Dawg Business Veterinarian Survey; Do Vets Have Difficulty In Convincing Our Clients That Their Dog Is In Pain?

My good friend, and uber dog blogger on all things dog, asked me to participate in her most recent veterinary survey about whether or not I have difficulty in convincing my clients that their dog is in pain.

For those of you who find this question perplexing I will provide a bit of background.

You see veterinary medicine has evolved considerably over the last four decades. There was a time when we didn't acknowledge (I was going to say believe, but I wanted to provide some small shred of credit to my predecessors), that pets felt pain. I know it seems preposterous now, doesn't it? Well, it is still a topic of some considerable debate and cajoling within the veterinary world.  Drug companies, vet schools, and even our veterinary conventions still have open debates about how to recognize pain. (I am encouraged that the discussion has progressed from "how to identify," because it has been about three decades of trying to convince vets that pets "do feel pain'). There were even studies done to try to scientifically prove (we like to think of ourselves as a science based profession), so every thought, idea, and principle has to be based on a study. (Sigh, how many pets had to endure unspeakable tests to prove this?, I dare not ask, and hope to never hear about). But, yes, after four decades the profession now "believes that pets are capable of feeling pain."

This is where Jana's question originates. She asked those of us vets active in the social media world about our experiences with our clients and whether the other side of the fence needed convincing that their pets might be experiencing pain.

What an interesting bunch of answers. They give a very interesting snapshot of where veterinary medicine is now.

From Jana Rade's blog, "Dawg Business,"

Saturday, November 30, 2013

Veterinarians Answer: Do You Often Have Difficulties Getting Clients To Believe Their Dog Is In Pain?

Would you know of your dog was in pain? Would you believe if your veterinarian told you? Many people are still denial about their dog's pain.

I asked my veterinary friends how commonly they deal with denial in regard to pain in dogs.

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Question: Do you often have difficulties getting clients believe that their dog is in pain? How do you convince them? 

Yes, trying to convince owners that their dogs are in chronic pain and not just "slowing down" or "getting older" is a daily struggle.

I find one of the most effective methods of proving pain is to prescribe an effective pain reliever and watch what happens. If the dog starts "acting like a puppy again" with a pain reliever on board, you know he or she was hurting before. 

—Dr. Jennifer Coates, DVM, Fully Vetted

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I've written not once, but twice about this.

First, "Top 7 Misleading Phrases Vets Hear in the Exam Room" described the problem, that most pet owners flatly refuse to believe their veterinarian when we tell them an animal is in pain. Then, in "15 Ways Dogs and Cats Tell Us They Are In Pain" I described in more detail the subtle clues pet owners can use to help them decide if their furry family member needs help.

I think the primary reason most pet owners refuse to acknowledge their animal is in pain is because of our stubborn refusal to accept guilt. 

By housing a painful animal, especially one not showing obvious symptoms of pain, a pet owner must acknowledge a few things. First, they are powerless to prevent pain. Second, they are directly responsible for choosing whether or not to let another living creature continue life in pain. Third, they are similarly solely responsible (emotionally and financially) for any treatment of that pain, which might impact other areas of their life. Fourth, acknowledging pain, especially that associated with senior health concerns, forces an owner to consider their own mortality.

In short, most people get a pet thinking it will live its whole life pain free and one day suddenly die in its sleep. When pain complicates the relationship, that creates a cognitive dissonance that most owners have difficulty processing.

How does a veterinarian help a pet owner deal with pain? Gently, patiently, with the forgiveness of a priest, and the acceptance of a zen monk.

—Dr. Greg Magnusson, DVM (Leo's Daddy), Leo's Pet Care
    Dr. Greg on Facebook and Twitter 

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People often underestimate the degree of pain or discomfort that their dog is experiencing. While many dogs are very stoic, cats Re even better at hiding pain.

Owner's will often come in with a dog that is limping, or even more dramatically not using a limb at all. A typical response is well, he's limping but at least it doesn't hurt him. It takes patience to explain each time that that the dog is limping because the leg hurts. Dogs do not necessarily cry out or whimper when in pain.

Pain can cause even more subtle changes in cats. Behavioral changes as reluctance to jump on furniture or changes in litter box habits can be a reflection of a painful condition.

So pets that are not acting well may be covering painful conditions and should be evaluated by a veterinarian

—Dr. Keith Niesenbaum, VMD, New York, Crawford Dog and Cat Hospital
    Dr. Keith on Facebook and on Twitter

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Some pet parents who have had experience with pet pain are receptive to the evidence of painpresented to them  and accept and believe there is pain present and they are on board with the need to treat it.

Others, when shown the rotten teeth, stiff legs, muscles in  spasm, inflamed ulcerated skin or ears will say, "Well he does not act like he is in pain."  All of these abnormalities are of course painful and  need treatment.

Owners and veterinarians who are tuned into pain recognize it, others do not accept the presence of pain and treat it with denial. Many confuse pain with aging.

Healthy aging is pain free, diseased pets are painful at any age. Unfortunately some (many) owners will ignore those abnormalities and someday will present a pet as not eating, moaning, gasping, and say "He must be in pain" and he may be BUT he is dying now as well.

Another piece of the puzzle is economics. A pet in pain is still a companion, goes for his walks and accepts the attention of the household. In other words, his pain does not affect his ability to do his job. Now consider a lame cow. A lame cow does not produce much milk, or meat. The farmer is economically punished for having a painful animal and will treat the cow.

A painful pet owner incurs no negative consequences related to denying the presence of pain, but if they accept there is pain then they incur an economic  penalty in the form of paying for the needed treatments. The willful blinding of humans to pet pain problems because of the economic issues that raises is one of the best reasons to have pet health insurance as it enables people to concentrate on the welfare of the pet rather than the cost of that welfare.

—Dr. Rae Worden, DVM, Ontario,  Fergus Veterinary Hospital
    Dr. Rae on Facebook and Twitter 

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Clients fall on a spectrum ranging from intuitively perceptive about their dog’s discomfort to blatantly ignorant.  

The most common scenarios where I have trouble convincing clients of pain are dental disease and lameness.  Both can be associated with chronic pain which dogs learn to live with.

Studies have shown that dogs and cats have similar pain thresholds to humans, so we know from research and professional experience that these conditions can be excruciating.Yet in most cases, the dogs will keep eating, keep wagging their tails, and never whine or cry.

I’ve had very smart people escort a limping dog into my exam room and say, “It doesn’t seem to bother him.”  If it didn’t bother him, he’d be bearing full weight on the leg.  He’s not using the leg because it hurts!

Animals mask pain.  For a wild canine, it’s the prudent thing to do when trying to survive in a pack.  Once I explain this to a client, often asking them to remember how their tooth abscess or sprained ankle felt, they come to understand that pain is real for their dog and undeniably decreasing their beloved pet’s quality of life.

However, the proof which is guaranteed to convince any skeptic is the pet’s new attitude and vitality when we resolve/control the pain. Witnessing that transformation is one of the most rewarding parts of being a veterinarian.

—Dr. Julie Buzby, South Carolina, ToeGrips
    Dr. Julie on Facebook and on Twitter

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I think that many people get so used to seeing their dogs limping or stiff-gaited that this becomes normal for them.

Additionally, many people seem to think that if there is no whining or whimpering, there is no pain. I take the time to gently explain that lameness or stiffness implies discomfort and ask clients to try what I recommend for a period of two weeks to see if improvement is recognized. This approach seems to work well for most folks.


—Dr. Nancy Kay, DVM, Speaking for Spot
    Dr. Kay on Facebook and Twitter 

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I am very fortunate to be working with a group of clients who trust my advice, and care deeply for their pet. 

Every patient that I see is asked a litany of questions about their pets full overall health. I spend a great deal of time in the exam room talking. We talk about everything from day to day activities, general health concerns, diet, exercise, mental alertness and stimuli, to any changes in behavior/activity, or ability to ambulate. I try to get a comprehensive over view of all aspects of the pets health and well being, and address any and all changes or needs.

All pets that are considered geriatric, present with any degree of limping, or that are pre-op candidates receive a comprehensive exam to identify any signs of pain or discomfort.

Every surgical patient is given pain medications for their procedure. To avoid any discussion of not wanting to provide a pain medication the cost of the medication is included and not optional for all procedures. On the invoice the pain medication is listed as zero to further remind our clients who important and necessary the pain medication is to our treatment plan.

For any patient that the owner is not convinced may be in pain we often provide a trial (these are provided free by the drug company) size of a pain medication for the client to use to see if they see "any response to treatment." This works well for the osteoarthritis or chronic disc disease dogs.

I spend a long time talking about the many different pain options available, the range of affordable options, any possible side effects, and long term monitoring should they decide to continue the medication.

I have found that in almost all cases if I can effectively communicate options and encourage trying, clients are very willing, and happy to provide pain relief to their pets.

The key to a successful pain management program is to talk openly and honestly about the many options available. And to remind clients that there is a large range of medication options and prices. And I never withhold the fact that many of these are available generically and at significantly discounted "bottle prices."

I am so fortunate to have clients that see their pets as family members and understand that pain management is one of the most important hallmarks to a "good quality of life" for their pet and that like every treatment option we try we may have to try a few options before the ideal one is identified.

—Dr. Krista Magnifico, DVM, Diary of a Real-Life Veterinarian
    Dr. Krista on Twitter
    Don't forget to check out Pawbly.com, around the clock free pet advice

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I think most pet parents I meet are aware of a pet's ability to feel pain,  especially when it comes to surgeries and post-operative pain control. 

Recognizing dental pain is still a struggle that I regularly face. Dental cleanings are not inexpensive and many pets have very advance periodontal disease by the time the pet parent agrees to or request a dental cleaning. I ask them to think about how much a tooth ache pained them and many people can then relate.

Others still deny the dental pain saying their pet still eats. I remind them if the pet won't eat,  they will die. I also ask about eating g behaviors such as excess drool,  dropping food,  or chewing on a preferred side. If they admit to any of these I explain this as a result of oral pain. 

—Dr. Laci Schaible, DVM, VetLIVE
    Dr. Laci on Facebook and Twitter

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I don't often encounter challenges in alerting my clients to their pet’s painful conditions.

By discussing the characteristics of their pet’s mobility during my history-taking process, my clients come to understand that the pet’s difficulty moving up or down from elevated surfaces, decreased interest in playing or socializing with human or animal family members, or reluctance to being touched in uncomfortable areas are all potential indicators of pain-causing medical conditions (arthritis, intervertebral disc disease [IVDD], cancer, etc.).

Pairing these characteristics with the physical examination and observation of a pet’s ambulation increases my client’s awareness of their pet’s pain.  Increased awareness promotes their willingness to pursue a diagnosis through diagnostic imaging (radiographs, MRI, CT, etc.) and the most appropriate treatments for their pet’s particular condition (pain medication, nutraceuticals, acupuncture, dietary and lifestyle modification, etc).

 —Dr. Patrick Mahaney, Los Angeles, The Daily Vet
     Dr. Patrick on Facebook and Twitter 

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Fortunately I do not often have difficulties getting clients to believe that their dog is in pain. Often it is the reason they are visiting.

If they do need convincing, for example, with previously undiagnosed oral pain from dental disease or hip pain from osteoarthritis, I demonstrate for them during the physical exam - press on the sore gums or extend the leg of the sore hip. 

Most pets are sweet and will not bite when you do this (the sign I was taught to look for! Either pets were grumpier or we used to let pain get WAY too severe before we recognized it!) So I also point out to clients how their dog is licking his lips or tensing up or turning when pain is elicited. I feel like a jerk for that few seconds, but it is worth the long term benefit of getting clients to realize their dogs' pain and getting the dogs the treatment they need.

If clients have any doubt, they believe 100% after their pets' pain has been treated and relieved, and seeing the pets at a late visit comfortable and pain free is one of the most rewarding aspects of what I do.

—Dr. Shawn M. Finch, DVM, Riley & James 
    Dr. Shawn on Twitter 

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