Vet. Susanne Lautner, AU:
After her doctorate of veterinary medicine 1988 Susanna was working in the Department of Surgery and Ophthalmology at the University of Veterinary Medicine. In 1993 she opened her own general veterinary practice in Vienna-Hietzing.
From 2009-2011 Susanna completed the trainings for the Animal Learn dog trainer and the International Dog Trainer and opened her own dog school in 2011.
PDTE Country representative of Austria
1988 – Promotion
2 years University of Vienna, Clinic for Small Animal Surgery
Assistant in different Small Animal Surgeries in Austria
1993 – Own small Animal Clinic in Vienna specializes in: allergies, natural feeding in dogs and cats (calculated daily food rations for healthy and sick dogs and cats) surgery, skin diseases, internal diseases.
2009-2011 – International Dog Trainer with Turid Rugaas, animal – learn dog trainer
2011 – Behavior diagnostic and therapy in dogs. Puppy-/Dog school
PDTE Country representative of Austria
2013 – Dog trainer in accordance with animal welfare of Austria
Pain in Dogs
PAIN IN DOGS, DETECTION AND PREVENTION
Dr. Susanne Lautner ©Dogsymposium Holland 2017
‘Never leave a dog in pain’, veterinarian Susanne Lautner is quite clear. ‘Be aware of behavioural changes or new behaviour of your dog.’ In her opinion the quality of life for the dogs should be the central point of veterinary medicine. Launtner’s own dog, a Golden Retriever 16,5 years of age, is on painkillers since he was about 10-11 years old. Susanne is sure he wouldn’t have reached this age if he wasn’t on pain killers and regularly having a massage. He is stiff and can’t walk properly, but he still is enjoying his life.90% of the cases Susanne Lautner has as a vet, are dogs that are old or young, are fat, have no muscles, cannot walk or stand up. Most of the time the owners tell the dog is like that for a long time, he is getting old. But getting older is not a disease.
What is pain?
We humans can go to a doctor and tell what is wrong. Dogs can’t. It is our responsibility to recognize pain in dogs. According to the International Association for the Study of Pain, pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components. It is unique to each individual.
There is a sensory and emotional part to pain. The sensory part is called nociception: a neuronal transport of a painful stimulus (the place where the pain is). The unpleasant experience of this painful stimulus (e.g. damaged tissue), is the emotional part of pain. It’s how the pain feels. How does acute pain arise? The pain receptors (nociceptors) in the skin are activated by tissue damage. A signal travels up to the peripheral nerve to the spinal cord.
Within the spinal cord chemical messengers (neurotransmitters) are released. These activate other nerves that pass the signals to the brain. The thalamus relays the signals on the somatosensory cortex (sensitation), frontal cortex (thinking) and limbic system (emotional response).
Neurochemicals of pain
Pain develops because of stimuli, such as: thermic (heat), acids (toxic), mechanical problems, chemic (inflammation) or coldness. Each pain receptor can only have one stimulus. So there are different ones. In the nociceptor, the end of a nerve cell from the spinal cord, neurotransmitters are activated that make the pain travel to the spinal cord and the brain. One of those neurotransmitters is prostraglandins. To deduce prostaglandins we need a lot of things, two of them are COX1 and COX2. Later on Susanne will explain more.
Hormones inhibit the feeling of pain. If you cut yourself, at the beginning you don’t feel it.
This is because of the adrenaline of endogenous opioids. Pain inhibits via the endogenous opioid system, before you even notice. For example: a dog that has pain in the joints often is licking his paws or licking the joints where the pain is. Dogs and people have lots of these endogenous opioid receptors, from the spinal cord to the brain and in the skin. Special receptors where only opioids can connect. Endogenous opioids from the body itself, but also opioid medication, like morfine. Nowadays there is lot of research going on to block one of the special receptors. We distinguish inhibitors and initiators. Inhibitors are serotonin, endorphins, enkephalins and dynorphin. Glutamate, substance p, brandikynin and prostaglandins are initiators.
Types of pain
Pain is called acute when it lasts no longer than 1 hour or 2 days. Acute pain is a warning signal of the body, it’s good that we have it. We know where the cause is and can eliminate it; we relieve this pain so there is time to heal. For example: pain after surgery. That’s why pain killers are given before surgery, they will work when the patient is waking up. Being painless accelerates the healing process.
Chronic pain is pain that lasts more than 15 days, 1 month or 5 months. The problem with chronic pain is that the pain is winding up, when not treated. The nerve cells get sensitised, we call it pain memory. It means we feel the pain although the cause is already gone; we get ‘over painful’. Therefore we need an early invention to control pain. It contributes to survival by protecting the organism form injury or promoting healing when an injury has occurred. Chronic pain is maladaptive; an expression of the pathologic operation of the nervous system. It is ‘pain as a disease’.
Location and measurement of pain
Not all types of pain can been seen very easily. Pain can be differentiated in surface pain, deep pain and visceral pain. Surface pain is easy to locate, like pricking a finger. This pain is very quick transmitting. Deep pain is the pain in muscles, joints – mostly inflammation. This is low transmitting pain. Visceral pain is very difficult to find in dogs, it is an internal pain for example when the smooth muscles in the bladder are stretching. This pain is slowly transported. There are a lot of clinics, hospitals and veterinarians that are thinking about how to measure pain. Since 2015 there are pain guidelines for dogs and cats. For acute postoperative and chronic pains, pain scales and questionnaires with images of a dog’s expression are being used. In America the AIM OA guideline to manage pain for dogs with chronic arthritis is used very often. It includes a cloud based monthly check up, exercises at home for the owners and guidelines to report to their vets.
How do I know my dog is in pain?
Pain in dogs can only be seen in behavioural changes, next to health parameters such as temperature. So as a dog owner, you have to know what the normal behaviour of your dog is at different stages of life and have to be aware of new behaviour of your dog. For example if a dog is suddenly shaking, or lifting a paw while walking. Remember: age is not a disease. If your dog gets older and isn’t moving that well, this changing behaviour can be because of pain.
Examples of changing behaviour are: less activity, hesitant to jump in and out of the car, avoiding stairs, suddenly reacting aggressive or avoidant when approaching other dogs, shy away from petting or snatch/growl, unusual facial expression, avoiding certain walking styles, not moving fluidly, showing noticeable different body position or lameness, suddenly cry out when performing certain movements, smell increasingly worse, panting more although it’s not hot, fur gets greasy of flaky or stands up in certain areas, changing weight or eating habits. If you see two or more of these changes you should go to a vet. Be aware that you as an owner, who sees his dog every day, will not be able to see all of these changes. Ask your friends if they do. For instance: a dog with hip problems will com- pensate by moving his body weight to his front legs. Eventually he gets problems in the front legs, but the actual problem are his hips.
Indicators of pain
Orthopaedic pain can be recognized when a dog shows lameness, has a relieving body posture and/or an altered walking pattern. For instance when a leg is hurting they will lift it up, or not use it while peeing. But not using some body parts can lead to muscle atrophy, the dog will lose muscles. A dog in chronic orthopaedic pain will not follow you around as much as he used to and can be licking his joints/paws. Other indications can be: avoidant movements, aggression, also towards familiar dogs, snatching when touched, or when the dog is passed by people. Dogs in pain are likely to sleep more and drink more. Increased belly breathing, heavy breathing or oxygen deficiency are indicators for pain in the chest region. For example: broken ribs, heart failure. A dog that does not like to be touched, carried, held or pet can also have pain in the chest region.
Belly problems can be recognized by a dog standing in the praying position (to relieve the abdominal region), a drawn-up belly. A dog with belly problems does not like to move, is heavily breathing, vomiting and has diarrhoea or doesn’t like to be pet or touched. When a dog has half closed eyelids, is resting his head against walls or in corners and has a ‘pain face’ he most likely has a head ache. This pain is very difficult to find out in dogs. Aggressive behaviour or lying in quiet, dark and cave-like places are other indicators a dog is suffering from a head ache. Light is affecting them.
A decreased appetite, drooling, head-rubbing, crying and snatching when pet, are indicators for a dog in toothache. When a dog is suffering from earache he will be head- shaking and rubbing or tilting the head, scrubbing the ears and will be sensitive to touch. A blood ear will make the ear and vessels swallow up.
Avoiding potential causes
To protect the joints, be sure you are giving your dog a careful warm up. Don’t start ‘cold’ when there is not enough liquid around the joint. Avoid unnecessary commands like sit or lie down, especially when a dog is older. Use a body harness instead of a collar and no auto- retracting leashes. Rethink dog sports, these are mainly about trophies for owners.
Dogs are not born to jump or run and stop suddenly or run next to a bicycle. Throwing a Frisbee or balls are non-appropriate strain movements, avoid them. Adrenaline and cortisol temporarily relieve pain; that’s why you have to avoid stress. Feed your dog properly, be sure your dog gets easily digestible meals, not too cold and let your dog rest afterwards. Provide a soft warm bed to sleep on, and buy an appropriate size: the dog has to be able to stretch out. Visit your vet regularly, so your vet knows the condition of your dog in good health and he is able to check blood, make an echocardiography if necessary and provide vaccination or anti- parasite medication which fits your dog. Do not support defective breeding of pugs, English Bulldogs, German Mastiffs or mini- dogs. Be sure you cover all the needs of your dog, like feeding, sleeping, warm and dry environments, little stress, lovingly treatment and enough sleep.
Diagnose and treatment
When a dog shows some pain, we need a proper diagnose: where it is, why it is. Vets can use X-Rays for bones and lung problems, an ultrasound for heart failure and problems in the abdominal region, MR or CT and blood tests. Pain management is the central component of veterinary medicine. The aim of all vets should be ‘a life worth living’: a good quality of life for every animal.
Why should we treat pain? Many people think, if a dog is not moving that much, he is in less pain. In the older days, when you did surgery on an dog, the vets didn’t give pain killers because they said: when it is painful
they don’t move so much and when they don’t move so much they can be better. That’s crazy. We do treat pain because of animal welfare off course, because of the pain memory and stress response.
Remember: pain is always stress. Dogs that are in pain, don’t eat. Within 24 hours of surgery a dog should be eating, because eating provides more and better healing. Dogs that don’t have appetite are not feeling good, and not feeling good means loss of muscles, they don’t heal that quick. Being painless increases the healing process, appetite, and leads to less muscle atrophy; the dogs feels well. Feeling well already relieves pain and prevents the pain memory.
There a lots of treatments, of course there is medication. Such as: opioids, they block the pain receptors which means you don’t feel the pain. NSAIDS inhibit the synthesis of the neurotransmitter prostroglantin. NSAIDs inhibit COX1 and COX2, which means NSAIDS stop the pain travelling to the brain and are anti-inflammatory (they increase the healing process). It depends on the dog and the doses, but these NSAIDS can have side effects.
Other ways to treat a dog are: local anaesthetics or local anaesthetics combined with skin injections, ketamin, general anaesthetics, peripheral nerve blocks, plexus block, neuro axial blocks such as a spinal or an epidural block. With surgery the cause of the pain can be reduced when a dog has trauma’s, fractures or tumors, etcetera. Two of the newest techniques to treat arthrosis and arthritis are stem cell injections to cure or relieve arthrosis and Autologous Conditioned Plasma (ACP): a platelet-rich plasma that is extracted from autologous blood using centrifugation is injected in the joints.
Each dog will react differently to type and dosage level of pain medication. That’s why a dog owner always has to monitor his dogs response. Never give medication on an empty stomach, 99% of the dogs will get problems. Susanne Lautner also stresses the importance of never stopping the medication when a dog is feeling better, then his good quality of life is beginning again. When the acute pain is gone, there are other manual techniques such as massage to help manage and relieve the chronic pain. But: a proper diagnose from a vet is important before you contact a physiotherapist or other manual therapist.
Modification of the environment
For dogs in chronic pain, modification of the environment is another way to manage the pain. Elevated food and water bowls, steps, ramps, special harnesses can help a dog that is less able to move around. Choices in dog beds and places to lie is important: dogs that are in pain like a cold floor, it reduces the inflammation. Different food may be needed.
Changing the walking pattern can give some relieve: walking slowly with friends, sniffing, looking around, resting with friends and sleeping together can be very pleasant. It’s all about doing things most loved in live. Mental stimulation is important as well. An enriched environment, or treat search affects the hormones serotonin, endorphins and oxytocin. They make a dog feel better, loved and feeling less pain.
©Images: Susanne Lautner