How to talk with the owner of a patient in chronic pain

Key signs that can flag chronic pain in patients

Pain assessment is a vital sign that should be part of every pet's clinical workup. Observing the patient's behavior in its daily routine is the most accurate way to detect pain, and even when the pet shows none of these changes in the clinic, we must rely on the owner's account and focus on questions that help recognize and assess pain.

The clinical conditions most often seen in practice today as sources of chronic pain include animals with cancer, especially osteosarcoma or bone metastases, chronic periodontal disease, degenerative joint disease, feline lymphocytic plasmacytic stomatitis, feline idiopathic lower urinary tract disease, inflammatory bowel disease, intervertebral disc disease, otitis externa and pancreatitis.

When a patient is suffering from chronic pain, there are at least five areas worth exploring through targeted questions.

1) Reduced activity and exercise intolerance

Owners may notice that the pet no longer wants to take long walks, becomes reluctant to keep going on outings, no longer joins in with its usual enthusiasm, or is lying down more than usual.

This is often misread as a normal part of aging, but it is important for owners to understand that these changes may be linked to a medical condition that needs follow-up.

Questions you can ask: Has your pet been more or less active lately? Are the distance, pace and number of walks the same as before?

2) Changes in daily activities

This point matters for finding out whether the pet has started or stopped doing something that was part of its routine.

Questions you can ask: Is your pet climbing onto furniture, the car seat or the stairs as usual? Is it reluctant to go up or down stairs? Is getting up harder for it than before? Does it stretch routinely after waking? Is it interacting less with you and with other pets?

3) Urinating and defecating in the wrong place

Telling behavioral problems apart from medical conditions is essential. When the cause is medical, the pet may be in pain or may hurt itself on the way to its elimination spot, whether because the spot is far away or because it has to cross an area it finds difficult, such as a slippery floor or steps. Pets may also defecate while walking because they struggle to hold a normal posture, often a sign of painful conditions in the hind limbs.

Questions you can ask: What posture does your pet adopt to urinate and defecate? Have its toileting habits changed? Is it still urinating and defecating in its usual places?

4) Lameness

Owners may report that the pet has an unusual gait, is favoring one of its limbs, is unable to stay in one spot for long, or is shifting its body weight to one side, to the front limbs or to the hind limbs.

Questions you can ask: Have you noticed the pet sparing one of its limbs while walking or sitting? Have you noticed any change in the way it moves, such as bunny-hopping? Have you noticed any change in posture, such as stiffness or hunching while standing?

5) Aggression

Another issue that can be mistaken for a behavioral problem. Some animals, trying to protect the limb or area where it hurts, may end up growling or even biting anyone who tries to handle them, whether for petting or for examination.

Questions you can ask: Does your pet let you pet it normally? Is there any part of its body it does not like being handled? Is it unusually aggressive when playing with other animals?

Conclusion

Detecting chronic pain in dogs and cats is a challenge, but asking the owner the right questions with the right focus can help the veterinary team pinpoint the area of concern. Owners rarely connect their pet's behavioral problems with chronic pain, yet treating it will improve the patient's quality of life and strengthen the bond between veterinarian, owner and patient.