Neuropathic Pain in Dogs

Research of the neurobiological mechanisms of neuropathic pain is an area of science where the input of human experience is being utilized to help the advancement of care for our animal friends. Neuropathic pain can take many forms, which cannot be described to us by our dogs, such as burning or stabbing. The veterinarian, of which it's important to pick a doctor with some experience in this particular field, will analyze the existence of this chronic pain in your dog by looking at your pet’s history, and checking causes like an identifiable lesion, and through a neurological examination to rule out other possible causes of pain. A combination of both medication and therapy such as acupuncture will be suggested upon identification of neuropathic pain.

Neuropathic pain is caused by an abnormality in the day to day function of the peripheral or central nervous system. In most cases, this type of pain is ordinarily chronic in nature. Because our pets are unable to verbalize their discomfort, the pain of a neuropathic origin can be difficult to diagnose, thus making a visit to the veterinarian paramount to your dog’s health. Although your dog will not be able to explain to you of the severity of the pain, he deserves to be relieved of it.

It is known that neuropathic pain in dogs is a condition that may be difficult to recognize. As a pet owner, you know your dog best and must seek veterinary advice if you feel that your dog is suffering from pain:

• One of the most obvious signs will be a change in your pet’s behavior
• Change in mood and vitality
• Low tolerance to activity, especially exercise - no matter how light
• Licking an area constantly
• Vocalization of pain
• Possible lack of appetite
• Change in urinary habits or bowel movements, including accidents in the house
• Noticeable change in posture
• Difficulty walking or standing up
• Trouble with jumping or managing stairs

Perhaps less obvious to you are the following symptoms of neuropathic pain:

• Your pet may exhibit a painful reaction to non-painful pressure such as touch (allodynia)
• Your dog may feel a heightened sensitivity to pain (hyperalgesia)
• Your dog may pull back from you when your are giving him attention due to extra sensitivity to touch and sensation (hyperpathia)

Simply put, neuropathic pain occurs when the pain moves from the original source and the neural pathways become unusually sensitized. The pain then occurs with or without stimuli. Some causes for neuropathic pain are listed below:

• Spinal tumor
• Injury to the spinal cord
• Injury to the peripheral nerves such as cauda equina syndrome (pressure and swelling of nerves)
• Phantom pain resulting from a limb amputation
• Intervertebral disk herniation
• Hypothyroidism
• Diabetes

When you bring your dog to the clinic, be prepared to discuss with the veterinarian a complete history of your dog’s past and present experiences. Because your pet is unable to speak for himself, you must be vigilant and as thorough as you can be when explaining the situation.

You may be asked the following questions:

• How long has the pain been obvious to you?
• Is the pain intermittent or continuous?
• Do you notice any specific areas where the pain may be originating from?
• Has your dog recently, or in the past, been ill or injured?
• Does your pet vocalize pain when you least expect it?

The determination of the presence of neuropathic pain is often diagnosed by recognizing abnormal behavior. Together you and the veterinarian will observe your pet and use various stimuli to diagnose neuropathic pain:

• Pain response to non-painful stimulation such as touch (allodynia)
• Heightened sensitivity to pain (hyperalgesia)
• Excessive sensitivity to touch, pressure, stimulation (hyperpathia)

Tools that may not cause a high degree of pain in a normal patient, but can cause extreme discomfort to a pet in a neuropathic state may be a pinprick, thermal heat or cold, stroking an area with gauze or cotton, and applying pressure.These assessments are crucial to diagnosing a case of neuropathic pain.

The veterinarian may decide to do blood tests or x-rays to look for lesions, infection, or to rule out other possible causes or symptoms of pain before confirming a diagnosis of neuropathic pain.

If we compare the treatment of human neuropathic pain to the same sort of constant pain in our dogs, the common goal of treatment is to provide as much relief as possible. In humans, neuropathic pain is determined on these deciding factors:

• There may be accompanying swelling
• There can be pain but no tissue damage with it
• A lack of some sensations may be evident
• The pain can come in sudden jolts and spasms
• allodynia, hyperalgesia, and hyperpathia are present
• the pain burns, stabs and tingles

If you think about the factors mentioned above, one can imagine the difficulty in treating neuropathic pain. Studies show that the best forms of managing this type of pain is a combination of drugs and non-pharmacological therapy. Some of the options include:

• Opioids
• Anti-inflammatories
• Local anaesthetics
• Massage
• Acupuncture
• Anti-epileptics

As this field is under constant study, the veterinarian will discuss with you the options available. It should be noted that finding the right mix and balance of medication will take some time, and your cooperation and the documentation of improvements in your pet’s behavior will be invaluable information for the primary veterinary caregiver.

Follow up with the veterinarian on a daily to weekly basis will be required when the drugs are being tailored to the needs of your pet. Avoidance of adverse side effects is important. Because different dogs respond in various ways to pain, we must remember that neuropathic pain management is really an individual case by case scenario.

The behavior of your dog as he responds to the pain management treatment will be key to deciding if the protocol being followed is the best one for your pet. Daily observance of your dog is necessary, as is reporting all changes, whether positive or negative, to the veterinarian. You should be aware that neuropathic pain does not usually resolve, resulting in lifelong pain management.