Dog Pain and Behavior

Hi and welcome to my presentation on decoding discomfort in the dogs that we work with and what you need to know. My name is Gemma Hodson and I am the founder and owner of Dynamic Dog and I actually teach other trainers and behaviorists how to do what I do which is to detect potential pain and discomfort that could be adding to or a direct cause of a dog's problematic behaviours. So just to give you a bit of background as to what I do and how I got to where I've gotten to. I actually grew up in a house full of show dogs from the 1980s. We had 14 at one point, varying between Cocker Spaniels, Italian Spanoni, Welsh Springers. And we had a Basset Griffon at one point. My grandparents also had German Shepherds growing up, so I was heavily involved with those as well. But working or living in a family of show dogs, I actually grew up knowing what sound confirmation and movement was and how key it was to a dog's comfort. I didn't want to actually work with dogs when I was older. So as an early teen, I actually went off to Hartpury College here in the UK and gained a degree in equine science. And it wasn't until actually owning my first horse, a big Dutch warm blood mare by the name of Poe, that I became aware of how pain affected an animal's behaviour. And my horse was actually diagnosed with something called equine gastric ulcers. And she was in quite a bit of discomfort and we couldn't tell until we scoped her. But her behaviours were a big indicator of what was going on for her. I then had to give up my horses and I fell back into dogs to fill the void and my interest in pain-related behaviour actually grew whilst kind of working with dogs and I ended up going off to study behaviour with the ISCP. I've also gained a level two in Tellington T-Touch. But I wanted to know more, I wanted to go and take it at a deeper level, to understand one end of the dog from another so I could properly assess the dog that was in front of me. So I studied canine massage and rehabilitation, hydrotherapy and also veterinary physio. I then merged my specialties of behaviour and rehabilitation and developed a way of assessing dogs for potential discomfort. that may be a direct cause or adding to those problematic behaviours that the owners are experiencing. And for the last four years, I've been running a course called the Dynamic Dog Practitioner Programme that actually teaches other trainers and behaviourists those same techniques, those tried and tested techniques that I've developed, so that they can work with a vet to get better support for their client's dog. So just an overview of the presentation that I'm going to run through today. We're going to be looking at what pain is and how it manifests in the body. We're also going to look at some pain medications, some of the common types and what to expect. We're going to look at some behaviours that are associated with pain as well and what to look out for. We're going to touch briefly on vets and how to approach them, so how to talk to them. I'm going to run you through Dynamic Dog, the Dynamic Dog protocol and why you need this knowledge. before ending on a case study example of a foreign rescue named Peanut and what he went through and some of the behaviours that he was actually displaying and his owners were experiencing. So to understand pain's effect on a dog we need to know what pain is. So according to the International Association for the Study of Pain, pain is defined as an and I'm pleasant sensory and emotional experience associated with actual or potential tissue damage. Now in humans pain is not just a physical sensation, it is influenced by attitudes, beliefs, personality and social factors and can affect emotional and mental well-being and we can assume the same of our dogs. Pain is usually a protective mechanism and that normally alerts your brain when your body is being harmed in some way. The nerves in that area send signals through the spinal cord to the brain. The brain locates the injury and triggers the healing process. Pain signals may be triggered by physical injury or damage to the body, for example a sprain or damage that occurs as part of a longer term condition such as osteoarthritis. chemicals produced within the body itself that can irritate the nerve endings. This may be linked to an infection or an overuse injury or a flare-up of a long-term illness such as rheumatoid arthritis, or it can be damage to the nerves that causes them to fire off pain signals to the brain without any physical cause which sometimes happens in growing pains or complex pain. regional pain syndrome. When we have an injury or tissue damage caused by an illness the nerves in the affected part of the body become more sensitive than normal so pain signals are triggered more easily and warn us if there's any further threat to the painful area. Normally as the injury heals the nerves become less sensitive again and the pain signals lessen and then stop. When pain interferes with our daily activities, pain killing drugs may help by blocking or reducing pain signals to the brain, even though they don't affect the injury or damage directly. Pain isn't just a physical sensation, it can have emotional effects too, especially if the cause of the pain isn't clear or it's difficult to find effective pain relief. It heightens other system responses leaving pain pathways open on full throttle to and from the brain and our emotions or mood can in turn make the pain seem worse or better. If you've ever had pain for months or even years it's not surprising that it can begin to affect your mood and self-confidence. The perception of pain varies from person to person and therefore we can expect to see that. from dog to dog. One person might have a broken bone and not even realise it, while another might feel significant pain from that same injury. That's because pain is mediated by nerve fibres in the body and these nerve fibres have the job of sending pain signals to the brain, which happens incredibly quickly. Once they find their way to the brain, the brain acts to make you aware of pain. Because every person's body is different, their nerve fibres and their brain can react differently to the same stimuli. That helps explain why pain perception and pain tolerance can differ so much from one person to another or one animal to another. So what are the different types of pain? This is both a simple and a complicated answer. There are five common types of pain. and some pain can fit into more than one category, which is where the complication comes in. And animals, including us, can experience more than one type of pain at the same time, depending on what's going on for them. And I'm going to try and break those down for you now. Neuropathic pain is the result of a problem with the nerves themselves and is often caused by an injury or an operation. Any event that can cause an injury to the muscle or a bone has the potential to damage the nerves at the same time. Nerves can also be damaged or squeezed by tumours and scar tissue or irritated by infection. Neuropathic pain may last for months or years and can be difficult to treat. Some less obvious signs are that your pet may exhibit a painful reaction to a non-painful pressure such as touch. Peace. known as Allodynia. Your dog may feel a heightened sensitivity to pain which is known as Hyperalgesia. Your dog may pull back from you when you are giving them attention due to extra sensitivity to touch and sensation. Put simply, neuropathic pain occurs when the pain moves from the original source and the neural pathways become unusually sensitized. The pain then occurs with or without stimuli. Some causes could be a spinal tumour, injury to the spinal cord, injury to the peripheral nerves such as cauda equina syndrome, phantom pain resulting from a limb amputation or intervertebral disc herniation, hypothyroidism or diabetes. In humans, neuropathic pain sufferers have described the feeling as follows. There may be accompanying swelling with these. symptoms as well. There can be pain but no tissue damage with it. A lack of some sensations may be evident. The pain can come in sudden jolts and spasms and where there's allodynia, hyperalgesia and hyperpatia are present, the pain can be burning and stabbing and can tingle. So we should assume that this is the same for our dogs too. Somatic pain is the result of an injury or disease to part of the body such as the skin, muscle or bone, joints or connective tissue. When one of these tissues is damaged through force or trauma, pain sensors send pain messages to the brain and the spinal cord. The pain feels as if it is in one place and it is constant and often aches or throbs. Somatic pain is caused by inflammation, repetitive trauma, excessive activity. Visceral pain results when the internal organs such as stomach, kidneys, gallbladder, urinary bladder or intestines are damaged or injured. Visceral pain is vague, it is not localised and is usually dull or diffuse. There may be other symptoms associated with visceral pain such as fever, nausea and diarrhea. Visceral pain can occur from the following Injuries to internal organs such as the gallbladder, intestines, bladder or kidneys. Damage to the core muscles or abdominal wall. Spasms to the core muscles. Acid indigestion and other digestive problems such as constipation. Infections in the digestive system and renal system. Problems in specific organs such as pancreas or liver. Cancer that affects internal organs such as spleen cancer or indeed menstrual pain. There is also acute and chronic pain. Now acute pain is where this is an instantaneous pain that is usually the outcome of a physical trauma, for example a road traffic accident or a broken bone or inflammation or an infection. This is emergency pain and this emergency pain is trying to warn the sufferer that the body is being damaged in some way. Acute pain is short-lasting and usually manifest in ways that can be easily described and observed. It can be extremely uncomfortable and may limit a dog's mobility. Acute pain normally goes away with time and treatment. Causes of acute pain may include surgery, broken bones, dental issues, burns or cuts, labour or childbirth and after acute pain goes away you can go on with life as usual. However, depending on how acute pain is dealt with and how tissues heal, it may turn into something known as chronic pain. Chronic pain is defined as pain lasting more than three months. It is much more subjective and not easily described as acute pain is. Chronic pain, unlike acute pain, will not simply go away and continues even after healing has occurred. Ongoing pain does not generally have any benefits to a patient and in fact has many disadvantages. Many conditions produce chronic pain. These may include osteoarthritis or spinal disorders and some cancers. Chronic pain is often called maladaptive pain because it doesn't appear to have any sort of protective purpose. Arthritis is a good example of maladaptive pain because it is not a disease that can be cured. The injury and inflammation are always present. This leads to a constant bombardment of the brain with pain signals and without recognition and proper management the pain can take on a life of its own. Daniel Mills, FRCVS, a veterinary researcher and behaviourist at the University of Lincoln here in England. suggests that a large portion of behaviour problems are exacerbated or caused by physical pain and that resolution of that pain can mitigate or even resolve the behavioural issue. Almost 80% of the behaviour problems in his own practice, says Dr Mills, have a component of diagnosed or suspected pain. Dr Mills is passionate about raising awareness of the importance of recognising and treating pain in behaviour cases, so much so that he has collaborated with other researchers and behaviourists to publish a framework for thinking about these cases, along with cases case series of examples from his and others practices. Mills describes a number of cases sharing a recurring theme. The initial veterinary consult reports a physical exam, blood work and possibly even radiographs as being unremarkable. Yet a subsequent exam with a veterinarian considering pain as a possible cause turns up something suggestive, perhaps an awkward gait and an even weight distribution. suggesting the dog is shifting weight off one leg or the owner reveals under more pointed questioning that the dog has been reluctant to go for walks recently. Often an old injury that was thought to be resolved is mentioned. Further testing finds a likely cause of pain or sometimes not but either way a trial of analgesics results in return to normal behaviour for that dog. His framework divides pain-related behaviour cases into four different categories. The first being unwanted behaviour directly caused by pain. Then we have pain causing secondary behavioural issues in addition to existing ones. Then unwanted behaviour exacerbated by pain. And lastly, behaviours that may not be problematic to the owners or caregivers, but are actually signs of pain. Veterinarians are trained to recognise certain behaviour changes indicative of pain, such as decreases in normal activity, licking the affected area, obvious changes in gait, repeated shifting of weight while standing and the most obvious of all a flinch, a yelp or growling when the area is touched. Vets are less likely, however, to recognise some of the more unusual manifestations of pain, such as stargazing or compulsive disorders, which can be indicative of gastrointestinal issues, which may be related to musculoskeletal pain. In addition to more obvious GI links, hypersensitivity to heat or cold, increased clinginess, seeking of attention from the owner as well as behaviors more commonly considered problematic such as fear, anxiety, aggression, resource guarding or destruction of household items when left alone. In fact differences between presentations of aggression can point veterinarians to the suspicion of a pain component. In the cases described by Dr Mills and his colleagues Dogs with pain-based aggression are often described as jackal and hide-like with unexpected and sudden behaviour changes. Pain-based aggression appears to occur more commonly when dogs are approached by a person, particularly when they are lying down. These dogs are more likely to bite a limb than any other part of the body and their aggression is briefer and easier to interrupt. Behavioural changes caused by pain may be more subtle than outright aggression. Dogs performing at a high level in their work or sports may begin to show degraded performance that doesn't have a clear cause but resolves when pain is identified and assessed and addressed. While pain may certainly prevent a dog from reaching his full athletic potential, it can also have more psychological effects such as making learning more difficult. The dog may appear to be less able to absorb training. Imagine trying to listen to one of one of your favourite audio books whilst you have a splitting headache. Behaviour cases can be quite complex and full resolution is not always reached. The owner may feel that they have hit a wall and that progress has stopped. Relapses are common and frustrating. In some cases, those final steps may be elusive because of an unrecognised pain component. Initially, picking apart which behaviours are due to pain and which are due to other triggers may be nearly impossible. However, as someone wanted behaviours are resolved through treatment of behavioural diagnosis, while other behaviours begin to appear interactable. with the relevance of pain may be resolved. In one such case, a border collie with separation anxiety was destructive when left alone, digging through the carpet and door frames. While his anxiety appeared to improve with anti-anxiety medication and behavioural modification, his digging did not. Pain in a hind leg, redirected to nearly compulsive digging with the front legs, was resolved with medication and the digging stopped. In this case, the digging initially appeared to be part of the dog separation anxiety and as a result, difficulty in resolving the digging was initially assumed to indicate that the anxiety had not resolved. In fact, the two problems were actually separate. In more straightforward cases, pain does not actually cause unwanted behaviour but instead worsens existing behavioural problems. The relationship between pain and behaviour is bi-directional. Stress in the form of frustration, fear or anxiety can cause a negative outlook that increases the perception of pain, while pain can itself increase stress. In fact, tensing from anxiety can directly exacerbate musculoskeletal pain. Who hasn't snapped at a co-walker or their spouse when dealing with a headache or another type of chronic pain? These cases will often present with behaviour that appears out of proportion to its cause, and animals' responses may be excessively intense, or the dog may generalise more quickly and wildly than otherwise expected. For example, a noise-sensitive dog may be startled by a loud noise in one location and then rapidly generalise to avoiding a wide area, perhaps even miles around the original source, such over-generalization may provide a hint that there's more going on than simply a learned association with the original startle resulting in sound sensitivity. Impressive reduction of reactivity may be achieved in such cases with regular pain medication or other measures to reduce pain, like appropriate physiotherapy or hydrotherapy, even if the root of the anxiety remains. As we care for animals who cannot verbalise their inner states to us, it is incumbent of us to be alert to signs of pain even when those signs do not present a problem for us. Pay attention if your formerly keen dog decides to stop. It is easy for us to normalise behaviour that is in fact not healthy, such as laboured breathing of flat-faced dogs, repetitive scratching of the neck, which might suggest syringomyelia, head shaking indicative of an ear infection, or just an unusual sitting position in a dog who cannot hold his legs or back normally, perhaps secondary to obesity or spinal malformation or hip dysplasia. Vets may not be alert to these multi-factorial problems. Indeed Professor Mills confides that despite being an established veterinary behaviour expert and leading academic in the field, he still struggles to convince some vets, those in general practice and specialists in relevant disciplines like orthopaedics, about the significance of the issue, presented with a behavioural issue that may reach for a behavioural solution. While a veterinarian may consider pain given a normal physical exam and other testing. He may not pursue a trial of analgesics or even more conservative pain management measures. Addressing pain is often seen as an avenue of last resort, where nothing else resolves the primary problem. Mills argues that pain should be addressed first and not last. Moreover, if pain is a reasonable possibility but no cause is apparent on physical exam or testing, Mills typically recommends a trial course of analgesics. Many documented behavioral cases have shown significant improvements or even resolution when treated with pain medication. If the first analgesia trial does not provide results it is appropriate to trial another type of analgesic with a different mechanism of action in case the first was not right for that particular dog's issue. Mills argues that the risk of side effects can be minimized and that the benefit of using pain medication will normally outweigh the risks. But it is important that any trial is done under veterinary supervision as over-the-counter medications for humans can be quite toxic to dogs. There seems to be a lot of emphasis on behavioural changes in Mills' study, but please do not forget that some dogs suffer right from the start, right from puppyhood, and those dogs also need our help. We cannot just send the dog to the vet to say they need check-in for pain. There are hundreds of things that could be wrong with a dog and you would be effectively asking the vet to find a needle in the haystack without telling them what the needle actually looks like. They need some help to get to the bottom of things, to pinpoint the area in most cases. All evidence needs to be obtained away from the veterinary clinic environment in order to get accurate data. Owners need to be advised on what to expect from their vet consultation and what they can actually ask for. We cannot blame the vet as to why pain often goes undiagnosed. They have a hard job to do. They have to be multiple species experts and certainly here in the UK they only have a 10 to 15 minute window to assess and diagnose which is not always possible. They have a limited knowledge in behaviour and pain related behaviour and unless they specialise they have a limited knowledge in conformation, posture and gait. The dog will almost certainly be affected by the veterinary environment as will the owner who is also going to be worried about what the vet may find as well as perhaps a bit intimidated by all the veterinary jargon that's going on. So what can you do to get the best possible outcome for the dog? This is where the Dynamic Dog Protocol comes in. We offer a 90 minute deep dive consultation with the owner to find out exactly what life is like with the dog and this is often the owner's first experience of actually being allowed to talk and to be heard to be listened to we then go into evidence gathering so we take a lot of photos and videos of the dog doing a variety of things including ambulation and activities of daily living We also go through the veterinary history. We then analyse all of that evidence, all of that data, and we sift through it and we compile basically a pool of evidence that we can share with the vet. We also write a specific veterinary report which gives the vet the nitty-gritty. We only give the vet what's wrong with the dog, not what's right with the dog, and we supply evidence to back up our findings. We then do a client follow-up to explain in layman's terms what our findings are and to discuss the next steps and we empower the owner. So when empowering the owner you can explain what they should expect from the veterinary consultation with the weight of the report in their hand. Palpation as they try to provoke a pain response. can look pretty, pretty rough, pretty scary. But this needs to be explained to the owner. Vets should want to see the dog move for themselves and outside, if possible, away from the veterinary area. And the vet might actually want to do diagnostic imaging such as x-rays, CT or MRI. And they may wish to refer on to a specialist such as an orthopaedic or neurologist or a vet. physio for further analysis. As a minimum an analgesic trial should be requested to try and rule out pain. Non-steroidal anti-inflammatory drugs are often prescribed to dogs as an analgesic trial. These work on something called COX. COX is an enzyme that is responsible for the inflammatory response. But COX isn't all bad, it's actually even necessary for non-cellular processes. Non-steroidal anti-inflammatory drugs affect COX to reduce inflammation. While they do this often successfully, occasionally there can be some negative side effects from non-steroidal anti-inflammatory drugs due to the types of COX they target, but I won't get into that today. Some types of non-steroidal anti-inflammatory drugs include carprofen, also known as Carprox, Rimidil and Ryokrafa. These are good for bone pain. Most of you would have heard of meloxicom, also known as loxicom or meloxidil, or even metacam. This treats musculoskeletal disorders and helps with long-term effects of arthritis. Aspirin is another good one, very good for preventing blood clots post-operative. Fibrocoxiv is also known as Prevacox and is used a lot with osteoarthritis. We also have Robonococcib also known as Onzio, very good for fever, pain and inflammation of both soft tissue and bone pain. And then we have things like Gapiprant also known as Galoprant which is a relatively new drug and does not appear to inhibit COX so has a lot less side effects. So on to our case study. I will want you to meet Peanut. Now Peanut is a crossbreed and a foreign rescue. He was about four years old when I worked with him and the vet had already put his behaviour down to it just being behaviour and prescribed him with fluroxetine which had no effect. Some samples of his behaviours included he was becoming increasingly scared to leave the house for a walk. and he would refuse to move and would start shaking and would even hide under the bed as you can see in this photo here. He would often look up and gaze at the ceiling. He could be sensitive around other dogs and would hide behind his owner and when the night started to draw in he would hold onto his toilet for as long as possible and often would only go out once in 24 hours. These are some static photos of Peanut. And as we can see here, he has this abnormal posture. He has something known as kyphosis of his lower lumbar area, where he's actually roaching or arching his back. He has rotation of his pelvis, so he's starting to tuck his bottom in underneath him. And this actually causes his hind limbs to be tucked in underneath him as well. and we also see there's an element of him actually starting to weight shift forwards. Now on his picture from behind, Peanut is actually displaying something known as cow hocks, whereas hocks, which are these bits here, often turn inwards and his toes and his stifles turn outwards. Now ideally with dogs we'll actually want to see the toes and the stifles actually pointing exactly forwards without any deviation at the hop. either then pointing inwards or outwards. So with his movement analysis we had a look at his gait to see what he was doing and he was actually starting to pace so the limbs on the same side were moving in unison and we could also see he's very tense through his spine as well and he was continued to roach or arch his back which was known as kyphosis. So we could see that his gait was abnormal. And also when we looked at kind of activities of daily living, so we watched him go downstairs, we could see that he was also skipping and hopping as he was going down. So we had to get Peanut back to the vet. Now, Peanut had to be mildly sedated to get him there before being anaesthetised for a series of x-rays. This was arranged as part of vet liaison between myself, Dynamic Dog, and the First Opinion vet. And this is what he was diagnosed with. Poor Peanut had osteoarthritis in his hip socket. And he also had something known as spondylosis of the lumbar and caudal vertebrae, which was basically where his spine had started to fuse. So his vertebrae had started to fuse together. and that can be incredibly painful for the dog. So treatment was that he was placed on gabapentin which was for neuropathic pain and he was also on some joint supplements which was Riaflex which was teamed with Boswellia. The fluoxetine was stopped because the trial of that had no impact on him him whatsoever. And then Peanut went on to ongoing support. So he had a combination of physio and hydro. And these two are exceptionally good at pain relieving and they're also drug free. So it has a bit of a double whammy. Whilst he was on that, we could see some improvements to his behaviour. He actually became much happier about going outside. So it was then decided that he would have a CT or MRI scan in order to find out the extent of nerve impingement going on in his right side due to the spondylosis. and potentially if it was severe enough he would need surgery. to release it. But his support and his pain relief is ongoing. There will probably never be a time where Peanut will be without it because spondylosis is actually a progressive disease and he will need ongoing support and treatment for the rest of his life. But it means that Peanut is now more comfortable and as a result his behaviour has lessened significantly. So thank you all very much for watching my presentation and if you have any questions do get in touch.

I actually grew up in a house full of show dogs from the 1980s. We had 14 at one point, varying between Cocker Spaniels, Italian Spanoni, Welsh Springers. And we had a Basset Griffon at one point.

My grandparents also had German Shepherds growing up, so I was heavily involved with those as well. But working or living in a family of show dogs, I actually grew up knowing what sound confirmation and movement was and how key it was to a dog's comfort. I didn't want to actually work with dogs when I was older. So as an early teen, I actually went off to Hartpury College here in the UK and gained a degree in equine science. And it wasn't until actually owning my first horse, a big Dutch warm blood mare by the name of Poe, that I became aware of how pain affected an animal's behaviour.

And my horse was actually diagnosed with something called equine gastric ulcers. And she was in quite a bit of discomfort and we couldn't tell until we scoped her. But her behaviours were a big indicator of what was going on for her. I then had to give up my horses and I fell back into dogs to fill the void and my interest in pain-related behaviour actually grew whilst kind of working with dogs and I ended up going off to study behaviour with the ISCP.

I've also gained a level two in Tellington T-Touch. But I wanted to know more, I wanted to go and take it at a deeper level, to understand one end of the dog from another so I could properly assess the dog that was in front of me. So I studied canine massage and rehabilitation, hydrotherapy and also veterinary physio. I then merged my specialties of behaviour and rehabilitation and developed a way of assessing dogs for potential discomfort. that may be a direct cause or adding to those problematic behaviours that the owners are experiencing.

And for the last four years, I've been running a course called the Dynamic Dog Practitioner Programme that actually teaches other trainers and behaviourists those same techniques, those tried and tested techniques that I've developed, so that they can work with a vet to get better support for their client's dog. So just an overview of the presentation that I'm going to run through today. We're going to be looking at what pain is and how it manifests in the body. We're also going to look at some pain medications, some of the common types and what to expect.

We're going to look at some behaviours that are associated with pain as well and what to look out for. We're going to touch briefly on vets and how to approach them, so how to talk to them. I'm going to run you through Dynamic Dog, the Dynamic Dog protocol and why you need this knowledge.

before ending on a case study example of a foreign rescue named Peanut and what he went through and some of the behaviours that he was actually displaying and his owners were experiencing. So to understand pain's effect on a dog we need to know what pain is. So according to the International Association for the Study of Pain, pain is defined as an and I'm pleasant sensory and emotional experience associated with actual or potential tissue damage. Now in humans pain is not just a physical sensation, it is influenced by attitudes, beliefs, personality and social factors and can affect emotional and mental well-being and we can assume the same of our dogs.

Pain is usually a protective mechanism and that normally alerts your brain when your body is being harmed in some way. The nerves in that area send signals through the spinal cord to the brain. The brain locates the injury and triggers the healing process.

Pain signals may be triggered by physical injury or damage to the body, for example a sprain or damage that occurs as part of a longer term condition such as osteoarthritis. chemicals produced within the body itself that can irritate the nerve endings. This may be linked to an infection or an overuse injury or a flare-up of a long-term illness such as rheumatoid arthritis, or it can be damage to the nerves that causes them to fire off pain signals to the brain without any physical cause which sometimes happens in growing pains or complex pain. regional pain syndrome. When we have an injury or tissue damage caused by an illness the nerves in the affected part of the body become more sensitive than normal so pain signals are triggered more easily and warn us if there's any further threat to the painful area.

Normally as the injury heals the nerves become less sensitive again and the pain signals lessen and then stop. When pain interferes with our daily activities, pain killing drugs may help by blocking or reducing pain signals to the brain, even though they don't affect the injury or damage directly. Pain isn't just a physical sensation, it can have emotional effects too, especially if the cause of the pain isn't clear or it's difficult to find effective pain relief. It heightens other system responses leaving pain pathways open on full throttle to and from the brain and our emotions or mood can in turn make the pain seem worse or better.

If you've ever had pain for months or even years it's not surprising that it can begin to affect your mood and self-confidence. The perception of pain varies from person to person and therefore we can expect to see that. from dog to dog.

One person might have a broken bone and not even realise it, while another might feel significant pain from that same injury. That's because pain is mediated by nerve fibres in the body and these nerve fibres have the job of sending pain signals to the brain, which happens incredibly quickly. Once they find their way to the brain, the brain acts to make you aware of pain. Because every person's body is different, their nerve fibres and their brain can react differently to the same stimuli.

That helps explain why pain perception and pain tolerance can differ so much from one person to another or one animal to another. So what are the different types of pain? This is both a simple and a complicated answer.

There are five common types of pain. and some pain can fit into more than one category, which is where the complication comes in. And animals, including us, can experience more than one type of pain at the same time, depending on what's going on for them. And I'm going to try and break those down for you now.

Neuropathic pain is the result of a problem with the nerves themselves and is often caused by an injury or an operation. Any event that can cause an injury to the muscle or a bone has the potential to damage the nerves at the same time. Nerves can also be damaged or squeezed by tumours and scar tissue or irritated by infection.

Neuropathic pain may last for months or years and can be difficult to treat. Some less obvious signs are that your pet may exhibit a painful reaction to a non-painful pressure such as touch. Peace. known as Allodynia.

Your dog may feel a heightened sensitivity to pain which is known as Hyperalgesia. Your dog may pull back from you when you are giving them attention due to extra sensitivity to touch and sensation. Put simply, neuropathic pain occurs when the pain moves from the original source and the neural pathways become unusually sensitized. The pain then occurs with or without stimuli. Some causes could be a spinal tumour, injury to the spinal cord, injury to the peripheral nerves such as cauda equina syndrome, phantom pain resulting from a limb amputation or intervertebral disc herniation, hypothyroidism or diabetes.

In humans, neuropathic pain sufferers have described the feeling as follows. There may be accompanying swelling with these. symptoms as well. There can be pain but no tissue damage with it. A lack of some sensations may be evident.

The pain can come in sudden jolts and spasms and where there's allodynia, hyperalgesia and hyperpatia are present, the pain can be burning and stabbing and can tingle. So we should assume that this is the same for our dogs too. Somatic pain is the result of an injury or disease to part of the body such as the skin, muscle or bone, joints or connective tissue. When one of these tissues is damaged through force or trauma, pain sensors send pain messages to the brain and the spinal cord.

The pain feels as if it is in one place and it is constant and often aches or throbs. Somatic pain is caused by inflammation, repetitive trauma, excessive activity. Visceral pain results when the internal organs such as stomach, kidneys, gallbladder, urinary bladder or intestines are damaged or injured. Visceral pain is vague, it is not localised and is usually dull or diffuse.

There may be other symptoms associated with visceral pain such as fever, nausea and diarrhea. Visceral pain can occur from the following Injuries to internal organs such as the gallbladder, intestines, bladder or kidneys. Damage to the core muscles or abdominal wall.

Spasms to the core muscles. Acid indigestion and other digestive problems such as constipation. Infections in the digestive system and renal system. Problems in specific organs such as pancreas or liver.

Cancer that affects internal organs such as spleen cancer or indeed menstrual pain. There is also acute and chronic pain. Now acute pain is where this is an instantaneous pain that is usually the outcome of a physical trauma, for example a road traffic accident or a broken bone or inflammation or an infection.

This is emergency pain and this emergency pain is trying to warn the sufferer that the body is being damaged in some way. Acute pain is short-lasting and usually manifest in ways that can be easily described and observed. It can be extremely uncomfortable and may limit a dog's mobility.

Acute pain normally goes away with time and treatment. Causes of acute pain may include surgery, broken bones, dental issues, burns or cuts, labour or childbirth and after acute pain goes away you can go on with life as usual. However, depending on how acute pain is dealt with and how tissues heal, it may turn into something known as chronic pain.

Chronic pain is defined as pain lasting more than three months. It is much more subjective and not easily described as acute pain is. Chronic pain, unlike acute pain, will not simply go away and continues even after healing has occurred. Ongoing pain does not generally have any benefits to a patient and in fact has many disadvantages. Many conditions produce chronic pain.

These may include osteoarthritis or spinal disorders and some cancers. Chronic pain is often called maladaptive pain because it doesn't appear to have any sort of protective purpose. Arthritis is a good example of maladaptive pain because it is not a disease that can be cured. The injury and inflammation are always present. This leads to a constant bombardment of the brain with pain signals and without recognition and proper management the pain can take on a life of its own.

Daniel Mills, FRCVS, a veterinary researcher and behaviourist at the University of Lincoln here in England. suggests that a large portion of behaviour problems are exacerbated or caused by physical pain and that resolution of that pain can mitigate or even resolve the behavioural issue. Almost 80% of the behaviour problems in his own practice, says Dr Mills, have a component of diagnosed or suspected pain.

Dr Mills is passionate about raising awareness of the importance of recognising and treating pain in behaviour cases, so much so that he has collaborated with other researchers and behaviourists to publish a framework for thinking about these cases, along with cases case series of examples from his and others practices. Mills describes a number of cases sharing a recurring theme. The initial veterinary consult reports a physical exam, blood work and possibly even radiographs as being unremarkable.

Yet a subsequent exam with a veterinarian considering pain as a possible cause turns up something suggestive, perhaps an awkward gait and an even weight distribution. suggesting the dog is shifting weight off one leg or the owner reveals under more pointed questioning that the dog has been reluctant to go for walks recently. Often an old injury that was thought to be resolved is mentioned. Further testing finds a likely cause of pain or sometimes not but either way a trial of analgesics results in return to normal behaviour for that dog. His framework divides pain-related behaviour cases into four different categories.

The first being unwanted behaviour directly caused by pain. Then we have pain causing secondary behavioural issues in addition to existing ones. Then unwanted behaviour exacerbated by pain. And lastly, behaviours that may not be problematic to the owners or caregivers, but are actually signs of pain.

Veterinarians are trained to recognise certain behaviour changes indicative of pain, such as decreases in normal activity, licking the affected area, obvious changes in gait, repeated shifting of weight while standing and the most obvious of all a flinch, a yelp or growling when the area is touched. Vets are less likely, however, to recognise some of the more unusual manifestations of pain, such as stargazing or compulsive disorders, which can be indicative of gastrointestinal issues, which may be related to musculoskeletal pain. In addition to more obvious GI links, hypersensitivity to heat or cold, increased clinginess, seeking of attention from the owner as well as behaviors more commonly considered problematic such as fear, anxiety, aggression, resource guarding or destruction of household items when left alone. In fact differences between presentations of aggression can point veterinarians to the suspicion of a pain component. In the cases described by Dr Mills and his colleagues Dogs with pain-based aggression are often described as jackal and hide-like with unexpected and sudden behaviour changes.

Pain-based aggression appears to occur more commonly when dogs are approached by a person, particularly when they are lying down. These dogs are more likely to bite a limb than any other part of the body and their aggression is briefer and easier to interrupt. Behavioural changes caused by pain may be more subtle than outright aggression.

Dogs performing at a high level in their work or sports may begin to show degraded performance that doesn't have a clear cause but resolves when pain is identified and assessed and addressed. While pain may certainly prevent a dog from reaching his full athletic potential, it can also have more psychological effects such as making learning more difficult. The dog may appear to be less able to absorb training.

Imagine trying to listen to one of one of your favourite audio books whilst you have a splitting headache. Behaviour cases can be quite complex and full resolution is not always reached. The owner may feel that they have hit a wall and that progress has stopped.

Relapses are common and frustrating. In some cases, those final steps may be elusive because of an unrecognised pain component. Initially, picking apart which behaviours are due to pain and which are due to other triggers may be nearly impossible. However, as someone wanted behaviours are resolved through treatment of behavioural diagnosis, while other behaviours begin to appear interactable. with the relevance of pain may be resolved.

In one such case, a border collie with separation anxiety was destructive when left alone, digging through the carpet and door frames. While his anxiety appeared to improve with anti-anxiety medication and behavioural modification, his digging did not. Pain in a hind leg, redirected to nearly compulsive digging with the front legs, was resolved with medication and the digging stopped. In this case, the digging initially appeared to be part of the dog separation anxiety and as a result, difficulty in resolving the digging was initially assumed to indicate that the anxiety had not resolved. In fact, the two problems were actually separate.

In more straightforward cases, pain does not actually cause unwanted behaviour but instead worsens existing behavioural problems. The relationship between pain and behaviour is bi-directional. Stress in the form of frustration, fear or anxiety can cause a negative outlook that increases the perception of pain, while pain can itself increase stress. In fact, tensing from anxiety can directly exacerbate musculoskeletal pain.

Who hasn't snapped at a co-walker or their spouse when dealing with a headache or another type of chronic pain? These cases will often present with behaviour that appears out of proportion to its cause, and animals' responses may be excessively intense, or the dog may generalise more quickly and wildly than otherwise expected. For example, a noise-sensitive dog may be startled by a loud noise in one location and then rapidly generalise to avoiding a wide area, perhaps even miles around the original source, such over-generalization may provide a hint that there's more going on than simply a learned association with the original startle resulting in sound sensitivity.

Impressive reduction of reactivity may be achieved in such cases with regular pain medication or other measures to reduce pain, like appropriate physiotherapy or hydrotherapy, even if the root of the anxiety remains. As we care for animals who cannot verbalise their inner states to us, it is incumbent of us to be alert to signs of pain even when those signs do not present a problem for us. Pay attention if your formerly keen dog decides to stop. It is easy for us to normalise behaviour that is in fact not healthy, such as laboured breathing of flat-faced dogs, repetitive scratching of the neck, which might suggest syringomyelia, head shaking indicative of an ear infection, or just an unusual sitting position in a dog who cannot hold his legs or back normally, perhaps secondary to obesity or spinal malformation or hip dysplasia.

Vets may not be alert to these multi-factorial problems. Indeed Professor Mills confides that despite being an established veterinary behaviour expert and leading academic in the field, he still struggles to convince some vets, those in general practice and specialists in relevant disciplines like orthopaedics, about the significance of the issue, presented with a behavioural issue that may reach for a behavioural solution. While a veterinarian may consider pain given a normal physical exam and other testing. He may not pursue a trial of analgesics or even more conservative pain management measures.

Addressing pain is often seen as an avenue of last resort, where nothing else resolves the primary problem. Mills argues that pain should be addressed first and not last. Moreover, if pain is a reasonable possibility but no cause is apparent on physical exam or testing, Mills typically recommends a trial course of analgesics. Many documented behavioral cases have shown significant improvements or even resolution when treated with pain medication.

If the first analgesia trial does not provide results it is appropriate to trial another type of analgesic with a different mechanism of action in case the first was not right for that particular dog's issue. Mills argues that the risk of side effects can be minimized and that the benefit of using pain medication will normally outweigh the risks. But it is important that any trial is done under veterinary supervision as over-the-counter medications for humans can be quite toxic to dogs.

There seems to be a lot of emphasis on behavioural changes in Mills' study, but please do not forget that some dogs suffer right from the start, right from puppyhood, and those dogs also need our help. We cannot just send the dog to the vet to say they need check-in for pain. There are hundreds of things that could be wrong with a dog and you would be effectively asking the vet to find a needle in the haystack without telling them what the needle actually looks like. They need some help to get to the bottom of things, to pinpoint the area in most cases. All evidence needs to be obtained away from the veterinary clinic environment in order to get accurate data.

Owners need to be advised on what to expect from their vet consultation and what they can actually ask for. We cannot blame the vet as to why pain often goes undiagnosed. They have a hard job to do. They have to be multiple species experts and certainly here in the UK they only have a 10 to 15 minute window to assess and diagnose which is not always possible. They have a limited knowledge in behaviour and pain related behaviour and unless they specialise they have a limited knowledge in conformation, posture and gait.

The dog will almost certainly be affected by the veterinary environment as will the owner who is also going to be worried about what the vet may find as well as perhaps a bit intimidated by all the veterinary jargon that's going on. So what can you do to get the best possible outcome for the dog? This is where the Dynamic Dog Protocol comes in.

We offer a 90 minute deep dive consultation with the owner to find out exactly what life is like with the dog and this is often the owner's first experience of actually being allowed to talk and to be heard to be listened to we then go into evidence gathering so we take a lot of photos and videos of the dog doing a variety of things including ambulation and activities of daily living We also go through the veterinary history. We then analyse all of that evidence, all of that data, and we sift through it and we compile basically a pool of evidence that we can share with the vet. We also write a specific veterinary report which gives the vet the nitty-gritty. We only give the vet what's wrong with the dog, not what's right with the dog, and we supply evidence to back up our findings. We then do a client follow-up to explain in layman's terms what our findings are and to discuss the next steps and we empower the owner.

So when empowering the owner you can explain what they should expect from the veterinary consultation with the weight of the report in their hand. Palpation as they try to provoke a pain response. can look pretty, pretty rough, pretty scary.

But this needs to be explained to the owner. Vets should want to see the dog move for themselves and outside, if possible, away from the veterinary area. And the vet might actually want to do diagnostic imaging such as x-rays, CT or MRI. And they may wish to refer on to a specialist such as an orthopaedic or neurologist or a vet. physio for further analysis.

As a minimum an analgesic trial should be requested to try and rule out pain. Non-steroidal anti-inflammatory drugs are often prescribed to dogs as an analgesic trial. These work on something called COX. COX is an enzyme that is responsible for the inflammatory response. But COX isn't all bad, it's actually even necessary for non-cellular processes.

Non-steroidal anti-inflammatory drugs affect COX to reduce inflammation. While they do this often successfully, occasionally there can be some negative side effects from non-steroidal anti-inflammatory drugs due to the types of COX they target, but I won't get into that today. Some types of non-steroidal anti-inflammatory drugs include carprofen, also known as Carprox, Rimidil and Ryokrafa. These are good for bone pain. Most of you would have heard of meloxicom, also known as loxicom or meloxidil, or even metacam.

This treats musculoskeletal disorders and helps with long-term effects of arthritis. Aspirin is another good one, very good for preventing blood clots post-operative. Fibrocoxiv is also known as Prevacox and is used a lot with osteoarthritis. We also have Robonococcib also known as Onzio, very good for fever, pain and inflammation of both soft tissue and bone pain. And then we have things like Gapiprant also known as Galoprant which is a relatively new drug and does not appear to inhibit COX so has a lot less side effects.

So on to our case study. I will want you to meet Peanut. Now Peanut is a crossbreed and a foreign rescue. He was about four years old when I worked with him and the vet had already put his behaviour down to it just being behaviour and prescribed him with fluroxetine which had no effect. Some samples of his behaviours included he was becoming increasingly scared to leave the house for a walk.

and he would refuse to move and would start shaking and would even hide under the bed as you can see in this photo here. He would often look up and gaze at the ceiling. He could be sensitive around other dogs and would hide behind his owner and when the night started to draw in he would hold onto his toilet for as long as possible and often would only go out once in 24 hours. These are some static photos of Peanut. And as we can see here, he has this abnormal posture.

He has something known as kyphosis of his lower lumbar area, where he's actually roaching or arching his back. He has rotation of his pelvis, so he's starting to tuck his bottom in underneath him. And this actually causes his hind limbs to be tucked in underneath him as well. and we also see there's an element of him actually starting to weight shift forwards.

Now on his picture from behind, Peanut is actually displaying something known as cow hocks, whereas hocks, which are these bits here, often turn inwards and his toes and his stifles turn outwards. Now ideally with dogs we'll actually want to see the toes and the stifles actually pointing exactly forwards without any deviation at the hop. either then pointing inwards or outwards.

So with his movement analysis we had a look at his gait to see what he was doing and he was actually starting to pace so the limbs on the same side were moving in unison and we could also see he's very tense through his spine as well and he was continued to roach or arch his back which was known as kyphosis. So we could see that his gait was abnormal. And also when we looked at kind of activities of daily living, so we watched him go downstairs, we could see that he was also skipping and hopping as he was going down.

So we had to get Peanut back to the vet. Now, Peanut had to be mildly sedated to get him there before being anaesthetised for a series of x-rays. This was arranged as part of vet liaison between myself, Dynamic Dog, and the First Opinion vet. And this is what he was diagnosed with. Poor Peanut had osteoarthritis in his hip socket.

And he also had something known as spondylosis of the lumbar and caudal vertebrae, which was basically where his spine had started to fuse. So his vertebrae had started to fuse together. and that can be incredibly painful for the dog. So treatment was that he was placed on gabapentin which was for neuropathic pain and he was also on some joint supplements which was Riaflex which was teamed with Boswellia.

The fluoxetine was stopped because the trial of that had no impact on him him whatsoever. And then Peanut went on to ongoing support. So he had a combination of physio and hydro. And these two are exceptionally good at pain relieving and they're also drug free.

So it has a bit of a double whammy. Whilst he was on that, we could see some improvements to his behaviour. He actually became much happier about going outside. So it was then decided that he would have a CT or MRI scan in order to find out the extent of nerve impingement going on in his right side due to the spondylosis. and potentially if it was severe enough he would need surgery.

to release it. But his support and his pain relief is ongoing. There will probably never be a time where Peanut will be without it because spondylosis is actually a progressive disease and he will need ongoing support and treatment for the rest of his life. But it means that Peanut is now more comfortable and as a result his behaviour has lessened significantly. So thank you all very much for watching my presentation and if you have any questions do get in touch.

Transcript for:Dog Pain and Behavior

Transcript for:
Dog Pain and Behavior