Very rarely will a pet whimper or cry in pain.  When he or she does, the degree of pain is considerable.  Therefore, we must be alert to indicators of pain because they can be quite subtle.  Many misguided pet owners tell me that they don’t think that their pet is in pain, yet the pet is showing many symptoms that the owners are not aware are pain indicators.  

Therefore, I have put together a list of pain indicators that will help you to decide whether or not your pet is in pain.  The list must be evaluated as a whole and of course there is a gradient of severity of each symptom.  I do hope this will be a helpful guiding tool.

1. Droopy head
2. Droopy ears
3. Tucked tail
4. Does not want to play
5. Lack of social interaction
6. Does not enjoy games
7. Subtle lack of alertness gradually increasing to a deep apathy (early sign will be subtle)
8. Diminished appetite
9. Body tension
10. Accepting treats or food gingerly (particularly if pet used to accept them enthusiastically)
11. Lack of interest in walks
12. Doesn't respond when called
13. "Worried" or "sad" facial expression
14. Uncomfortable when resting
15. Shifts frequently when resting
16. Difficulty getting up
17. Excessive panting (particularly when it is not hot)
18. Shivering/trembling
19. Unsettled
20. Pacing
21. Difficulty moving after a long rest
22. Difficulty lying down
23. Limping
24. Hunched back
25. Compulsive licking or rubbing of a certain body part
26. Looking at sides or other body part suddenly and/or worriedly
27. Suddenly running away from “nothing in particular” (particularly cats)
28. Can't jump on couch or bed
29. Reluctance to lie down
30. Sleeps in a position that avoids a certain body part from touching the ground or bed
31. "Guards" a particular body part
32. Reluctance to be touched in a certain area
33. Reluctance to be picked up
34. Lying down at a distance from everybody and somewhat isolated
35. Disinterested in surroundings
36. Flinching when touched in a certain area
37. Doesn't rest easily when lying down
38. Aggressive behavior to protect a particular area
39. Aggressive behavior on a usually docile pet
40. Crying when a particular area is touched
41. Wakes up at night
42. Does not sleep well
43. Refusal to go on walks
44. Moaning
45. Whimpering
46. Refusing to eat
47. Pressing head against wall (if head pain is present)
48. Unable to get up
49. Crying in pain

These pain indicators have been placed more or less in a gradually increasing pain order.  The severity of the pain is not necessarily exact and proportional to this scale.  Some pets will display certain symptoms earlier than others.  For example, some pets will lose their appetite sooner than other pets who are more “food motivated”.  Some more sensitive breeds (for example like chihuahuas or miniature/teacup poodles) will cry or scream out of fear without a great deal of pain while the more stoic breeds won’t cry unless the pain is unbearable.  So, this scale is not necessarily of an unvarying nature, but is true for most pets and knowing this information will raise your awareness on the way pets display pain and may alert you early in the process and may allow you to bring up pain management to your veterinarian earlier rather than later, thereby saving your pet from untold pain in the suset of his or her life.

Please remember that a single yes answer does not mean that your pet’s quality of life is poor.  It depends on the degree to which the pet exhibits the symptom and it depends on the symptom.  For example, if a pet cries, it is a more severe symptom than if the pet’s head or ears droop.  However, subtle symptoms should not be ignored especially if several of those symptoms are present.  Do not disregard uncharacteristic behavior on your pet's part.  He might be telling you something.  It could be pain, illness or something else.  It is worth bringing it to your veterinarian's attention.

Pain killers can be quite effective at handling pain and can restore your pet’s quality of life, at least temporarily.  If you notice one or more pain indicator listed above in your pet, please discuss this with your primary veterinarian to see if a simple pain killer would be appropriate to try on your pet.  Sometimes, the only way to see if a symptom or behavior is pain related is trying pain killers to see if the symptom or behavior disappears.  If it disappears with the use of a simple pain killer, chances that this was a pain indicator.  However, there will come a time when even the strongest pain killers will be ineffective and you will have to consider the option of euthanasia.

Additional comments on pain

In the section dedicated to pain we discuss manifestations of pain in pets.  There are other factors that may not be considered pain per se, but that produce such discomfort that it can be equated to a peculiar kind of pain.  Some examples of these factors are pruritus (itching), nausea, anorexia (lack of appetite), lack of oxygen intake, weakness and various disabilities.  Each of those factors may not be sufficient ground to consider euthanasia, but pushed to an extreme, they can be.  

For example, a pet with chronic allergies who gets no relief from itching no matter what medications are used may be miserable and this may be grounds for considering euthanasia.  Also, it may be very expensive and very time consuming to ADEQUATELY care for a pet with a disability or chronic illness.  If you are not able to provide that level of care or a level of care sufficient to make the illness tolerable, it may be kinder to opt for euthanasia.  

Anorexia and lack of hydration will lead to other pains and discomforts:  stomach pain, headaches, dry mouth, sores, disorientation, lightheadedness, weakness, etc...  

Constant or frequent intermittent nausea can be considered to be a particular kind of pain.  

Lack of adequate oxygenation has also been described as a peculiarly painful sensation by many cancer and cardiac patients in the human medical field and is now acknowledged as a sort of pain.

Therefore, all serious unpleasant sensations have to be taken into consideration when one is evaluating pain in relation to Quality of Life.

I hope that the above has been helpful to you and will help you make the right decision at the right time.