Is Your Pet Suffering From This Hidden Mystery Pain?

STORY AT-A-GLANCE

• Since dogs and cats are naturally inclined not to show pain, it can be difficult to know when a pet is hurting, and this is especially true when it comes to chronic (vs. acute or sudden) pain
• When a pet is hurting (or you suspect as much), it's very important to make an appointment with a veterinarian, as untreated pain can worsen and lead to additional health issues
• If your pet has a painful condition, his or her treatment will depend on what's causing it; there are many nontoxic therapies that can be used alone or in conjunction with medications to alleviate pain
• Myofascial pain — a type of muscle pain resulting from trigger points — is a common but frequently undiagnosed condition in dogs and cats

If you're a pet parent, it's probably very unsettling to wonder if your dog or cat is hurting, unbeknownst to you. Canine and feline family members are hardwired to minimize their discomfort and in fact, cats actively hide pain, which makes it doubly hard on pet owners trying to do what's best for nonverbal animal companions.

Chronic vs. Acute Pain

Chronic pain differs from acute pain.

"Acute pain, also known as adaptive pain, serves a purpose," says Dr. Daniel Eckman, a staff veterinarian at the Texas A&M School of Veterinary Medicine & Biomedical Sciences' Veterinary Medical Teaching Hospital. "It tells us not to use or do something in the short-term. Acute pain usually goes away within minutes to days, weeks, or months."¹

Chronic pain is described as pain lasting three months or more and at some point, is no longer a direct response to an injury or illness. It is sometimes referred to as maladaptive pain. Per Eckman, "Chronic pain serves no purpose and creates changes within the body and nervous system that can lead to further pain states or psychological changes."

A variety of medical conditions can lead to the development of chronic pain in pets. Some of the most common include:

• Osteoarthritis (degenerative joint disease)
• Neurologic disease or injury
• Dental disease
• Cancer pain
• Untreated or improperly treated acute pain

Signs and symptoms of chronic pain include:

• Limping
• Lameness
• Trouble standing
• Reluctant or unable to jump up on objects
• Decreased activity level
• Decreased appetite
• Obsessive grooming of an area
• Withdrawing from family or other pets

You can find more information on signs of pain at these links: How Your Dog Tells You He's in Pain and How to Tell If Your Cat is in Pain. If you notice or suspect your pet is showing signs of pain, it's important to make an appointment with your veterinarian, as untreated pain can worsen and lead to additional health issues.

"Chronic pain can have major impacts on pets, both physically and psychologically, and it should be addressed aggressively with frequent rechecks and modifications," says Eckman.²

Pet Pain Management

Research suggests that oral opioids, including tramadol, are ineffective for managing pain in dogs.³ However, I do keep drugs in my veterinary toolbox, in part because they can be beneficial as part of a multimodal pain management protocol, especially if instituted early on, before pain escalates.

Since felines are physiologically unique, there are few effective pharmacologic agents that can be safely given long-term to control pain. Thankfully, once the pain is well managed on appropriate medications, most cats can be weaned onto all-natural protocols (or a blended protocol including a reduced amount of pain killers) that do a great job of handling mild to moderate pain.

How your animal companion's pain is managed depends on what's causing it, so gain, it's crucially important to make an appointment with your veterinarian for a thorough exam. Once your vet has evaluated your pet and depending on the root cause of his or her discomfort, there are a number of integrative therapies that blend nicely to reduce the amount of medications needed to manage pain, including:

• Acupuncture and/or chiropractic
• Therapeutic massage
• Helping your pet stretch
• Laser therapy

There are also some newer therapies I've used with good success, including infrared heat therapy and the Assisi Loop, a form of pulsed electromagnetic field therapy. In addition, there are a variety of beneficial supplements and dietary interventions you can incorporate, again depending on your pet's diagnosis and treatment protocol.

Myofascial Pain in Pets

Myofascial pain, which is pain in the muscles that results from one or more trigger points, is common in pets, but because it doesn't show up on x-rays or other diagnostic tests, it's often left untreated. The result is that many furry family members suffer needlessly with significant, chronic muscle pain.

Trigger points, sometimes described as knots in the muscles, are focal points for inflammation and irritation. They may be in an active or latent phase. In the active phase, a trigger point may be very painful for your pet. If pressure is applied, pain may radiate from the trigger point to other areas of the body, such as down the limbs (this is known as referred pain).

Your dog or cat may also have latent trigger points that are sensitive, but not as acutely painful as active trigger points. However, even latent trigger points may lead to problems, including stiffness and restricted range of motion.

There are many situations that can lead to this type of muscle pain. Some of them may occur suddenly, such as an injury from an unexpected wrenching movement, a fall, or a blow to a muscle. Often, however, the development of such pain, and its related trigger points, is gradual.

Just like in humans, pets may suffer from muscle pain as a result of overuse or muscle imbalance. For example, if your dog runs along a fence every day or favors a back leg due to arthritis, some muscles are being overused and others underused, leading to muscle imbalance and the development of trigger points.

When the pain and related dysfunction becomes chronic, it's known as myofascial pain syndrome (MPS). Unfortunately, MPS is rarely mentioned in conventional veterinary schools, so it's often overlooked and left untreated. As veterinarian Dr. Michael Petty wrote in a 2012 article for veterinary journal dvm360:

"Myofascial pain syndrome is a difficult-to-diagnose and seldom-treated condition in dogs. This is despite the fact that it's been a recognized pain issue for more than 400 years and entered mainstream human medicine almost 80 years ago. It's rarely taught in the university setting and there are no books about it."⁴

Potential signs of myofascial pain include weakness, muscle tension, stiffness and lameness, or your pet may jump from pain or twitch if you happen to press on a trigger point. Without treatment, trigger points and myofascial pain can turn into a chronic and worsening condition.

Treating Myofascial Pain by Relieving Trigger Points

If you suspect your dog or cat is suffering from myofascial pain, see an integrative veterinarian who is experienced at finding trigger points. Once they've been located, there are a couple of options for treatment.

One, which is fairly invasive, is dry needling. This involves using an acupuncture needle that is pushed through your pet's skin to stimulate the trigger point. This may release the tight muscle bands associated with the trigger point, leading to decreased pain and improved function.

Electro-acupuncture and acupressure may also be helpful for some dogs with myofascial pain. Cold laser therapy and ultrasound therapy may be beneficial for dogs who won't tolerate acupuncture. Another less invasive option is manual manipulation of trigger points using trigger point massage or trigger point therapy.

I have found that recurrent trigger point problems can be a result of an underlying chiropractic issue, so if your pet isn't getting better, consider getting a chiropractic evaluation.

Lastly, physiotherapy incorporates all of the above strategies for managing acute and chronic pain and is the most comprehensive way to effectively address your pet's discomfort. Ask your vet for a referral for physical therapy, if they don't offer these services; rehab professionals create multimodal plans that support your pet's muscular, skeletal, and nervous system, which is the most comprehensive way to maintain quality of life.

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