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Pain: The 4th Vital Sign and the Most Overlooked

When most people are ill, they are accustomed to having the three vital signs evaluated: temperature, pulse and respiration. What is as equally important and often overlooked is the evaluation of pain. Pain can change all of these vital signs. Animals in pain, both acute and chronic can have an increase in respiratory rate, heart rate, and even temperature. What most people do not realize is that pain can also delay healing and impair the immune system. Like most people you know, pain can also account for lack of movement and for being antisocial and grumpy. We can see all of these signs in our pets, but what is most concerning is that unlike people (who will be more than willing most of the time to let you know they are in discomfort or pain), our pets try their best to hide their signs of pain. In the animal world, pain is a sign of weakness, and weakness can get you picked on or even killed.

Dogs in pain are much easier to read than cats. Although many people may mistakenly attribute "Rover's" slowing down as being due to age, it is usually so much more than that. Pain - or the euphemism discomfort - is much more universal than most of my pet owners ever knew. People are expecting a similar notification they would get from another human (i.e. "aah my back", "my arthritis is really acting up") or just a wince or motion most of us would recognize as discomfort. Dogs rarely will vocalize their discomfort this way, but they do routinely show it, if you know what to look for. The following are some examples:
• Slow to get up or get down
• Not coming when called
• Quicker to sit rather than stand
• Plopping down ungracefully
• Getting up the same way, same leg
• Off-loading one of their legs (weight not evenly distributed)
• Getting "grumpy" in their old age
• Significant reduction in activity
• Less social
• Quick to sit with just mild pressure on their back
• Using the front legs more to pull themselves up
• Dropping food when eating
• Eating on just one side of the mouth (who even watches for this?)
• Stop eating dry food or certain treats
• Not wanting to be picked up anymore

These are just a few of the signs of pain in the dog.

Cats can be much harder to read. One study had statistics showing that more than 90% of cats over six years of age have at least one joint with DJD (degenerative joint disease). Recognizing and evaluating pain in cats can be a challenge. The following are some signs to look for:
• Reluctance to jump up and down like they used to
• Height they are not willing to jump up and down to anymore
• Changes in general movement (really need to know your cat!)
• Grumpiness on handling especially when picking up a certain way
• Seeking seclusion
• Playing less with toys or other pets
• Stop running to food
• Less climbing and/or descending stairs
• Less sharpening of claws
• Less grooming
• Defecation outside of the litter box
• Urination outside of the litter box. It is important to note that inappropriate defecation & urination can have multiple underlying reasons. We can discuss with you whether specific testing is recommended.
• Stop hunting
• Choosing to lay down instead of sitting
• Sleeping more
• Running less or not at all
• Squirming more or fussing when being held or picked up
• Reluctance to be petted on certain areas

A universal truth I've understood about cats after 30 years of practice is that they are incredible at hiding their illness and this includes hiding any signs of pain or discomfort.

I hope you have found this blog on Pain In Our Pets informative. Next time we will give examples of how to treat this quality of life issue.

-Dr. James Miele, DVM

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