Though in many ways, our dogs communicate with us all the time, when it comes to their pain, we have to figure it out on our own. Here to help with that daunting task is Michael Petty, DVM, author of the newly released Dr. Petty’s Pain Relief for Dogs in a Q&A with Bark editor Claudia Kawczynska.
What are the most common ways dog guardians can recognize that their dogs are in pain, beyond obvious signs like limping or decreased appetite?
The answer to this is complicated and I probably can’t do it justice here. However, if people start to see their dog as lazy, not socially interacting, reluctant to do the things they liked in the past—really, any behavioral change—then pain should be on the list of possible problems. Dogs rarely quit doing the things they like to do because they’re old, they quit doing them because there’s something wrong. And that usually means disease, commonly something painful like degenerative joint disease.
You note in your book that “there is no one-size-fits-all approach to pain treatment.” You also mention something called a “pain examination.” What does that entail, and is it something that’s perhaps best handled by a specialist?
A pain exam can take many forms. My approach depends in part on the history given to me by the dog’s caregiver, the breed, prior medical conditions and watching the dog walk into the exam room, just to name a few.
Every pain exam should consist of a complete physical exam; an observation of the dog’s gait when possible; a basic neurological exam (many neurological issues can mimic pain); and a hands-on palpation of the dog’s joints, muscles and bones. Based on the fi ndings, X-rays are often indicated, as well as blood work and urinalysis in anticipation of possible pharmaceutical interventions and procedures requiring sedation or anesthesia.
No one specialty “owns” pain. Anesthesiologists are well trained to handle acute pain, but not chronic. Neurologists are trained in matters like intervertebral disc disease, but not osteoarthritis. The list goes on. My fi rst choice would be to seek out someone with a pain certifi cation—a Certified Veterinary Pain Practitioner—from the International Veterinary Academy of Pain Management (ivapm.org). This certification takes several years to earn, and program graduates are experts in the fi eld of pain management.
Do most vets understand the importance of neuropathic pain (essentially, a misfire between the sensory/nervous system and a region of the body)? And how is it best diagnosed?
Most of the veterinarians I talk to, outside of those belonging to pain-aware organizations such as the IVAPM, do not have a firm understanding of neuropathic pain. In human medicine, diagnosing neuropathic pain is difficult; it requires both a verbal description of what the pain feels like and verbal responses to certain tests. Without these tools, most of the time, our diagnosis is, at best, an educated guess. However, patient response to therapy for neuropathic pain is one indication that a veterinarian is on the right track.
You note that aspirin is dangerous for dogs. Are there any over-the-counter medications that can be given to a dog who has sustained an injury, to ease pain and infl ammation before taking the dog to a vet?
No. No OTC medications are licensed for use in dogs. Ice and stabilizing injured limbs are about the best you can do.
You support the importance of omega-3 fatty acids as part of a dog’s diet because they work to help decrease the production of pain-causing prostaglandins. Why is a fish-based source of omega-3 fatty acids preferred, and do foods such as canned salmon and water-packed sardines and tuna contain enough of it? How do we determine the correct amount?
Fish-based sources are best because of bioavailability. Sources like flax seed are okay for people but useless for dogs, as they cannot convert flax to omega-3s. If you are feeding a food that has salmon or sardines as an ingredient, then you don’t have to worry about the amount, as it takes very little of these foods to provide enough omega-3s.
You call out a few botanicals, like ashwagandha, boswellia serrata and turmeric, for their benefits in pain relief and/or in reducing infl ammation. Do you prescribe these in your practice?
Yes. The problem is finding a reliable source of herbs, as they are not monitored by the FDA like pharmaceuticals are. One good option is a product called Dasuquin Advanced, from Nutramax; it has many important pain-modifying ingredients, including several herbs.
The veterinary attitude toward acupuncture seems to have changed a lot. In your experience, which conditions respond best to acupuncture? And how do you know which dogs are good candidates for this treatment? (I had a dog who would shake out the needles!)
Talking about acupuncture is one of my favorite things to do. I cannot imagine practicing without it, especially in my geriatric population, which is more sensitive to the effects of many drugs. I think attitudes have improved—in both veterinarians and dog owners—as more and more research is being published on the benefi ts of acupuncture; also, people hear about someone’s dog being helped by it. In addition, it has the support of the National Institute of Health for the treatment of pain.
For many dogs, the proof of being a good candidate is obvious in their response to treatment. Within one to three treatments, we can usually see an improvement in pain scores and observations. If we don’t, then sometimes the decision is made to stop treatment. I have had a few clients return and say they didn’t realize how much it was helping until it was stopped.
Many people experience what you did with your own dog. Some dogs are needle-phobic and resent even one needle going in. Some dogs are just afraid of being at the veterinary clinic and won’t sit still. I sometimes give these patients a mild sedative to get over this hump. A reduction in anxiety for several treatments often means that they eventually accept acupuncture without continued use of the sedative.
Finally, dewclaws. You make the point that a dog’s dewclaw, the equivalent of a human thumb, plays important functions in both the mechanics of the front foot and in joint stability, and that ligaments and tendons connect it to surrounding tissues. Yet you also observe that some breeders routinely remove it. How can this horrible practice be changed? Do any vet groups take a position on this?
Both the AVMA and the American Animal Hospital Association discourage any surgery done for cosmetic reasons, but they only name ear-cropping and tail-docking. Unfortunately, I don’t think this has had much of an impact, as very few breeders belong to either organization. I cannot speak for every state’s practice act, but most (if not all) specify that surgery must be performed by a veterinarian. Every instance where a breeder chooses to perform surgery crosses that line, and they are breaking the law. I feel that the best way to address this issue is through kennel clubs, such as the AKC. If the AKC were to say, “No dog born after such-and-such date who has had cosmetic surgery, including dewclaw removal, ear-cropping or tail-docking, can be shown in AKC sanctioned shows,” the practice would grind to a halt.