The Difficulties of Chronic Pain
Why Chronic Pain Can’t Be Reliably Assessed in a Veterinary Clinic
For many dogs, pain is not something that can be neatly identified in a single veterinary appointment. Research and common sense both tell us that chronic pain cannot be effectively assessed in a clinic setting. This isn’t due to lack of skill or care on the part of veterinarians, but because the context itself makes accurate assessment nearly impossible.
1. Pain is context-dependent
Pain behaviour changes depending on where the animal is and how they feel about that place. A veterinary clinic is unfamiliar, often noisy, and filled with scents of other animals. Most dogs experience a degree of stress or fear there, and that stress can temporarily suppress outward signs of pain, a protective “survival mode” response. In evolutionary terms, showing weakness in a threatening environment would make an animal vulnerable.
2. Adrenaline masks pain
When dogs are stressed, adrenaline and cortisol rise sharply. These hormones dampen pain perception, allowing the dog to move, walk, and appear “normal” even when they are not. It’s common for a dog who limps at home to walk almost soundly in the clinic. This physiological masking effect can last for hours.
3. Static, short-term assessment
A veterinary consultation usually lasts 10–20 minutes and occurs in a small room. Chronic pain, however, is a condition of patterns, subtle changes in posture, behaviour, mobility, sleep, and mood over time. These signs are best observed by the people who see the dog daily, not in a single static exam.
4. Handling suppresses behaviour
In the clinic, dogs are often restrained or held for examination. Even gentle handling can cause them to freeze, shut down, or enter “appeasement” mode. A dog that is tense or compliant under restraint may appear cooperative but is actually suppressing communication. That stillness can be misread as calmness or comfort, when it’s really the opposite.
5. Environmental flooring and space
Clinic floors are typically smooth and slippery, and rooms are small. Dogs who are cautious about movement, weight-shifting, or joint pain will move differently in this setting not because they are pain-free, but because they are trying not to slip. Lack of space also prevents normal gait observation or free movement, both of which are essential for accurate pain assessment.
6. Dogs rarely yelp in chronic pain
Yelping is an acute pain response, a reflex to sudden, unexpected pain. Chronic pain is different. It develops slowly, often affecting multiple systems. Dogs adapt by changing how they move, sleep, interact, or express emotion. They may become quieter, withdrawn, restless, irritable, or reactive. Chronic pain alters the nervous system gradually, and because it becomes the “new normal,” dogs stop signalling it in obvious ways. In fact, animals that live with ongoing discomfort often show less vocalisation, not more.
8. Behaviour is the most reliable indicator
The most accurate information about chronic pain comes from behavioural change, reluctance to jump, shorter walks, altered posture, increased irritability, licking or chewing at body parts, or changes in sleep and play. These are observations that require time, context, and familiarity. Owners and behaviour professionals who see the dog at home are best placed to provide this evidence, while vets interpret it alongside clinical findings.
You cannot reliably assess chronic pain in a short, high-arousal clinical visit. Stress hormones, restraint, environment, and context all interfere with true pain expression. Defensive behaviour often reflects discomfort, not defiance, and the absence of yelping does not mean absence of pain.
Pain hides best under pressure and the clinic is full of pressure.
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