Is My Pet In Pain?: How to Recognize and Treat Pain in Your Beloved Pet
We’ve all experienced pain, but what do we really know about it in our pets? Pain is an unpleasant sensory and emotional experience, designed to prevent you from getting injured. For example, feeling heat on a stove allows you to pull your hand away before you get burned deeply, or feeling the sharp pain of stepping on a rock allows you to stop bearing weight on the leg before you cut your foot. Pain is a signal transmitted to the brain, where it is then processed.
It is essential to know that pets of any age or size can experience pain, and no two pets experience it the same way. For example, arthritis is thought to be a disease of old pets, but research shows that approximately 20% of dogs over the age of 1 year old and 35% of young cats have arthritis and associated pain.
Pets are excellent at hiding pain—it is a survival instinct to try and minimize outward signs. Cats are especially difficult to detect pain in. That's why we say, “you know your pet best.” Some signs are tricky to notice because they can be subtle, gradual, or sometimes mistaken for aging, anxiety, laziness, or even behavioral quirks. Although they can’t speak, our pets communicate their discomfort with us in many subtle ways.
Subtle Signs of Pain:
Mild behavioral changes: A dog that becomes less playful, or a cat that’s "just sleeping more" could actually be in pain.
Stiffness: Especially in older pets, owners might think stiffness is “just getting old,” when it’s often chronic pain caused by arthritis.
Changes in appetite: Skipping meals might be blamed on pickiness, but pain can make eating or getting to food uncomfortable.
Changes to grooming: An unkempt haircoat can be a sign of discomfort, often mistaken for the cat being "lazy" or "dirty" for undergrooming. Or overgrooming until hair is shortened, or fully removed (bald).
Subtle posture changes: Slight shifts in how your pet stands, sits, or lies down, such as kicking their legs out to the side instead of putting them squarely underneath them, may be a red flag.
Panting or heavy breathing in dogs: This can be mistaken for overheating or anxiety, but it can indicate pain. In cats, this is always a cause for immediate concern.
Hiding or withdrawing: What seems like "being shy" could really be a sign that they are hurting, especially when the behavior is new.
Changes in sleep habits: More sleep or rest could be an attempt to cope with pain.
Specific Signs of Pain
Signs of Pain in Cats:
Hiding more than usual
Decreased grooming (appearing scruffy or dirty)
Overgrooming painful or general areas (resulting in patches of thin, short, or absent hair)
Hesitation or inability to jump to usual places
Limping or stiffness, especially after resting
Changes in litter box habits (reluctance to step into the box, eliminating outside of the box or in other areas of the home, urine or fecal retention)
Decreased appetite
Purring often or when not obviously happy (cats can purr as a way to self-soothe when in pain)
Flattened ears, narrowed eyes, and a hunched body posture (see more on the Feline Grimace Scale below)
Increased irritability or aggression to other pets or people in the household
Decreased activity, movement, or play
Signs of Pain in Dogs:
Limping or favoring a limb
Reluctance to move, run, jump, or climb stairs
Whimpering, whining, or yelping
Moving away, sitting, twitching, growling, or snapping when touched
Restlessness (unable to get comfortable)
Panting excessively even when not hot
Changes in posture (arched back, lowered head)
Changes in gait
Decreased appetite
Licking, biting, or chewing at a specific body part
Behavioral changes like becoming withdrawn, anxious, overly clingy, or unusually aggressive to other pets or people in the household
Understanding Pain Types
Pain can be categorized in several ways, based on its purpose, duration, and how it works.
Pain can then be divided into two categories based on the duration of its presence:
Acute Pain: Pain that lasts for a short period of time, usually subsiding after the inflammatory and healing processes that are causing the pain are completed. It is defined as pain that exists during the expected time of inflammation and healing after injury (up to three3 months).
Chronic Pain: Pain that exists beyond the expected duration associated with acute pain, often defined as pain lasting more than three months.
Pain is broadly divided into two categories based on the purpose it serves:
Adaptive Pain: Serves the protective purpose of guarding the body from harm and allowing it to heal from injury. (Example: not putting as much weight on an injured leg.)
Maladaptive Pain: Occurs from sensitization over time and serves no purpose. This pain can be present with or without an obvious cause. (Example: abdominal cramping from IBS, generalized pain from fibromyalgia, chronic nerve pain).
Adaptive pain can be further described by its how it works and what causes it:
Nociceptive Pain: Short-lived pain that results from noxious stimuli, or something physically harmful or unpleasant. This includes cuts, burns, bruises, broken bones, and surgical pain.
Within nociceptive pain, there are subtypes related to cancer: somatic and visceral pain. Somatic pain is caused by cancer cells causing direct injury to tissues and visceral pain is caused by changes to internal organs, often diffuse and compressing, like a squeeze.
Inflammatory Pain: Spontaneous pain that occurs in response to tissue inflammation or injury.
Neuropathic Pain: Directly related to pain of nerve roots or nerve endings, or the spinal cord, often described by people as feelings of burning, shooting, pins/needles, or numbness.
Diagnosis and Customized Treatment
Although there is no specific test for pain, it can be diagnosed or suspected based on your pet’s history, examination, diagnostics, behavioral assessment, and response to intervention.
Since every pet is different—from their preferences to their experience of discomfort— they each deserve a care plan that is customized to their needs.
When pain is complex and often progressive, our approach should be multimodal. This means we use multiple approaches that have different mechanisms of action—or ways in which we treat the pain. Using multiple medications allows us to manage different aspects of pain and coming at a source of pain from a few directions may provide greater relief. This can also include non-pharmaceutical pain relief including physical therapy, movement, laser therapy, and acupuncture.
If pain is suspected and not obvious on diagnostics or testing is unable to be pursued, response to treatment can be a test in itself. A pain trial is often prescribed as 6–8 weeks of medication while monitoring to see if the symptoms respond to treatment.
Pain management involves three steps: suspicion or diagnosis of the presence of pain, treatment of the pain, and monitoring for a response to treatment.
Treatment Options
Pharmaceuticals: Drugs with peer-reviewed research are the best treatment option we have for pain in our pets—and often multiple can be used together to target pain.These may include:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Medications for nerve pain
Muscle relaxants
Opioids
Monoclonal antibody therapies
Non-Medication Therapies: Other options can be added to, or sometimes instead of, medications that can help with pain:
Physical and hydrotherapies
Movement and stretching
Massage
Thermal therapy (hot or cold)
Pulse electromagnetic field (pEMF) therapy
The key to effective pain management is early and proactive intervention. The earlier we can catch pain, the better we can relieve it. Preventing the occurrence of maladaptive pain should be our goal. This allows us to maintain their quality of life while promoting longevity.
Monitoring for a Response to Treatment
We use objective measures like pain scales or customized scales to monitor our pet’s response to the treatment options we’ve chosen. It can be helpful to start one treatment at a time, staggering their start so we can measure impact and potential side effects. And remember, if the first option doesn’t work for your pet, continue to seek options to keep your pet comfortable.
Some ways to monitor include:
Client Specific Outcome Measures (CSOM): Adapted from human medicine, this personalized tool has guardians choose 3–5 specific activities to monitor that affect their pet’s mobility.
For example, hesitation to use the stairs, getting into the car, and running in the park could be used for a dog, and jumping on the bed, playing with a toy, and laying on their back could be used for a cat.
Canine Brief Pain Inventory: Developed by PennVet, this 11-question survey is completed by the guardian about the last 7 days of their dog's comfort. The answers are given in a 1–10 format, providing a quantitative (numerically measured) comparison when repeated.
Feline Musculosketel Pain Index (FMPI): Developed by NC State University’s College of Veterinary Medicine, the FMPI is the only clinically validated instrument for diagnosing and monitoring feline chronic pain arising from degenerative joint disorders.
Feline Grimace Scale: Used for acute pain assessment in cats by observing the position of the ears, eyes, and muzzle.
Recognizing pain in your pet can be difficult. If you are concerned that your pet is in pain, talk to your veterinarian and share your concerns. It can be helpful to keep a list of observations, use a tracker to recognize patterns, and take videos and photos when possible. The more information you can provide, the easier it will be to collaborate with your pet’s care team. From there, you and your vet can work together to identify and treat your pet’s pain.
