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How Your Dog Tells You He's in Pain

Your pup can't tell you how he's feeling, and most dogs in pain won't whine or cry until it becomes intolerable. So how can you know when your pet needs help? The answer may lie in this indispensable five-point pain scale and knowing your dog's subtle clues.

csu pain scale dog


  • It can be challenging for both pet parents and veterinarians to assess pain in dogs, since they can’t tell us if or how much they hurt
  • Signs of pain to watch for in your pet include trembling, favoring a leg, crouching and excessive panting
  • Increasingly, veterinarians are using pain scales to assess discomfort in their patients
  • A recent study suggests dogs who develop noise sensitivity later in life should be assessed for a painful condition
  • Treatment for your dog’s pain will depend on what’s causing it; there are a number of integrative therapies that can be beneficial

Editor's Note: This article is a reprint. It was originally published March 13, 2019.

Because humans rely so heavily on spoken communication, it can be challenging at times to understand what's happening with the nonverbal members of our families — the ones covered in fur who bark but don't talk. This can be particularly stressful in situations where a pet may be ill or hurting.

To further complicate matters, dogs are generally thought to have a higher tolerance for pain than humans do, and many actually try to hide their discomfort as a natural survival instinct.

Signs to Watch for

Determining if your dog is hurting is all about picking up subtle cues. Generally speaking, dogs in pain often look sad or tense. But since they typically don't whine or cry unless they're in tremendous pain, here are some other signs to keep an eye out for:1

  • Lack or loss of appetite
  • Not greeting you as usual
  • Trembling/shivering
  • Crouching
  • Not bearing weight on a leg
  • Taking longer than usual to urinate or defecate
  • Reluctance to climb up or down stairs
  • Excessive panting

How Your Veterinarian Assesses Your Dog's Pain

Unlike in human medicine, our veterinary patients can't tell us in words how much they're hurting, so pain scoring is by necessity done primarily through observation. Since every animal is an individual with a specific pain threshold, to use pain scoring effectively, we must observe the dog before painkillers are given and before any procedure is attempted, no matter how minor (e.g., a blood draw).

We also need to apply some science to the art of observation when determining a dog's pain score. We need to know average pain levels for the condition the animal has or the surgery about to be performed, and factor those into the equation. This is necessary because many dogs are stoic even when in significant pain.

Pain scales such as Colorado State University's (CSU) below were developed for use by veterinarians and their staffs, but they can also be helpful for pet parents who want to learn what signs to look for to determine if their dog might be in pain.2

  • Pain score: 0 — No pain present. The patient is happy, acts normally, moves comfortably, has a normal appetite and (if applicable) does not bother the surgery site. TPR (temperature) is normal.
  • Pain score: 1 — Mild pain present. This is usually displayed by a slight limp, difficulty getting up or down, or a slight increase in TPR. The patient is eating, tail wagging and not depressed.
  • Pain score: 2 — Moderate pain present. The patient shows sensitivity and may lick or chew at the surgical site or wound. The patient may refuse to eat and may seem depressed, and has slow, shallow respirations.
  • Pain score: 3 — Severe pain present. Signs include depression, reluctance to move and sensitivity at the surgical site or wound. The patient will usually not eat, may vocalize and may lie down but not sleep.
  • Pain score: 4 — Excruciating pain present. The patient shows all the signs described with a pain score of 3, in addition to intermittent panting, increased TPR — even at rest — constant vocalizing, profound depression, dilated pupils, aggressiveness and deep breathing.

You can see the full detailed CSU pain scale, which include rough drawings of how your dog might appear with a pain score of 0, 1, etc.: Canine Pain Scale.

Another Sign of Pain in Dogs: Noise Sensitivity

A 2018 study recommends that dogs who display fear or anxiety when they hear loud or sudden noises should be assessed for pain.3 The researchers found that dogs with musculoskeletal pain developed a greater sensitivity to noise. According to ScienceDaily:

"The researchers believe that pain, which could be undiagnosed, could be exacerbated when a noise makes the dogs tense up or 'start', putting extra stress on muscles or joints which are already enflamed, causing further pain. That pain is then associated with a loud or startling noise, leading to a sensitivity to noise and avoidance of situations where they had previously had a bad experience — for example a local park, or a louder room in the house."4

The researchers looked at the veterinary records of 20 dogs diagnosed with noise sensitivity by clinical animal behaviorists at the University of Lincoln in the U.K. The dogs were divided into two groups: 10 who had also been diagnosed with musculoskeletal pain (hip dysplasia, arthritis and focal spondylosis), and 10 control dogs without pain.

All 20 dogs showed noise sensitivity symptoms that included trembling, shaking and hiding. However, the painful dogs showed an increased level of avoidance of places where they had a bad experience with noise. Sensitivity triggers included fireworks, thunderstorms, airplanes, gunshots, cars and motorcycles.

The study also revealed that the age of onset of noise sensitivity in the painful dogs was on average about 4 years later than the dogs in the control group. In addition, the dogs with diagnosed pain generalized their noise sensitivity to related environments and avoided other dogs, which didn't happen with the control dogs. More about noise sensitivity in dogs and how to manage it.

Treating Your Dog's Pain

How your pet's pain is managed will depend on what's causing it. That's why it's crucially important to make an appointment with your veterinarian for a thorough exam, which will go beyond a visual pain assessment to look for the underlying root cause. Once your vet has evaluated your dog and depending on the source of his discomfort, there are a number of integrative therapies that blend nicely to reduce the amount of medications needed to manage pain, including:

  • Chiropractic
  • Therapeutic massage
  • Stretching
  • Acupuncture
  • Laser therapy

There are also some newer therapies I've used with good success, including the Assisi Loop, a form of pulsed electromagnetic field therapy. In addition, there are a variety of beneficial supplements you can add to your pet's diet, again depending on his diagnosis and treatment protocol.

Sources and References

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