Yes, your canine osteopathy patient could be in pain.

Introduction

Recognizing signs of pain in dogs, especially in your canine osteopathic patients, is invaluable. Signs may manifest only at home, at home and in the office, or only in the office during treatment. It is of the utmost importance to recognize when your patient hurts.

Acknowledging areas of pain helps guide your therapy and provides a means to monitor progress. Track pain response and progress over time and provide owners with monitoring tools at home to help in therapy.

General signs of pain in dogs

Painful dogs can show a wide variety of signs. They fall on a broad spectrum of severity. Sometimes very stoic animals do not appear painful at all yet may have a severe injury. While others, sometimes specific breeds, huskies, for example, are a bit more melodramatic and more apt to demonstrate overt signs of pain, even with only mild disease.

Canine osteopaths need to recognize signs of pain in their patients

Erica Tramuta-Drobnis (2020) notes that the following are good indicators that the patient has pain.

It is critical to remember that even the sweetest dog may bite when painful!

Make slow and deliberate movements. Talking to the dog while treating assures that the pet always knows you are there. Make sure you make them aware of your touch and that they are ok with it before proceeding with any type of manipulation or treatment.

Remember that pain can be anywhere

Your patient may be coming to you because of an abnormal gait, poor performance in agility, or for other reasons. But always remember that underlying causes may not be specific to the limbs or musculoskeletal system.

Pain can occur from abdominal organs such as the pancreas in pancreatitis or the bladder because of urinary tract infections or bladder stones. The pet may have severe dental disease or chronic ear infections. These may have led them to carry their head differently or use muscles differently, creating a musculoskeletal manifestation of a systemic problem.

So, as a canine osteopathic practitioner, you must be mindful of other underlying diseases. These core conditions can contribute to discomfort in various body systems. This can cause higher levels of pain than the problem that brought them to you may dictate.

Critical point owners NEED to know: pain delays healing

It is your job to educate the owner. Inform them that pain WILL DELAY healing. We want adequately controlled pain. For many patients, canine osteopathy may provide sufficient pain management and resolution. Still, pain medication or canine physical therapy, AKA canine rehabilitation exercises, may also be warranted. Finally, modalities such as laser or ultrasound therapy, heat, or ice therapy, may need to be considered.

So, we must know how the pet does at home with the treatment. If our treatment is not enough, we need to intervene. Perhaps just modifying your protocol will be sufficient. Still, it may require a veterinarian's advice and interventions to enable thorough treatment of the pet.

Client education: teach owners to recognize pain

As animal osteopaths, tracking patient progress is essential. Using several methods can be helpful, including detailed patient notes from one session to another and the inclusion of at-home observations by the owner. You can develop a pain assessment check sheet or a handout to give your owners. Use something with information showing signs of pain. Provide a record format for the owner to use at home. For example consider this checklist option from the International Veterinary Academy of Pain Management.

Feel free to use this as a template listing signs of pain for which your owners should be on the look out. Modify it to fit your needs. Regardless, have your owner record a journal of findings throughout the interval between appointments. Have them note when the last appointment was, findings the night of treatment, and over several days, then again, following the next appointment. This allows your clients to be part of the treatment process. Encourage them to monitor and participate in their pet's care.

https://tripawds.com/wp-content/blogs.dir/1/files/2016/09/Is-My-Dog-in-Pain-IVAPM.pdf

Pet owner observations

Pet owner observations will help you to

Determine if your treatment plan is working
1. If it IS working, great, pat yourself on the back. BUT make sure to re-evaluate the whole patient. Because of your work, you may have altered body posture and, in turn, improved the body's biomechanics creating different troubled areas or awakening new issues.
1. Suppose your protocol is NOT providing pain relief, gait improvement, or other noticeable improvements in quality of life. In that case, you need to re-evaluate the pet and determine a new plan of attack.
Identify the owner's thoughts and concerns about therapy progress. Are they satisfied? Have they noticed new signs of pain they had not before? Are they noticing them because they are now looking or because something changed?
Monitor the patient's overall pain score throughout treatment—your perceived pain level on examination as well as the owner's at home. When the pet's pain is appropriately controlled, any oral pain medications or other therapies may be tailored, decreased, or even discontinued over time.

What your owners should monitor at home

- - Monitor for any changes in behavior
    - Aggression (i.e., snapping at a child they had usually tolerated)
    - Hiding or anti-social behavior
    - Overly affectionate or turning away from affection
    - Sleeping more or sleeping less than average
    - Increased vocalization at varying times or for no apparent reason
    - Overly grooming a body part (especially one that may have been previously injured)
    - Panting when not hot and no recent exercise
    - Pacing
    - Restlessness/not settling (cannot get comfortable, may change positions non-stop or every few minutes)

Monitor for certain postures/positions
- Holding up a leg
- Shifting leg-lameness (lameness that shifts from one leg to another over time)
- Tail posture changes (not wagging it, holding it limp)
- Not entirely putting weight on a leg
- Prayer position (both front legs on the floor with back legs standing; often stretched far forward; eyes wide or unfocussed,
  - The prayer position (see Figure 1.)
    - Note the eyes, the ear position, the tail position
- - - At a brief glance, this can look like a play bow, so it is critical to look at other body cues and overall posture
    - Often indicates abdominal pain but can occur with other types of pain or referred pain
- - The play bow
    - Relaxed, loose body position
    - Playful eyes, normal eye position (not sunken or wary)
    - High tail wag
    - Ears at a neutral natural position
    - May bark or vocalize playfully
    - Looks like a happy dog
  - A dog that wants to play is less likely painful, but it doesn't rule out the pain. It just means that it's not enough to stop playing
Increased stretching
Stiffness/ trouble getting up
Hesitating to go up and down stairs or on/off furniture
Squinting the eyes, blinking a lot (Can indicate pain of the eyes, but also general pain/discomfort)

Give owners homework

Make sure your pet owners know how to monitor for future signs of pain. Sometimes osteopathy alone can treat an injury or medical problem. But it is often one tool out of many to treat and support long-term conditions, such as arthritis

The goal is, of course, a cure. But that is not always feasible. So, we need to ensure owners have the tools to monitor for subtle signs of pain. This will allow them to be proactive with their dog's care in the future. Ensure owners recognize that seeing subtle changes suggestive of pain is important. We want owners to seek intervention and re-evaluation before the pet becomes too painful, chronic pain occurs, or wind-up develops.

Help owners prevent wind-up pain

Make sure your owners understand that we want to treat pain in the initial stages. Letting it go too long can lead to chronic inflammation, chronic pain, weaken the immune system, and increase stress to the body. Osteopathy may be sufficient but advise clients they may need a combination of manual therapy, pain medications, exercises, even other treatments to help the pet.

Untreated pain can lead to wind-up pain or central sensitization. This is the body becoming overly sensitized to pain to the point where the brain perceives non-painful stimuli as a threat. This, in turn, makes the pain worse and creates a vicious cycle that can be hard to break, negatively affecting the patient's overall quality of life.

With central sensitization, the spine and brain are constantly flooded with noxious (painful) stimuli without pain management. So, say you lightly graze your toe against a table leg; it may feel like you broke it rather than just grazed it. Even just a light pet to the dog could be translated by the brain as painful rather than pleasurable. This increases anxiety, stress, pain and can occur in as short as one hour. So it doesn't even require chronicity to develop (Mills, 2018).

Wind-up, thus, describes "the increased ease of transmission of impulses as they travel through the pain pathways to the brain" (Hudson, 2018). Therefore, teaching owners to recognize signs of pain, initiate intervention rapidly, and seek re-evaluation is critical. This lessens the chance the dog will develop wind-up pain and minimizes the pet's pain and suffering

Final remarks

For those working in veterinary medicine in any capacity, recognizing signs of pain is a crucial part of the job. We need to both understand canine body language and communication cues and recognize pain to help minimize it and improve our patient's quality of life.

Recognizing Canine Communication

Additionally, we need to recognize the signs of pain because just a gait abnormality or a tense muscle alone may not be the whole picture. If the patient demonstrates signs of pain, this may indicate

additional disease processes
additional areas needing treatment

Additionally, recognizing pain may serve as a means of caution – it means you must be careful when treating painful areas. Ensure you are not causing more pain. Safeguard that the animal does not react with biting, aggression, or other changes that could be harmful to you, your staff, or the patient.

Remember, pain delays healing. Pain unchecked leads to a cascade of problems, causing the frequent release of stress hormones and worsening your patient's life quality. Additionally, do all you can to minimize wind-up pain and ensure owners understand how to prevent it.

Ensuring owner education is critical. You and your owners need to understand pain signs, continue to monitor patient progress over time, and recognize that pain can lead to aggression or erratic behavior.

Always strive in your practice to make certain you, your staff, and your owners recognize signs of pain in dogs. While treating your canine osteopathy patients, make certain that you are always vigilant for signs of pain, changing behaviors, and communication cues. This will ensure you and all involved remain safe, and that the pet gets the best benefit from your osteopathic therapy.

Figures:

Figure 1. The canine "prayer position" suggestive of abdominal pain. Borrowed from

https://www.wikihow.com/Cure-a-Dog%27s-Stomach-Ache#/Image:Cure-a-Dog%27s-Stomach-Ache-Step-13.jpg

Figure 2.The Playful dog. The "play bow". Borrowed from https://www.canva.com/

Works Cited:

Hudson, D. (2018,September 20). Analgesia Without Opioids. VIN.Com. Southwest Veterinary

Symposium 2018.

https://www.vin.com/members/cms/project/defaultadv1.aspx?id=8669934&pid=21982&

Mills,A. (2018, June 28). Pain Management: Start to Finish. VIN.Com. Pacific Veterinary Conference

2018, San Francisco, CA.

https://www.vin.com/members/cms/project/defaultadv1.aspx?id=8550828&pid=20885&

Tramuta-Drobnis, E. (2020, July 13). How Long Can a Dog Live With Arthritis—The Animalista—

Animal Vitals. The Animalista.https://theanimalista.com/how-long-can-a-dog-live-with-arthritis/

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