Dear Pet Owners: Stop saying your pet doesn’t hurt!

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.

Maybe people will take it better from this older, distinguished-looking actor in a lab coat.

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.

The rule of thumb for pain management specialists is Assume Pain, meaning, if a pet is likely to have a painful condition, go ahead and treat for it even if they aren’t obviously in pain.

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.

Dogs in pain do not act like an Excedrin commercial

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.