By Suzanne Gould. Canine Behaviourist and Dynamic Dog Practitioner.

Is your dog hiding their pain? They often do. That’s why pain relief trials are so important. But a quick one to two-week test? It’s often a waste of time and can lead to missed diagnoses and ineffective treatment. Let’s explore why a ‘one-week wonder’ pain management approach is not enough for your dog.

I recently had a client share some feedback from their vet, who felt their dog wasn’t likely experiencing pain despite showing slight behavioural improvements and better quality sleep after a six-week course of NSAIDs. The vet believed any medication benefit would be substantial and apparent within two weeks, so she didn’t feel the NSAIDs changed anything for the dog. While that might hold in some situations, it’s a bit of a blanket statement and misleading, particularly when you consider the complexities of chronic pain and the different ways pain can show up in dogs. This is a very generic and frustrating approach that some vets still utilise.

Many of my behaviour consultations lead to the creation of detailed health and behaviour reports, which I then share with the dog’s veterinarian. These reports are designed to provide a comprehensive overview of the dog’s physical, emotional and behavioural health. I conduct evaluations, including gait and posture analyses, observations of daily life activities to identify movement abnormalities, dietary and toileting assessments to flag potential gastrointestinal concerns, and reviews of sleep patterns and overall lifestyle.

This detailed information gathering allows me to construct a holistic picture of the dog, highlighting areas that warrant veterinary attention. Due to the time constraints of standard veterinary appointments, it’s often impractical for vets to gather this in-depth data. 

Furthermore, many of the dogs I work with experience heightened anxiety in clinical environments, which can complicate veterinary assessments. Dogs experiencing stress will have adrenaline flooding their bodies, which masks pain. Also, if the dog is not comfortable being touched by strangers, a hands-on assessment is almost impossible. This is where my reports, with video and photographic evidence, assist vets in creating a more accurate evaluation.

Following the vet’s review of my report, coupled with direct consultations with the owner and clinical observations of the dog, a pain relief trial is frequently recommended as the next step in the diagnostic process.

Why Pain Relief Trials Are Essential

Veterinarians suggest pain relief trials for dogs for several reasons, all of which aim to provide the best possible care and improve the dog’s quality of life.

To Accurately Diagnose and Assess Pain: 

Pinpointing a dog’s exact cause and severity of pain can be tricky, even with physical exams and X-rays. A pain relief trial helps by showing how the dog reacts to medication, confirming pain, and sometimes revealing affected areas. Since dogs can’t use words to tell us how they feel, these trials also allow owners (and their behaviourists) to watch closely for changes in their dog’s behaviour and movement. This feedback provides valuable information to the vet, helping them understand the dog’s pain experience.

To Determine the Efficacy of Pain Medications:

Dogs react differently to pain medications, so what works for one might not help another. A pain relief trial lets vets see how dogs respond to specific drugs and doses. By watching the dog’s reactions, vets can adjust the treatment plan, changing doses or medications, to give the best pain relief with the fewest side effects.

To Monitor for Potential Side Effects:

Pain medications, particularly NSAIDs, can cause side effects, especially when used long-term. A pain relief trial lets owners keep a close eye on their dog for any problems like stomach upset, appetite changes, or gastrointestinal issues. Vets use this trial to find the right balance between pain relief and the risk of side effects, ensuring the long-term treatment plan is safe and effective.

To Improve the Dog’s Quality of Life:

Pain can severely limit a dog’s ability to move, play, and enjoy life. A successful pain relief trial aims to restore this lost functionality, allowing dogs to return to their normal activities. Beyond physical improvements, reducing pain can also significantly boost a dog’s emotional well-being. By minimising stress, anxiety, and depression, pain relief can lead to a happier, more fulfilling life for the dog. It can often go a long way to resolving the behavioural issues initially caused by the pain itself.

To Gather Data for Long-Term Management:

Many dogs suffer from long-term pain conditions like osteoarthritis, requiring ongoing care. A pain relief trial is crucial for gathering the information that vets need to create effective, long-term management plans. The data collected during the trial allows for better-informed decisions about future treatments, ensuring the dog’s comfort and well-being over time.

Understanding Chronic Pain’s Impact 

Chronic pain is typically behind the gait, posture, and/or behaviour challenges dogs present with. In dogs, chronic pain is a persistent, maladaptive state that can extend beyond any healing period, unlike acute pain, which signals immediate injury. 

Chronic pain involves complex neurological changes, including peripheral and central sensitisation, leading to heightened pain sensitivity. The longer the dog experiences pain, the stronger the pain connections with the brain become.

Chronic pain significantly impairs a dog’s quality of life, affecting physical health, behaviour, and emotional well-being. It is often associated with underlying conditions like osteoarthritis or neuropathic pain.

Managing chronic pain in dogs is complex and requires a systematic and patient approach. While the desire for immediate relief is understandable, relying on a one to two-week pain relief trial can lead to inaccurate assessments and suboptimal treatment outcomes.

Types of Pain 

Not all pain is created equal, especially for dogs. They can experience a wide range of pain types, from the familiar ache of a pulled muscle to the more complex sensations arising from nerve damage or internal organ issues. When using pain relief trials, understanding these different categories of pain—visceral, somatic, and neuropathic—is essential for both dog owners and veterinary professionals. 

Visceral Pain: This deep, internal pain originates from organs like the stomach, intestines, or kidneys. Often described as a dull ache or cramping, it’s difficult to pinpoint and can be accompanied by nausea or changes in breathing. It’s triggered by stretching or organ tissue inflammation, making it a challenging pain to diagnose due to its diffuse nature and potential for referred pain.

Somatic Pain: This type of pain comes from muscles, bones, joints, and skin. It’s usually well-localized, meaning the dog can indicate a specific area. Triggers include injuries like cuts or sprains and inflammatory conditions like arthritis. Because it often involves visible signs like swelling or limping, it’s generally easier to identify than visceral pain.

Neuropathic Pain: This distinct and complex type of pain arises from damage or dysfunction within the nervous system. Triggers include nerve injuries, compression, or metabolic disorders like diabetes. Neuropathic pain is notoriously difficult to treat, often requiring specialised medications, and can cause significant behaviour changes.

Understanding the ups and downs of Chronic pain:

Chronic pain conditions, such as osteoarthritis, degenerative myelopathy (hind limb weakness, for example), or neuropathic pain (Intervertebral disc disease), are characterised by their persistent and fluctuating nature. It’s rare that your dog will experience the same level of pain day in and day out. 

 A short trial period of 1 to 2 weeks fails to capture the changes. What happens if you trial the medication during a week that you’ve planned to keep things calm for your dog? You are not likely to see any changes, which can lead to the wrong conclusion that there is no pain. With pain relief trials, it is essential to remember these considerations. 

How pain changes the body: Chronic pain leads to lasting changes in the nervous system, increasing nerve sensitivity. These changes are not instantaneous; they require time to stabilise or react to treatment. Consequently, a one-week trial cannot gauge the medication’s impact on these complex nerve alterations. (Woolf, 2011) 

Environmental and Activity-Related Influences: A dog’s environment and activity levels have a real impact on their pain. Things like temperature, humidity, and how active they are can change how much pain they experience day to day. That’s why a longer trial is so important – it gives time to see how the medication performs in different situations, leading to a more complete assessment. (Lascelles & Robertson, 2004).

Emotional Health: It’s important to remember that a dog’s emotional state and environment significantly affect their pain perception. Factors like stress, anxiety, and changes at home can all influence how much pain they experience. That’s why observing a dog over a longer period is crucial, as it allows us to see how these factors interact with their pain levels (Hewson, 2003) 

Medicine Considerations and Long-Term Effects

How a pain medication moves through and affects a dog’s body means we must test it longer. As our dogs can not talk to tell us how they feel, we must rely on careful observations over several weeks. 

Achieving consistent medication levels: To truly evaluate the efficacy of many chronic pain medications, it’s essential to allow them time to reach a consistent level in the dog’s body. Assessing their impact before this point can lead to misleading results, as the medication may not have had sufficient time to take full effect. (Papich, 2016)

Adaptation and Tolerance:It’s possible for some pain medications to lose their effectiveness with prolonged use. A longer trial period is essential for vets to observe this potential decrease in efficacy and adapt the treatment strategy as needed. (Sawyer & Wright, 2003).

Long-Term Organ Function Monitoring: It’s well-documented that prolonged use of some pain medications, especially NSAIDs, can pose risks to a dog’s kidney and liver health. To mitigate these risks, longer trials are essential, enabling vets to monitor organ function closely and proactively. (Luna et al., 2007).

Drug Interactions: A longer trial is needed to observe drug interactions if the dog is on other medications. (Plumb, 2018). 

Choosing the right medication: Finding the ideal pain management approach often requires fine-tuning. It’s not uncommon for the initial medication choice to need adjustments. So, a simple ‘no change in two weeks means no pain relief needed’ approach is too simplistic. It overlooks crucial factors like the specific type of pain, whether it’s chronic, and how a dog’s lifestyle might be affected. Additionally, the initial medication might not be sufficient on its own, necessitating the addition of other pain relief strategies. This process requires careful observation and timely adjustments to track and manage changes in the dog’s condition effectively.

The Importance of a Longer Trial Period 

The 6-to-8-week window provides a practical balance between the need for accurate data gathering and the realities of veterinary practice. It allows for a comprehensive assessment of pain relief efficacy, side effects, and overall quality of life, leading to better long-term pain management.

A 6-8 week pain relief trial might seem like a long time, but it’s an investment in your dog’s comfort and well-being. It’s about getting a complete picture of how the medication is working and ensuring your dog can live their best, most comfortable life.

This time frame isn’t set in stone. Your vet might need to adjust the trial based on your dog’s response. There may be changes in medication, dosage, or even the addition of other therapies like physical therapy or acupuncture.

Objective Data: More Than Just Guesswork

Instead of guessing how much pain a dog is in, we need to use real measurements to see how well they can move and do things. A more complete dog re-assessment done after several weeks of pain relief allows the vet to see all the changes, positive and negative, for the dog.

Gait Analysis: We assess how a dog walks and moves to see if there are any improvements. To be sure they’re improving, we need to take these measurements many times over a longer period.. (Budsberg & Bergh 2012).

Activity Monitoring: Owners keeping detailed diaries to track changes in behaviour, sleep, emotional health, eating and toileting habits, changes to physical abilities. Any changes in behaviour, and of course, their perceived pain levels. You can even use a simple pain-scoring chart from your vet. This detailed record is invaluable for your vet to make informed decisions

Behavioural Assessment: Observing and documenting changes in a dog’s behaviour and cognitive function is crucial for assessing pain management efficacy. By tracking improvements or declines in emotional state, social interactions, and daily habits, veterinarians and owners can gain valuable insights into treatment effectiveness and make informed adjustments to enhance the dog’s overall well-being.. (Landsberg et al 2017)

Conclusion

Investigating potential pain for our dogs, the limitations of a brief one-to-two-week pain relief trial become strikingly clear, like a fleeting glimpse through a foggy window. To truly unlock the potential for a pain-free, active life for your dog, a more comprehensive approach is essential – one that delves into the depths of their well-being. 

By extending the trial to 6 to 8 weeks, we move beyond mere tolerance checks, which only scratch the surface, and delve into the nuanced world of chronic pain management. This extended period allows for thorough identification of subtle improvements that might otherwise be missed – a springier step, happier moods, and renewed interest in play. 

It also provides the necessary time for monitoring of potential risks, ensuring that the chosen medication is not only effective but also safe for long-term use. This slow approach enables the creation of a personalised, sustainable treatment plan, tailored to the unique needs and responses of each dog’s individual case. 

Remember, we’re not just treating symptoms; we’re making a lasting improvement in their quality of life. 

So, getting back to that vet visit I mentioned earlier, they were expecting immediate improvements from the pain medication. And they dismissed the subtle improvements in the dog’s behaviour and sleep. They told the owners, ‘No pain relief needed,’ and that was that. This raises a few questions for me. Should those behavioural changes have been taken into account? Could it be that the medication wasn’t the right fit? And doesn’t it make sense to explore further, with some imaging, to get a clearer picture? Of course, we all know there’s no way to guarantee a dog is entirely pain-free, but we can certainly do more to understand what they’re going through.

Ultimately, successful pain management is a partnership. Your intimate knowledge of your dog’s daily routines and behaviours, along with the behaviourist’s observations, paired with your veterinarian’s expertise and scientific understanding, all together form the cornerstone of a happier, healthier future for your dog. 

It’s about giving them back the joy of a life unburdened by pain, where they can thrive, not just survive.

Key Points To Remember :

If your is given a pain relief trial for suspected pain or discomfort, its essential to remember the following – 

• Dogs Often Hide Pain: Dogs are adept at masking pain, making it crucial to rely on more than just obvious signs.
• One-Week Trials Are Insufficient: A one-week pain relief trial is often too short to assess medication efficacy, especially for chronic pain accurately.
• Chronic Pain is Complex: Chronic pain involves neurological changes that take time to develop and respond to treatment.
• Individualised Assessments are Essential: Dogs respond differently to pain and medications, requiring tailored treatment plans.
• Environmental and Emotional Factors Matter: A dog’s environment, activity levels, and emotional state significantly influence pain perception.
• Medication Requires Time to Work: Many chronic pain medications need time to reach therapeutic levels in the dog’s body.
• Objective Measurements Are Crucial: Objective assessments, such as gait analysis and activity monitoring, provide valuable data for pain management.
• Behavioural Changes Indicate Pain: Pain can significantly alter a dog’s behaviour and cognitive function. It is important to track positive and negative behaviour changes.
• 6-8 Week Trials are Recommended: A 6-8 week pain relief trial allows for a more comprehensive assessment of pain relief efficacy and potential side effects.
• Collaboration is Key: Successful pain management requires a collaborative effort between owners, behaviourists, and veterinarians.
• Quality of Life is the Goal: The ultimate goal of pain management is to improve the dog’s quality of life, allowing them to thrive.
• Different types of pain: It is important to remember that there are different types of pain and that each type needs to be treated differently.

More to read – Pain and Behaviour: Why a 15 minute vet check is not enough.

Your Role in Your Dog’s Pain Relief Trial: A Guide for Owners

References

1. https://www.zeropainphilosophy.com/post/pain-trials-as-a-tool
2. https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/canine-health-information/recognizing-pain-dogs
3. https://www.dogstrust.org.uk/how-we-help/professionals/vet-clinics/resources/how-pain-affects-behaviour
4. https://www.fda.gov/animal-veterinary/resources-you/what-veterinarians-should-advise-clients-about-pain-control-and-nonsteroidal-anti-inflammatory-drugs
5. https://versusarthritis.org/about-arthritis/treatments/drugs/painkillers-and-nsaids/
6. (Woolf, C. J. (2011). Central sensitisation: implications for the diagnosis and treatment of low back pain. Journal of Pain, 12(4), S2-S15.)
7. (Lascelles, B. D. X., & Robertson, S. A. (2004). Analgesia for canine osteoarthritis: pharmacology and therapeutics. Veterinary Clinics: Small Animal Practice, 34(2), 501-525.)
8. (Hewson, C. J. (2003). What is animal welfare? Common definitions and their practical consequences. The Canadian Veterinary Journal, 44(6), 496.)¹
9. (Papich, M. G. (2016). Saunders handbook of veterinary drugs: small and large animal. Elsevier Health Sciences.)
10.  (Sawyer, D. C., & Wright, B. D. (2003). Perioperative pain management. Journal of Veterinary Emergency and Critical Care, 13(4), 219-233.)
11.  (Luna, S. P. L., Taylor, P. M., & Padovani, C. R. (2007). Effects of long-term administration of carprofen, etodolac, flunixin meglumine, ketoprofen, and meloxicam in dogs. American Journal of Veterinary Research, 68(3), 258-264.)²
12. (Plumb, D. C. (2018). Plumb’s veterinary drug handbook. John Wiley & Sons.)
13. (Budsberg, S. C., & Bergh, M. S. (2012). Objective assessment of canine osteoarthritis. Veterinary Clinics: Small Animal Practice, 42(5), 803-814.)
14. (Landsberg, G. M., Hunthausen, W., & Ackerman, L. (2017). Handbook of behaviour problems of the dog and cat. Elsevier Health Sciences.)