thorough exam. Once your vet has evaluated your dog and depending on the root cause of his discomfort, there are a number of integrative therapies that blend nicely to reduce the amount of medications needed to manage pain, including:
There are also some newer therapies I've used with good success, including the Assisi Loop, a form of pulsed electromagnetic field therapy. In addition, there are a variety of beneficial supplements you can add to your pet's diet, again depending on his diagnosis and treatment protocol.
A Type of Pain in Dogs That Often Goes Undiagnosed
Myofascial pain, which is pain in the muscles that results from one or more trigger points, is common in dogs, but because it doesn't show up on x-rays or other diagnostic tests, it's often left untreated. The result is that many dogs suffer needlessly with significant, chronic muscle pain.
Trigger points, sometimes described as knots in the muscles, are focal points for inflammation and irritation. They may be in an active or latent phase. In the active phase, a trigger point may be very painful for your pet.
If pressure is applied, pain may radiate from the trigger point to other areas of your dog's body, such as down the limbs (this is known as referred pain). He may also have latent trigger points that are sensitive, but not as acutely painful as active trigger points. However, even latent trigger points may lead to problems for your dog, including stiffness and restricted range of motion.
Causes of Myofascial Pain
There are many situations that can lead to this type of muscle pain. Some of them may occur suddenly, such as an injury from an unexpected wrenching movement, a fall or a blow to a muscle. Often, however, the development of such pain, and its related trigger points, is gradual.
Just like in humans, dogs may suffer from muscle pain as a result of overuse or muscle imbalance. For example, if your dog runs along a fence every day or favors a back leg due to arthritis, some muscles are being overused and others underused, leading to muscle imbalance and the development of trigger points.
When the pain and related dysfunction becomes chronic, it's known as myofascial pain syndrome (MPS). Unfortunately, MPS is rarely mentioned in conventional veterinary schools, so it's often overlooked and left untreated. As veterinarian Dr. Michael Petty notes in his article for dvm360:
"Myofascial pain syndrome is a difficult-to-diagnose and seldom-treated condition in dogs. This is despite the fact that it's been a recognized pain issue for more than 400 years and entered mainstream human medicine almost 80 years ago. It's rarely taught in the university setting and there are no books about it."3
Potential signs of myofascial pain include weakness, muscle tension and stiffness and lameness, or your dog may jump from pain or twitch if you happen to press on a trigger point. Without treatment, trigger points and myofascial pain can turn into a chronic and worsening condition
Treating Myofascial Pain by Relieving Trigger Points
If you suspect your dog is suffering from myofascial pain, see a holistic veterinarian who is experienced at finding trigger points. Once they've been located, there are a couple of options for treatment.
One, which is fairly invasive, is dry needling. This involves using an acupuncture needle that is pushed through your pet's skin to stimulate the trigger point. This may release the tight muscle bands associated with the trigger point, leading to decreased pain and improved function.
Electro-acupuncture and acupressure may also be helpful for some dogs with myofascial pain. Cold laser therapy and ultrasound therapy may be beneficial for dogs that won't tolerate acupuncture. Another less invasive option is manual manipulation of trigger points using trigger point massage or trigger point therapy. I have found that recurrent trigger point problems can be a result of an underlying chiropractic issue, so if your pet isn't getting better, consider getting a chiropractic evaluation.