One of the most common concerns and one of the big decisive factors regarding euthanasia is pain.  The amount and degree of pain and discomfort is a big factor in the quality of life of a pet and no loving pet owner wants his pet to suffer.  However, we can easily be blind to our pet’s suffering.  The reason is that pets are experts at hiding their pain for 2 main reasons:  Instinctively, they know that, in the wild, if they show any sign of weakness or pain, they will be killed either by a pack leader or by a predator.  The other reason is particularly true for dogs since they are pack animals.  They consider us part of their pack and they love us.  They do not want to weaken us and therefore will do everything they can to hide their pain and weakness in order to protect us.  


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.

Please note that cats manifest pain in different ways than dogs do.  Dogs tend to be restless when in pain.  They pant, they pace, they are unsettled...  While cats, when in pain, then do be withdrawn, introverted and very still. 

  1. Pain-facial tension, almond shaped eyes, panting, can't rest comfortably 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. Facial tension
  11. Accepting treats or food gingerly (particularly if pet used to accept them enthusiastically) Pain-almond shaped eyes, facial tension, panting, protecting area, droopy ears, low head
  12. Lack of interest in walks
  13. Doesn't respond when called
  14. Worried or sad facial expression
  15. Ears pulled back or flattened
  16. Eyes wide open to expose “white of the eye”
  17. Avoidance of direct eye contact
  18. Lips may be retracted, exposing the teeth in a submissive grin (dogs)
  19. Almond shaped eyes (caused by facial tension)
  20. Whiskers pulled back against cheeks (caused by facial tension)
  21. Uncomfortable when resting
  22. Shifts frequently when resting
  23. Head held abnormally low Pain-Sad look, droopy ears, limping
  24. Difficulty getting up
  25. Excessive panting (particularly when it is not hot)
  26. Shivering/trembling/shaking
  27. Unsettled
  28. Pacing
  29. Difficulty moving after a long rest
  30. Difficulty lying down
  31. Slow or unusual gait
  32. Limping
  33. Hunched back
  34. Compulsive licking or rubbing of a certain body part
  35. Looking at sides or other body part suddenly and/or worriedly 
  36. Suddenly running away from “nothing in particular”  Pain-tucked tail, can't get up, droopy ears
  37. Can't jump on couch or bed
  38. Reluctance to lie down
  39. Sleeps in a position that avoids a certain body part from touching the ground or bed
  40. Any change in normal sleep patterns
  41. Purplish tongue color (NOT gums:  tongue)
  42. "Guards" a particular body part
  43. Reluctance to be touched in a certain area
  44. Reluctance to be picked up Pain-facial tension, almond shaped eyes, whiskers flat on cheekd, protecting painful area, can't rest comfortably
  45. Lying down at a distance from everybody and somewhat isolated
  46. Disinterested in surroundings
  47. Unusual attention seeking
  48. Flinching when touched in a certain area
  49. Doesn't rest easily when lying down
  50. Aggressive behavior to protect a particular area
  51. Aggressive behavior on a usually docile pet
  52. Crying when a particular area is touched
  53. Wakes up at night
  54. Does not sleep well
  55. Refusal to go on walks
  56. Moaning
  57. Whimpering
  58. Refusing to eat Pain-sad look, does not want to play
  59. Pressing head against wall (if head pain is present)
  60. Unable to get up
  61. Crying in pain
  62. Teeth clenched, biting down on an object (particularly cats)
  63. Howling/screaming uncontrollably

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 Pain-worried look, droopy ears, can't get up 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 pain-tucked tail, droopy ears, head held low, sad look, limping 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 A purplish (not blue) tongue can be a sign of chronic, unmanaged pain 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.

It is recommended that, when assessing your pet's pain, you rate each indicator above with a score from 0-10 (0 being that the symptom is absent and 10 being maximum manifestation of the symptom).

Please see the "Home tests" page where you will find the list in a table format ready to print and check off each symptom.

Keeping track of these symptoms and how their intensity varies throughout the course of the disease your pet has will help you monitor the progress and the success of any pain management being conducted.

Additional comments on pain

Chronic, unmanaged vomiting 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.  

Chronic, untractable pruritus (itching) 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.