Jul 23 / Natalie Weller-Cliff

Do we have a problem with pain?

There’s a new kid on the block when it comes to canine behaviour: pain.
Ever since Mills et al published their (oft-misquoted) 2020 paper on pain and problem behaviour, the professional community has been getting steadily ever more obsessed with it. But I find myself wondering why the role pain plays has been suppressed for so long. And how comfortable are canine caregivers with the idea of pain?

Ignoring the obvious
The first question to ask is why wouldn’t dogs feel pain? Just like we humans do? There is little risk of anthropomorphising or projecting when it comes to the ability to feel pain. We are biologically very alike. As Gemma Hodson from All About the Dog Therapy points out, compare a human skeleton to a dog’s and you will see that it has the same components, except for the absence of clavicles in canines. We all have an abundance of nociceptors ready to signal the presence of pain wherever it’s felt.
Pain can come from injury and strains, including the impact of repetitive activity that stresses joints. It can come from medical conditions which may additionally affect the dog’s physical development, coordination, metabolism, breathing or cognition. Like us, the likelihood of experiencing some form of pain increases with age. Canine Arthritis Management, aka CAM, was created to “combat the epidemic of undiagnosed pain” in senior dogs.
Specific to the dog world, particular body shapes can make certain breeds more prone to pain and disease, as can poor breeding. I just need to say “pug” and you know what I mean.
The impact of pain
“Pain increases stress, stress increases pain” says Dr Amber Batson in her 2022 webinar, A Pain in the Neck? Links Between Behaviour & Pain in the Dog. By way of an example, she references a paper illustrating a link between increased gut permeability caused by chronic stress and altered pain perception from osteoarthritis (Turroni et al, 2021). Canine pain is a wider welfare issue, not just a health one.
Pain is not just a sensory experience, it's an emotional one too – and deeply individual. Reaney, Zulch & Mills et al (2017) confirmed that the presence of pain lowers positive affect in dogs. In other words pain makes dogs, like humans, less likely to feel enthusiastic, energetic or confident. When my own dog’s IBD flares up, it’s often sleepiness and snappiness that signal its onset.

When it comes to acting on pain however, our dogs have a problem: us.

The people problem
We’re not good at spotting it. Some pain is obvious: limping or holding up a paw, for example. But there are a whole host of other behaviours where pain may be in play that we – dog pros and guardians alike – readily attribute to personality traits.
Dog stops on walks? He’s stubborn.
Small breed barks at bigger dogs? ‘Little man syndrome’. Dog growls when you sit on the sofa? Possessive.
Dog walks away from his food bowl? So fussy!
How many of us would consider that the dog might be suffering from joint degeneration; might be protecting himself out of fear of pain; might be struggling to get comfortable; might have a gastric disorder?
Some trainers do see the signs and encourage a vet visit. But even today, to be accredited by leading UK dog training associations, there is no requirement to know the most common canine health conditions and their symptoms. Educated dog trainers learn about the role of pain as an unconditioned stimulus that can reinforce or punish behaviour. Do we have a wide enough understanding, as a professional community, of pain as a motivating operation and its behaviour altering effects (Cooper et al, 2020)?

The difficulty with diagnosis
Standard practice ahead of any training or behaviour modification is to get our dogs checked out by a vet. Once given the all-clear, I have observed a tendency to assign good health to our dogs as some kind of perma-status. We also risk turning a blind eye to the difficulty of diagnosing a patient who cannot speak. (Ok, Netflix featured a dog who appeared to communicate pain in her paw via voice buttons. But I think we may be some way off being able to send our dogs off for a chat with the doc.) Much like GPs, vets see their patients in sterile environments during a relatively brief consultation. Our dogs rarely behave normally under such conditions. Unlike GPs, vets also have to be au fait with multiple species – not just their diseases and disorders but also what normal looks like physiologically. With some conditions, there are no clinical signs. The only indication of illness are behavioural changes (Camps, Amat and Manteca, 2019).
Changes can be sudden but also subtle – noticed only by those who know the dog well, if at all, over a period of time. Vets rely on quality information from the dog’s guardian for diagnosis. Yet caregivers are the least likely to know what to look for. Where there is disagreement, asserting your opinion of your dog’s health over a medical professional’s opinion takes balls. Not even a simple pain medication trial is straightforward. Different types of pain are felt in different parts of the body: peripheral, neuropathic and possibly even social pain (McMillan F., 2020). Accordingly pain medications vary too. Have we trialled the right drug? Has the guardian administered it correctly? Have they been advised how to track and report the outcome? Was the trial long enough? Fear of pain can make changes in behaviour slow to show. Was a pain trial the best way forward compared to a manual assessment or imaging? With x-rays costing at the low end £369 (Animal Trust 2022 price list) and UK insurers excluding conditions willy-nilly, I suspect the provision of pills may, at least in some cases, be pandering to clients’ desire for a cheap solution.

Ruling in pain to rule it out
It’s not always pain causing the problem behaviour. The Mills study mentioned earlier gets regularly quoted as ‘4 out of 5 dogs with behaviour problems have underlying pain’ or similar. Whereas the study concludes there is a range of prevalence, and a wide one at that. Given that the research subjects were also ALL cases seen by university hospitals – indicating they were specialist referrals  – the upper range is unlikely to be representative of the general populace of dogs-with-issues. If you jump into Dogenius Institute student Facebook group, our very own tutor Emma Lee has dug right into the ‘dirty data’ and found a few tasty worms. The takeaway for me is that we should be mindful of Munchausen and avoid inventing a pain pandemic. For the dog’s welfare, rule out pain as a necessary check, not a cure-all.   Pain management is not the magic button to solve all behaviour problems. It does not replace or trump the very long list of factors that need to be explored in each individual case. Even where pain is diagnosed, learnt behaviour may still need to be addressed. We should be careful as dog pros about how we raise the subject of pain with guardians. Ill health is emotionally distressing for humans. We want our dogs to be happy!
In my experience, when clients first hear that their dog may be suffering, they tend to express guilt or shame. We have to help them navigate those negative feelings and their fallout.  Is pain the panacea of behaviour problems? No. Do we need to be better at recognising it and acting on it? I think it’s painfully obvious the answer needs to be “yes.”

Batson, A., A Pain in the Neck? Links Between Behaviour & Pain in the Dog, webinar, July 2022 Canine Arthritis Management | Animal Therapy Magazine (animaltherapymedia.co.uk) – accessed July 2022
Camps T., Amat M. and Manteca X., 2019. ‘A Review of Medical Conditions and Behavioral Problems in Dogs and Cats’. Animals, 2019, 9, 1133 – accessed July 2022, available at Animals | Free Full-Text | A Review of Medical Conditions and Behavioral Problems in Dogs and Cats (mdpi.com) Cooper, J., Heron, T., Heward W. (2021), Applied Behavior Analysis, 3rd edition, Pearson
Hodson G., Dynamic Dog Practitioner course, 2022
McMillan, F., Social pain in dogs, APBC webinar, Sep 2020 Mills DS, Demontigny-Bédard I, Gruen M, Klinck MP, McPeake KJ, Barcelos AM, Hewison L, Van Haevermaet H, Denenberg S, Hauser H, Koch C, Ballantyne K, Wilson C, Mathkari CV, Pounder J, Garcia E, Darder P, Fatjó J, Levine E. Pain and Problem Behavior in Cats and Dogs. Animals (Basel). 2020 Feb 18;10(2):318. doi: 10.3390/ani10020318. PMID: 32085528; PMCID: PMC7071134 – accessed July 2022, available via Pain and Problem Behavior in Cats and Dogs - PubMed (nih.gov)
Reaney, SJ., Zulch, H., Mills, D. et al. (2 more authors), 2017. Emotional affect and the occurrence of owner reported health problems in the domestic dog. Applied Animal Behaviour Science, 196. pp. 76-83 – accessed July 2022, available at Emotional affect and the occurrence of owner reported health problems in the domestic dog (whiterose.ac.uk)
Turroni S, Pedersini P, Villafañe JH. The Human Gut Microbiome and Its Relationship with Osteoarthritis Pain. Pain Med. 2021 Jul 25;22(7):1467-1469. doi: 10.1093/pm/pnaa422. PMID: 33313892 – accessed July 2022, available at The Human Gut Microbiome and Its Relationship with Osteoarthritis Pain - PubMed (nih.gov)
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You can find out more about the work Natalie  does here: http://www.dogslikeyours.co.uk/

Natalie is currently completing our Level 6 Applied Canine Behaviour Management Diploma: https://www.thedogenius.com/course/ofqual-level-6-applied-canine-behaviour-management-2022-2025
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