Yes, your canine osteopathy patient could be in pain.

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.

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.

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.

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.

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.

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 will help you to

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.

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

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.

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/

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/