What is the appropriate management for pain in a dog?

Pain Management in Dogs

For pain management in dogs, use NSAIDs (specifically carprofen) as first-line therapy for most painful conditions, combined with multimodal analgesia including opioids for moderate-to-severe pain, following a preemptive rather than reactive approach.

Assessment and Recognition

Pain assessment in dogs requires systematic observation since they cannot verbalize discomfort 1. The most reliable clinical indicators include:

• Vocalization (whining, crying, growling) 2
• Response to palpation or handling of the affected area 2
• Mental depression or behavioral changes 2
• Immobility or altered gait 2
• Altered respiration patterns 2

Assess pain at every veterinary visit and whenever new therapy is initiated 3. For chronic pain specifically, owner evaluation using validated pain-assessment instruments is essential 3.

Pharmacologic Treatment Algorithm

First-Line: NSAIDs

Carprofen is FDA-approved for oral use in dogs and represents the standard NSAID option 4. NSAIDs are widely used for painful or inflammatory musculoskeletal disorders, with phenylbutazone, aspirin, and pentosan polysulphate also commonly employed 2.

• Start with carprofen 75 mg chewable tablets (dose adjusted to patient weight) 4
• NSAIDs are more widely used in dogs than cats 2
• Monitor for gastrointestinal and renal adverse effects 2

Second-Line: Opioid Analgesics

For moderate-to-severe pain, add opioid therapy 3:

• Pethidine and buprenorphine are the most commonly used narcotic analgesics in dogs 2
• Administer doses before anesthetic recovery for surgical procedures 2
• Opioids are used more widely in dogs than in cats 2

Multimodal Approach

Combine pharmacologic agents preemptively rather than waiting for pain to develop 3. The 2022 AAHA guidelines emphasize proactive, preemptive pain management over reactive "damage control" 3.

Procedure-Specific Recommendations

Analgesic use rates vary significantly by procedure 2:

• Acute severe trauma: 94% of veterinarians use analgesics 2
• Cruciate ligament repair: 60% 2
• Perineal herniorrhaphy: 29% 2
• Ovariohysterectomy and castration: ~5% 2

This low usage for routine surgeries is inappropriate—analgesics should be used for all potentially painful procedures 3, 2.

Chronic Pain Management

For chronic pain conditions 5:

• Utilize licensed treatments first when available 5
• Incorporate non-pharmacological therapies (physical rehabilitation, acupuncture, weight management) into every chronic pain plan 3, 5
• Consider trial analgesic therapy when neuropathic pain is suspected based on history 1
• Titrate dosing to patient needs while avoiding adverse effects 1
• If one analgesic class is ineffective, switch to an alternate class 1

Glucocorticoid Use

For specific inflammatory conditions 2:

• Prednisolone is the preferred glucocorticoid for allergic/pruritic dermatoses 2
• More than 90% use glucocorticoids for immune-mediated hemolytic anemia or thrombocytopenia 2
• Alternate-day administration is favored for long-term enteral steroid therapy 2

Critical Pitfalls to Avoid

• Never withhold analgesia from routine surgical procedures like spays and neuters—this outdated practice persists despite clear evidence of pain 2
• Do not rely solely on behavioral changes—dogs may mask pain as a survival instinct 1
• Avoid reactive pain management—preemptive analgesia is more effective 3
• Do not use single-agent therapy when multimodal options are available 3