Being in pain is miserable, both for humans and for dogs. None of us like the idea of our pets being in pain, but thankfully there are effective medications available to keep our pets as comfortable as possible whilst we treat the cause of their pain.
But how can we tell whether our pets are in pain? What are the different treatment options – how do they work, and what might the side-effects be? Is there anything besides medication that we can do to help our dogs in pain? This article will answer those questions and more.
Signs of pain in dogs
- It can be difficult to spot the signs of pain in our dogs, as they cannot tell us that they are sore, and are often good at hiding it with their body language. This is especially true if the pain is “chronic” (has been present for a while) rather than “acute” (has only just become painful).
- In general, dogs in pain will appear quieter and more withdrawn. They may be less active and sleep more than they used to, but occasionally they will become unsettled and restless. They will rarely yelp unless the pain is sudden and severe; sometimes they will whine, but often only for a short time, even if their pain is ongoing. Panting a lot is also common.
- If dogs are in severe or long-term pain, this can also lead to changes in their behavior. They may become more “grumpy” – less keen to interact with other dogs or humans – and can even become aggressive.
Certain types of pain may also show other, more specific signs.
Signs of leg pain
- Limping – but only if the pain is affecting one leg in a pair. If, for example, both back legs are sore, then you may not see a limp
- Licking at the leg
- Laying the leg out at an odd angle when resting
- Swelling of the limb, or a particular joint
- Reacting (flinching, crying, barking, or snapping) when the leg is touched
Signs of back pain
- A stiff posture, sometimes with the back hunched or arched
- Spasms in the back or leg muscles
- Reluctance to go up and down steps, or to jump up.
- Pain when trying to go to the toilet, or even being unable to get into the right position to defecate.
- Reacting (flinching, crying, barking, or snapping) when the back is touched
Signs of neck pain
- Head lower down than normal
- Neck held straight, and not turning to the left or right.
- Stiffness and spasms in the neck muscle
- Reluctance to eat or drink from bowls on the floor
- Reacting (flinching, crying, barking, or snapping) when trying to reach the head down, up, or to the sides.
Signs of dental pain
- Eating more slowly
- Dropping food when eating
- Preferring soft, rather than hard, food.
- Not eating chews
- Not wanting to play tug-of-war or other games that involve holding a toy
- Reacting (flinching, crying, barking, or snapping) when touched around the mouth
Signs of pain in the belly
- Restlessness
- Panting
- Groaning
- “Praying position” – stretching out with their front end down and their back end raised.
- Reacting (flinching, crying, barking, or snapping) when the belly or back is touched
If you suspect at any time that your dog may be in pain, always get them checked out by your veterinarian as quickly as possible.
Should My Pet Be Seen by a Veterinarian?
1. Have you noticed changes in your pet’s appetite?
2. Does your pet have diarrhea or loose stools?
3. Have you noticed changes in your pet’s thirst/water consumption?
4. Is your pet having accidents in the house?
5. Is your pet pacing and unable to settle?
6. Is your pet panting more than usual?
7. Is your pet whining or vocalizing more than usual?
8. Is your pet shaking more than usual?
9. Is your pet hiding or avoiding physical contact more than usual?
10. Is your pet more lethargic and sleeping more than usual?
11. Are you concerned about changes in your pet’s behavior?
12. Is your pet scratching their ears?
13. Is your pet licking their paws more than usual?
14. Does your pet have a rash?
15. Is your pet moving more slowly than usual or having a harder time getting up or down?
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Should My Pet Be Seen by a Veterinarian?
1. Have you noticed changes in your pet’s appetite?
2. Does your pet have diarrhea or loose stools?
3. Have you noticed changes in your pet’s thirst/water consumption?
4. Is your pet having accidents in the house?
5. Is your pet pacing and unable to settle?
6. Is your pet panting more than usual?
7. Is your pet whining or vocalizing more than usual?
8. Is your pet shaking more than usual?
9. Is your pet hiding or avoiding physical contact more than usual?
10. Is your pet more lethargic and sleeping more than usual?
11. Are you concerned about changes in your pet’s behavior?
12. Is your pet scratching their ears?
13. Is your pet licking their paws more than usual?
14. Does your pet have a rash?
15. Is your pet moving more slowly than usual or having a harder time getting up or down?
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Pain management: Prescription medication
There is a wide range of different medications that your veterinarian may prescribe to help treat your dog’s pain. All of these are effective at treating pain in the right situations, but like all effective medications, they will come with side effects too. Your veterinarian can discuss the risks and benefits of using each kind of prescription medication with you.
Some of the medications used to treat pain in dogs are FDA-approved, but some are not – instead, they are borrowed from human medicine. Your vet will only suggest a drug that has not been FDA-approved when there is no alternative available and can discuss the potential risks and benefits with you.
Most of the medications in this section are only available on prescription from your veterinarian. Even if you have access to these medications in other ways, you should never use medication on your dog without checking with a veterinarian first. Otherwise, you risk giving them a drug that is not suitable for them or giving them an overdose. Sadly, either of these issues can be fatal in some circumstances.
Often, pets with chronic (long-term) pain will need more than one pain killer to keep them comfortable. Many of these drugs can be used in combination – your veterinarian can advise you about this, and about the risks and benefits of doing so.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are some of the most common drugs used to treat both acute and chronic pain in dogs, as they are fast-acting and can be taken easily in tablet or liquid form. They can help treat mild to moderate pain by themselves or can be used together with other medications to help with severe pain.
Examples of FDA-approved NSAIDs for dogs include:
- Meloxicam (Many brand names, including Metacam®, Meloxidyl®, Loxicom®, Orocam®)
- Carprofen (Many brand names, including Rimadyl®, Carprieve®, Vetprofen®)
- Robenacoxib (Onsior®)
- Firocoxib (Previcox®)
- Grapiprant (Galliprant®)
Human NSAIDs such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®, Midol®) should not be given to dogs. They are not effective medicines for our pets and are more likely to be toxic than the FDA-approved pet versions.
Aspirin is sometimes used off-label in dogs to treat blood clotting disorders, but is not an effective painkiller, and can also be toxic if used at the wrong dose.
How do NSAIDs work in dogs?
Most NSAIDs work by blocking a group of enzymes called “Cyclo-Oxygenases” (COX). These enzymes create inflammatory compounds which cause pain and swelling, and so blocking them can reduce both soreness and inflammation.
However, COX enzymes also have other roles in the body, including protecting the stomach from acid damage and controlling blood flow through the kidney. Some NSAIDS only target a particular enzyme (called COX-2) which is involved in fewer of these other roles, and so may have fewer side effects. However, no medication is completely free of these risks.
Grapiprant (Galliprant®) works in a slightly different way, blocking a receptor called “Prostaglandin EP4”, which causes inflammation and pain differently. This receptor is not involved in some of the other roles that COX has, and so grapiprant may have fewer side effects than other NSAIDs.
What are the side effects of NSAIDs in dogs?
Several recognized risks come with taking NSAIDs for both humans and dogs. Your veterinarian should be able to tell you if your dog is at a particularly high risk of any of these possible problems.
Vomiting, Diarrhea, and stomach ulcers
There are several different reasons why NSAIDs may lead to an upset stomach. Some NSAIDs are acidic and can directly irritate the lining of the stomach and intestines, which can cause vomiting, diarrhea, or both. However, there are also other reasons why NSAIDs may affect our dogs’ digestion.
Our dogs’ stomachs contain high levels of acid to help kill any bacteria, viruses, or parasites in their food, and to help with the process of digestion. The lining of the stomach is protected from this acid by a layer of mucus, which stops the acid from attacking the stomach itself.
NSAIDs can both cause the amount of acid to increase, and the amount of protective mucus to decrease. This means that the lining of the stomach (and other parts of the gut) can become irritated, and sometimes ulcers will form. This will cause vomiting and diarrhea, but also pain in the abdomen.
In rare cases, NSAIDs can lead to serious bleeding or perforation - a hole being created that lets the contents of the gut spill into the abdomen. This can cause a serious infection, which can lead to sepsis and death.
If your dog is taking an NSAID and experiences vomiting, diarrhea, or abdominal pain, then you should contact your veterinarian straight away for advice.
Kidney damage
NSAIDs can affect the way blood flows through the kidney. Most of the time, this does not cause any problems, but in rare cases, it can lead to the kidneys not getting enough blood, which can damage them.
Several factors may make it more likely a dog will develop kidney damage from an NSAID, including:
- Dehydration
- Taking other drugs that affect the kidney, such as:
- Furosemide
- Aminoglycoside antibiotics e.g. gentamycin
- Pre-existing kidney disease
Make sure your vet knows about any pre-existing health conditions or medication before they prescribe your dog NSAIDs.
The signs of kidney damage include:
- Drinking more
- Peeing more
- Lethargy (quietness)
- Loss of appetite
- Vomiting
If you see any of these signs in your dog who is taking an NSAID, contact your veterinarian for advice.
If your dog is going to be taking NSAIDs long-term, your veterinarian may recommend a blood test to check their kidney function first.
Liver damage
NSAIDs are usually metabolized by the liver, and in rare cases, this can lead to damage to the liver. However, this usually only happens in dogs who receive a much higher dose than they should (for example, if they accidentally eat a whole packet of medication), rather than dogs who are on the prescribed dose.
Dogs who have any pre-existing liver disease may be at a higher risk of further damage, as well as a risk of the other side-effects mentioned above. Always make sure your veterinarian knows about any pre-existing health conditions before they prescribe your dog medication.
Acetaminophen / Paracetamol
Acetaminophen (Tylenol®) is a common drug store medicine for humans. There is no FDA-approved version available for dogs in the US, but some other countries have licensed versions of this drug available. It can be useful for treating both pain and fever in dogs but must be used very carefully or it can have serious side effects.
Veterinarians may use acetaminophen on its own to treat mild to moderate pain (similar to NSAIDs), or together with other medications for severe pain. Unlike NSAIDs, acetaminophen generally does not cause an upset stomach, and also has no effects on the blood flow through the kidney. For these reasons, acetaminophen is sometimes preferred to NSAIDs in dogs with sensitive digestion, or those with pre-existing kidney problems.
How does acetaminophen work in dogs?
Scientists are still not exactly sure how acetaminophen works in either dogs or humans. It may act on COX enzymes, but unlike NSAIDs, it does not have an anti-inflammatory action. It may also help to block pain signals coming from the body to the brain.
What are the side effects of acetaminophen in dogs?
There are several recognized side effects of acetaminophen in dogs. The difference between a safe dose and a toxic dose of acetaminophen is smaller than for many drugs, so it is important to stick strictly to the dose that your veterinarian recommends.
Liver damage
The most serious side-effect of acetaminophen is damage to the liver as a result of toxins building up as the liver breaks down the drug. This causes the cells in the liver to die and can be fatal if the cell death is widespread.
Liver damage generally only happens when dogs are given a higher-than-recommended dose of the medication, but in rare cases, it can happen even at normal doses.
Acetaminophen should never be given to dogs whose livers are not working properly, as it can be toxic even at low doses.
Vomiting and diarrhea
Acetaminophen is not as irritating to dogs’ guts as NSAIDs, but it can still sometimes cause vomiting or diarrhea, as almost any medication cat.
Damage to red blood cells
In high doses, acetaminophen can damage red blood cells, causing methemoglobinemia. This means that the red blood cells are no longer able to carry oxygen around the body properly, and can cause the blood to turn a dark brown color. However, this is not usually seen at the normal doses of acetaminophen used by veterinarians.
Opioids
Opioids are a family of drugs that are used to treat moderate to severe pain in both dogs and humans. There are a large number of different opioid drugs currently available, but those currently used most commonly in dogs include:
- Hydromorphone
- Buprenorphine
- Butorphanol
- Methadone
- Fentanyl
- Pethidine
- Morphine
Some opioids are stronger painkillers than others, and they will also last for different lengths of time. Some of them also have a stronger sedative effect than others. This means that veterinarians will choose to use different opioids at different times. Not all of these medications are FDA-approved for use in dogs.
Opioids are almost always given by injection in dogs, rather than as a tablet. This is because our dogs’ livers are much more effective at breaking down opioids than human livers. When tablets are swallowed, the medication is absorbed by the gut and then filtered by the liver before it can get to the rest of the body. Dogs’ livers will remove almost all of the opioid medication from the blood before it can reach the rest of the body, and so it will have little or no painkilling effect.
Opioids are usually only used short-term for treating pain in dogs - for example, after surgery, trauma, or severe abdominal pain. This means that dogs are unlikely to develop an addiction to the medication in the same way that humans can.
How do opioids work in dogs?
Opioids work by stopping pain signals from reaching the brain. They are particularly good painkillers because they can affect pain signals in all parts of the body, including the spinal cord and the brain.
What are the side effects of opioids in dogs?
Opioids are generally considered to be safe drugs, outside of the risk of addiction, but can still come with some side effects for our dogs.
Sleepiness
Opioids affect the brain, and so can often cause some sleepiness as a side-effect. Sometimes this is useful – for example, during sedation or anesthesia – but sometimes this is an unwanted side effect. Veterinarians will try to balance this sleepiness with the need for pain relief.
Nausea, vomiting, lack of appetite
Opioids will often make dogs less interested in their food, and will occasionally cause them to feel sick or to vomit. This is often mild and may not cause a problem, but in more severe cases, medication may be needed to treat these side effects.
Constipation
Opioids cause food to pass more slowly through dogs’ guts. This means the body has more time to absorb all the moisture from them, and so their stools may become firmer and more difficult to pass. This is usually only a problem when opioids are used for more than a few days and can be treated with medication.
Tramadol
Tramadol is sometimes considered an opioid medication, but also has other effects that other opioids do not. Like other opiates, it is not particularly effective when given as a tablet in dogs, but may be useful for a minority of dogs.
How does tramadol work in dogs?
Tramadol may work in a similar way to opioids, by stopping pain signals from reaching the brain. However, it also has effects on some other chemicals in the brain (serotonin and noradrenaline) which may change the way that the brain perceives pain. This can be useful for long-term pain, such as from arthritis or cancer.
What are the side effects of tramadol in dogs?
Opioids are generally considered to be safe drugs, outside of the risk of addiction, but can still come with some side effects for our dogs.
Sleepiness
Tramadol acts on the brain, and so can cause dogs to feel more sleepy than normal. This effect is usually mild.
Nausea, vomiting, lack of appetite
Tramadol’s effects on the brain may also cause dogs to be less interested in their food than normal. Again, this is usually mild but can cause a problem if the dog is already having difficulty eating (for example, in kidney disease).
Seizures
Tramadol changes the levels of various chemicals in the brain, and in humans, this can lead to an increased risk of seizure. It is not known if this is also true for dogs, but veterinarians usually avoid using tramadol in dogs who are already prone to seizures, such as epileptics.
Gabapentin
Gabapentin is a human painkiller that is sometimes used off-label in pets, as there is no similar FDA-approved product.
In humans, gabapentin is also used to treat seizures. However, it seems to only have a very weak effect on pets, so is not normally used specifically for this purpose.
How does gabapentin work in dogs?
Gabapentin is good at treating nerve pain, which happens either when nerves are directly damaged (for example, by a slipped disc) or when pain has been present for a long time (for example, with arthritis) and it has started to affect the nerves. It takes some time to be effective, and so is best used to treat long-term pain, rather than short-term.
At higher doses, gabapentin can make dogs sleepy, so it is occasionally also used as a mild sedative.
What side effects does gabapentin have in dogs?
Gabapentin is usually a well-tolerated medication, but we can see some side effects. These are usually short-term but occasionally can last for longer periods of time.
Sleepiness, weakness, wobbliness
Gabapentin acts on the brain as well as on other nerves. This means that it can cause dogs to feel more sleepy than normal, and they may be slightly wobblier and weaker than normal. This effect is usually temporary and improves significantly after a week or two.
Withdrawal
As we mentioned earlier, gabapentin may have some anti-seizure effects. If a dog has been on gabapentin for a while and then stops it suddenly, this can make them temporarily prone to having seizures, even if they have never had one in the past. You can avoid this by reducing the dose slowly if it is time for your pet to stop gabapentin – your veterinarian will tell you how to do this.
Monoclonal antibody therapies
There is a new treatment that has recently become available for dogs in the UK and Europe called Librela®. This is a custom-designed antibody that targets pain in dogs with arthritis, though it may also be useful for treating other kinds of pain, too. Librela® is still in the process of applying for FDA approval but may become available in the US soon, too.
These antibody therapies are given as a long-lasting injection (usually monthly) and have very few side effects on the liver or kidneys, so can be a very useful and effective option when available.
Local anesthetics
These drugs work to numb certain areas of the body (large or small) by blocking the pain signals that would normally be sent to the brain. They are very useful to keep dogs comfortable after surgical or dental procedures but are currently not used much outside this. Your veterinarian will be able to tell you if they are being used for pain relief for your pet’s surgery.
CBD oil
There has been increasing interest in using CBD oil to treat pain in pets, much as in humans. However, we currently do not know a great deal about how safe or effective these products are in dogs. We do know that in larger doses, CBD can be toxic to dogs, so this is a medication that must be used carefully.
CBD oil (or other products) should only be given to your dog if your veterinarian has specifically recommended it. You need to be careful to use exactly the product that they recommend, or you may accidentally end up giving your pet too much.
Keep in mind that different CBD oils will produce different benefits for your pet. For example, you can pick among these 7 types of CBD oil for dogs from Honest Paw, one of which helps with anxiety, while another aids pet mobility.
Other painkillers
There are many other medications that veterinarians may use less commonly to treat pain in dogs – for example, after surgery, or with long-term conditions that are not responding to normal treatments. If you are unsure about any mediation, always speak to a veterinarian or vet tech for an explanation of what it is, how it works, and what side effects you should look out for.
Pain management: Supplements and diets
There is a whole range of non-prescription supplements available that will claim to help your pet with pain – often pain from arthritis, but sometimes other kinds of pain, too. These are not the same as drugs and have not been proven to be effective, so should only be used alongside conventional pain killers. Otherwise, you risk your pet staying in pain.
Joint supplements
There is a wide range of different supplements available designed to help your pet with their joints. These usually contain glucosamine and chondroitin, and often some essential fatty acids (omega-3s and -6s) and antioxidants.
There is some weak evidence that these kinds of supplements may be helpful in dogs with arthritis, but the effect is slow (usually over 4-6 weeks) so they should be started alongside painkillers to keep your dog comfortable.
Other supplements
You can buy many different supplements – either at the pet store or online – which will claim to be pain-killing, or have anti-inflammatory effects. However, the reason that these are supplements (and not medication) is that they have not been proven to work. These should be used alongside traditional painkillers to make sure that your dog stays comfortable while you try them.
Always let your veterinarian know about any supplements that you are giving your dog before they prescribe them medication.
Joint diets
There are some specialized diets available that may help with their arthritis. These often contain the same kinds of ingredients as joint supplements, and may also be moderate-calorie to help with weight loss, or with maintaining a lean body weight. There is some evidence that these kinds of diets can be helpful.
Speak to your veterinarian for advice on choosing a joint diet.
Other diets
As with humans, there are many trendy diets available for pets that will claim to be “anti-inflammatory” or have other effects that may help with pain. However, there isn’t evidence to back up these claims. If you are considering changing your pet’s diet, speak to your veterinarian for advice.
Weight loss
If your dog is suffering from arthritis and is overweight, the weight loss can be hugely beneficial in controlling their pain. There is evidence that losing weight can be as effective as starting your dog on painkillers – and of course, it’s cheaper, has few side effects, and is generally good for their overall health, too!
Helping dogs to lose weight can be difficult, but it’s generally best to start by reducing their food by around 10% (by weight) and see if that makes a difference. Weigh your dog every 2-4 weeks to see if they are losing – if not, speak to a veterinarian or vet tech at your local practice for further guidance.
Pain management: Complementary therapies
Manging our dogs’ pain is not just about medication, supplements, and diets – other things can be helpful, too. Some of these need a qualified therapist, but some you can do at home.
Physiotherapy
A qualified physiotherapist can be very helpful for dogs who are in pain from arthritis or recovering after a slipped disc, as well as for those dogs who are recovering from certain surgeries. They can usually offer treatment sessions, and also teach you techniques that you can use on your dog at home.
Your veterinarian may be able to recommend a qualified physiotherapist for your dog.
Hydrotherapy
Hydrotherapy involves your dog exercising whilst their body is supported by water – either by swimming or by using an underwater treadmill. This can be helpful for dogs recovering from some surgeries, as well as those with arthritis or other long-term muscle or joint conditions.
Hydrotherapy is best done under the supervision of a qualified specialist (rather than just letting your dog swim in a pool or river!) so speak to your veterinarian for advice on finding the right kind of facility.
Changes at home
Dogs who are in pain may struggle with some aspects of day-to-day life, so making a few small changes can make a big difference to them.
Slippery floors
Some muscle and joint conditions (including arthritis) can mean that dogs struggle much more with hard floorings such as tiles, wood, or laminate. They may find it harder to get up after lying down or may slip when walking.
Laying rugs or mats can make it much easier for your dog to get around these areas of your house.
Steps and stairs
Many dogs with painful health conditions will struggle with steps or stairs, even if they have previously used them with no issues. Try to make sure that everything your dog needs (food, water, sleeping places, toys, etc. ) are all on the same level of your house so that they can easily access them. Ramps, or multiple smaller steps, can also be useful where a change in floor height is unavoidable.
Some dogs with neck pain may appreciate having their food and water bowls raised a few inches so they do not have to bend down.
Comfy bedding
Providing the right kind of bed for dogs with painful health conditions can make a big difference to their comfort. Make sure the bed is soft enough that it can support all their joints, but not so deep that they struggle to get out of it afterward. A foam mattress often works well in these cases.
Conclusion
Pain in dogs can be difficult to spot, so if you are in any doubt, a trip to the veterinarian is best. Our dogs’ pain should always be treated with effective medication, but there are other supplements, diets, and therapies that can sometimes be helpful, too. You should also consider your dog’s particular pain, and make sure that your home is comfortable for them to move around.
If at any time you think that your dog’s pain is not under control, always speak to a veterinarian for advice.
