owner identification of pain
TOD SAYS...
Osteoarthritis affects at least 1 in 5 dogs, and its prevalence increases as dogs age; it is therefore very likely your dog has or will get osteoarthritis.
identifying & monitoring the signs of pain
It is speculated that arthritis affects at least 1 in 5 of all dogs. However, this figure is from a telephone survey of vets in North America in 1996. Many experts believe it is a lot higher than this. Its prevalence increases with age with 50% of dogs affected diagnosed between 8 and 13 years of age. At least 80% of dogs over the age of 8 years old suffer from arthritis, therefore it is likely that your dog will develop arthritis in one or more joints at some stage in their life.
Dogs are incredible at ‘coping’ with discomfort. Some suggest it is due to them wishing to mask their pain and avoid appearing vulnerable. Others suggest the only option is ‘to cope’ when you do not understand there is an alternative. And some feel they demonstrate tolerance to musculoskeletal pain due to the insidious chronic nature of its development and through the ability to shift weight away from the pain into other regions of the body.
Whatever the reason, dogs often have significant disease even before it is suspected as detecting it can be very difficult.
Pain is typically classed as either being acute or chronic. This is an important distinction as while acute pain serves a useful biological purpose, chronic pain does not.
Pain has evolved to protect our bodies from harm. Acute pain in particular is an adaptive response to an injury that makes the individual experiencing the sensation of pain take action to protect them from re-injury and help the tissues heal. For example, acute pain will make you move your hand away from a hot pan to prevent a more severe burn or will make you avoid using a sprained wrist so the ligaments can heal more quickly.
Acute pain usually only lasts as long as the injury itself.
Animals with arthritis are usually suffering from chronic pain, though they can have episodes of acute pain if they experience a sudden trauma or injury to an area.
Chronic pain outlasts the initial trigger for the pain and goes on for months or even years, no longer protecting the body from imminent danger.
The effects of chronic pain go beyond the sensation of pain itself. It’s often associated with prolonged inflammation which can actually stop tissues healing. It can have a serious effect on mental state - many people who suffer from chronic pain will also suffer with depression and anxiety.
We do not fully understand what chronic pain develops. Usually following injury, the pain systems will adapt over time to become less responsive to signals from the injured tissues and the pain goes away. However, in chronic pain this doesn’t happen and instead the signals become amplified.
Arthritis will present differently in every dog. The signs can vary from an obvious limp to simply walking slower, or being stiff when they first get up after resting.
Diagnosing arthritis initially relies on recognising changes in behaviour, posture and mobility.
Identification 1st Monitoring 2nd
Having identified that your dog may be showing signs of chronic pain and clearly recorded them on the CAM Suspicion of Chronic Pain document. After presenting your thoughts and observations to your vet and obtaining a diagnosis of arthritis, the need to continue being able observers is essential to make sure the interventions that are chosen work. No intervention comes with a promise that it will work or that it will suffice. The owner must continue to observe and monitor to ensure treatment goals of improved pain state and increased capability are reached and maintained.
There are many ways this can be achieved, and what works for one owner may seem impossible for another. We will list a few options below.
Questionnaires are brilliant for organising your thoughts and observations. Prompting you to consider actions and behaviours that you may have overlooked as normal ageing.
They are best used to track progress, and guide treatment plans. Being freely accessible, they can be downloaded and used repeatedly. Best practice is to not look at what was written at the previous assessment prior to completion to ensure it doesn't bias your current observations.
Most veterinarians are aware of the questionnaires and work with you to interpret your observations.
- Canine Brief Pain Inventory
- Liverpool Osteoarthritis in Dogs Study
- Helsinki Chronic Pain Index
Another tool that your practice may subscribe to is the Vetmetrica online Health related Quality of Life tool. This is a very useful digital tool which looks at your dog’s overall well-being. It will email you when it needs to be completed, and prevents you reading your previous responses so minimises bias.
A very simple way to monitor your dog’s condition which can be tailored to each dog is via Client Specific Outcome Measures. This requires the owner to identify 3-5 signs of pain and discomfort and re-evaluate them frequently. The observations chosen to monitor should be able to demonstrate changing pain.
For example: a dog that has chosen to separate themselves from the family due to pain when on improved pain control will become more sociable is a good marker. Whereas a dog that can’t jump in the back of the car is not a good marker as this is not likely to change rapidly as the dog’s capability is also dependent on the physical capability which is likely diminished. Plus we encourage owners to stop their dog performing activities that can lead to further injury such as impact landings.
Recording videos of your dog moving using your smartphone and reviewing changes in the movement and capability can be a very effective way to follow improvement and deterioration. CAM has created a guidance sheet to help you take excellent videos which you can share with your vet and therapist.
There are many other tools that are used to monitor improvement and deterioration, but not all practices or therapists offer them.
- Force plate analysis will measure details of how your dog walks, as well as gait analysis walkways.
- Gulick tape measures can be used to measure muscle mass which should increase or be maintained as the dog uses their limbs more appropriately.
- Goniometers are used to measure the range of motion of the joint and are a good way for monitoring reduction in flexion and extension which is part of this progressive disease.
- Algometers can measure the amount of pressure that can be placed on part of the body before signs of pain/ discomfort are exhibited which tend to decrease with escalating pain states.
Working with your vet and their clinical examination skills as well as some of the tools mentioned is an excellent way to ensure your dog is responding to the interventions chosen.