Neuropathic Pain in Dogs

Neuropathic Pain in Dogs - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost

What is Neuropathic Pain?

Research of the neurobiological mechanisms of neuropathic pain is an area of science where the input of human experience is being utilized to help the advancement of care for our animal friends. Neuropathic pain can take many forms, which cannot be described to us by our dogs, such as burning or stabbing. The veterinarian, of which it's important to pick a doctor with some experience in this particular field, will analyze the existence of this chronic pain in your dog by looking at your pet’s history, and checking causes like an identifiable lesion, and through a neurological examination to rule out other possible causes of pain. A combination of both medication and therapy such as acupuncture will be suggested upon identification of neuropathic pain.

Neuropathic pain is caused by an abnormality in the day to day function of the peripheral or central nervous system. In most cases, this type of pain is ordinarily chronic in nature. Because our pets are unable to verbalize their discomfort, the pain of a neuropathic origin can be difficult to diagnose, thus making a visit to the veterinarian paramount to your dog’s health. Although your dog will not be able to explain to you of the severity of the pain, he deserves to be relieved of it.
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Symptoms of Neuropathic Pain in Dogs

It is known that neuropathic pain in dogs is a condition that may be difficult to recognize. As a pet owner, you know your dog best and must seek veterinary advice if you feel that your dog is suffering from pain:

  • One of the most obvious signs will be a change in your pet’s behavior
  • Change in mood and vitality
  • Low tolerance to activity, especially exercise - no matter how light
  • Licking an area constantly
  • Vocalization of pain
  • Possible lack of appetite
  • Change in urinary habits or bowel movements, including accidents in the house
  • Noticeable change in posture
  • Difficulty walking or standing up
  • Trouble with jumping or managing stairs

Perhaps less obvious to you are the following symptoms of neuropathic pain:

  • Your pet may exhibit a painful reaction to non-painful pressure such as touch (allodynia)
  • Your dog may feel a heightened sensitivity to pain (hyperalgesia)
  • Your dog may pull back from you when your are giving him attention due to extra sensitivity to touch and sensation (hyperpathia)

Causes of Neuropathic Pain in Dogs

Simply put, neuropathic pain occurs when the pain moves from the original source and the neural pathways become unusually sensitized. The pain then occurs with or without stimuli. Some causes for neuropathic pain are listed below:

  • Spinal tumor
  • Injury to the spinal cord
  • Injury to the peripheral nerves such as cauda equina syndrome (pressure and swelling of nerves)
  • Phantom pain resulting from a limb amputation
  • Intervertebral disk herniation
  • Hypothyroidism
  • Diabetes

Diagnosis of Neuropathic Pain in Dogs

When you bring your dog to the clinic, be prepared to discuss with the veterinarian a complete history of your dog’s past and present experiences. Because your pet is unable to speak for himself, you must be vigilant and as thorough as you can be when explaining the situation.

You may be asked the following questions:

  • How long has the pain been obvious to you?
  • Is the pain intermittent or continuous?
  • Do you notice any specific areas where the pain may be originating from?
  • Has your dog recently, or in the past, been ill or injured?
  • Does your pet vocalize pain when you least expect it?

The determination of the presence of neuropathic pain is often diagnosed by recognizing abnormal behavior. Together you and the veterinarian will observe your pet and use various stimuli to diagnose neuropathic pain:

  • Pain response to non-painful stimulation such as touch (allodynia)
  • Heightened sensitivity to pain (hyperalgesia)
  • Excessive sensitivity to touch, pressure, stimulation (hyperpathia)

Tools that may not cause a high degree of pain in a normal patient, but can cause extreme discomfort to a pet in a neuropathic state may be a pinprick, thermal heat or cold, stroking an area with gauze or cotton, and applying pressure.These assessments are crucial to diagnosing a case of neuropathic pain.

The veterinarian may decide to do blood tests or x-rays to look for lesions, infection, or to rule out other possible causes or symptoms of pain before confirming a diagnosis of neuropathic pain.

Treatment of Neuropathic Pain in Dogs

If we compare the treatment of human neuropathic pain to the same sort of constant pain in our dogs, the common goal of treatment is to provide as much relief as possible. In humans, neuropathic pain is determined on these deciding factors:

  • There may be accompanying swelling
  • There can be pain but no tissue damage with it
  • A lack of some sensations may be evident
  • The pain can come in sudden jolts and spasms
  • allodynia, hyperalgesia, and hyperpathia are present
  • the pain burns, stabs and tingles

If you think about the factors mentioned above, one can imagine the difficulty in treating neuropathic pain. Studies show that the best forms of managing this type of pain is a combination of drugs and non-pharmacological therapy. Some of the options include:

  • Opioids
  • Anti-inflammatories
  • Local anaesthetics
  • Massage
  • Acupuncture
  • Anti-epileptics

As this field is under constant study, the veterinarian will discuss with you the options available. It should be noted that finding the right mix and balance of medication will take some time, and your cooperation and the documentation of improvements in your pet’s behavior will be invaluable information for the primary veterinary caregiver.

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Recovery of Neuropathic Pain in Dogs

Follow up with the veterinarian on a daily to weekly basis will be required when the drugs are being tailored to the needs of your pet. Avoidance of adverse side effects is important. Because different dogs respond in various ways to pain, we must remember that neuropathic pain management is really an individual case by case scenario.

The behavior of your dog as he responds to the pain management treatment will be key to deciding if the protocol being followed is the best one for your pet. Daily observance of your dog is necessary, as is reporting all changes, whether positive or negative, to the veterinarian. You should be aware that neuropathic pain does not usually resolve, resulting in lifelong pain management.

Neuropathic Pain Average Cost

From 17 quotes ranging from $3,000 - $6,000

Average Cost

$3,800

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Neuropathic Pain Questions and Advice from Veterinary Professionals

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Bulldog

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Gladys

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6 Years

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My pet has the following symptoms:
Muscle Atrophy
Ataxic
Facial Paresis
Progressive Hind Leg Weakness
I believe my dog suffered a neck trauma while she was lying on her back and I was cleaning her teeth. When she got up, she seemed dizzy and she couldn't walk straight - she also had nystagmus. After a month of the vet doing nothing under the impression she was suffering from idiopathic vestibular disease, she began to lose the use of her facial muscles and struggled eating and drinking. I requested that she be given prednisone which had an immediate positive effect. However, every time we reduce the steroid amount, she seems to relapse therefore, I believe the steroid is treating the symptom rather than the cause. Could she have suffered nerve damage due to a neck injury? Could this progressively get worse? Is there a treatment available for pinched/damaged nerves that does not involve high-dose steroids? The nystagmus only lasted a few days and she could cope with short wobbly walks but her difficulty eating and drinking is affecting her quality of life. Any ideas would be much appreciated.

Aug. 24, 2018

Answered by Dr. Michele K. DVM

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From your description, it might be a good idea to have a consultation with a neurologist. Those are strange signs, and dogs don't typically have nystagmus from a nerve or disc problem. Nystagmus happens if the vestibular system or brain is having a problem. A neurologist will be able to localize the problem more clearly and give you an idea what might be able to be done for Gladys.

Aug. 24, 2018

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mini schnauzer

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Camo

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11 Years

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My pet has the following symptoms:
Hind Limb Paralysis
Hello! Camo is a neutered male mini Schnauzer mix aged about 10-11 yo. In 2009 he was probably 2-3 and began having seizures. Vet placed him on K Bromide, it did not alleviate seizures so I discontinued it after four months. Lethargy appeared along with seizures and has increased with time while seizures rarely occur any more and when they do they are mild and transient. Poor spatial sense developed as well as stiffness in neck and sadly hypersensitivity to gentle touch on neck as well as forelimbs. Exaggerated pain response is VERY evident in forelimbs, over time slight bowing of forelimbs has occurred with a limp/shuffle predominantly on left side of body. Left eye is prone to conjunctivitis like symptoms; thick ropy mucous overproduction in left eye only and only occurs intermittently since Spring 2018. Progressive paralysis of rear legs, extreme sensitivity to heat, sun, and now has advanced to intolerance of even moderate climate changes. Intermittent tremors, visible muscle spasms in both rear legs. Inability to sense left rear leg, probounced knuckling of left leg if he has a good day and can stand on his own. Known skeletal problems: expanded cervical vertebrae which impacted spinal cord, surgery performed April 2018 to decompress region, fenestration of surrounding vertebrae done as well to prevent future constriction of cervical spinal cord. Confirmed IVDD in caudal region, surgery was recommended and will likely occur before Christmas. Voracious appetite to the point of pica along with excessive lethargy and incessant panting led to diagnosis of Pituitary Dependent Cushing’s 2015 and subsequent treatment with daily Trilostane for approximately two years. Exercise intolerance increases with time. Within the past 2 years Camo has had repetitive functional urinary retention which progressed to requiring manual expression several times daily. Distended abdomen, oversize bladder that has thickened, swollen kidneys and consistently high liver values. Fecal incontinence development since 2015; and seems unaware that he is pooping whatsoever most of the time. Cervical decommission surgery did allow him to sometimes recognize he needs to poop and he does alert me on those times otherwise he is just as surprised as I am when poops come out. Joint supplements were suggested by vet and given by me once per day for at least 18 months from 2015-2017. Supplements had MSM, Boswellia, Glucosamine Chondroiton in a base of desiccated beef liver. Canned pumpkin added to diet in order to regulate unpredictable irritable bowel episodes. Fed consistent diet of Orijen Senior dry kibble for several years, recently switched to organic turkey breast meat or organic chicken boiled at home w safe fruits and veggies like apple slices, blueberries, spinach, chia seeds, etc. Current medications are: 1mg diazepam 3x daily for bladder emptying but I have seen no improvement of sphincter release even on 2mg 3x daily. Prazosin 1mg 2x daily, caused extreme loss of gait control as well as narcolepsy and syncope. Dropped Prazosin dose to 1mg once daily but still seeing bad side effects with zero therapeutic effects. Gabapentin 100mg 2x daily, does not appear to ease his hyperesthesia nor general disconfort, causes coma-like state so dropped dosage to .75mg 2x daily hoping to reduce his time spent in a drugged out daze. Anipryl once daily dose for 20 lb canine since April 2018 with an incredible improvement of his overall happiness and seemed to relieve some pain too, but fizzled out by late July and now seems as ineffective as giving him a placebo, but displays noticeable withdrawal signs if Anipryl is withheld so still taking it daily despite loss of therapeutic results. On to therapy: After three weeks of strict post surgical crate rest began with ROM exercises several times per day. Slowly increased amount of time he was allowed to stand and walk around to avoid injuring his recovering spine. Worked up to sand walking early in mornings three times a week as well as jetpool therapy twice weekly on alternating days with sand walk. Endless muscle massages. Vast improvement in mobility and mindset immediately following commencement of physical therapy. Reached a plateau 3-4 weeks ago and did not just plateau he dive-bombed downhill within a matter of days. Visits to local vet uninformative, told to see the neurologist now waiting on pins and needles for that appointment. I’m hoping for some hope. Recommended vaccinations at recommended intervals. Seems to get kennel cough from the kennel cough vaccine lately but my vet is using some newfangled (Vanguard?) oral vaccine all of the sudden. Camo has hyperpigmentation on his skin, inexplicable yellowing patches on what was soft white fur, asymmetrical patches of darkened hair in addition to a shocking amount of flesh toned cutaneous warts suddenly appearing. Lately displays some level if disorientation, especially if subjected to change in ambient temperature as well as momentary confusion over change in surroundings. Inappropriate vocalization began a week ago, he now occasionally barks at what I assume are the ghosts he “sees”. Barks at animals on the television and sometimes barks at outside noises he happens to hear, he NEVER barked at random things...”be quiet” and “Camo talk” were the first commands he learned and never broke. He is developing a fondness for secluded quiet places and will suddenly decide he HAS to be alone then drags his rear legs and crawling underneath my bed with increasing frequency. Some cognitive dysfunction is suspected in my Mom diagnosis. Possible vision disturbance in left eye, that is also the eye that rolls backwards into the socket so all I see is a white creepy fluttering left eye while right eye maintains normal control and stays closed while asleep. Heavy snoring, some sleep apnea, oh and apparently in 2014 God decided to curse this sweet boy with nightmares so he literally has night terrors about once every 2-4 months. Immediately after waking up screaming he seems to be blind and also temporarily deaf he just stares blankly for a bit then slowly comes back to reality. My frustration with this is that I noticed symptoms and brought him to his doc every single time like a good Mom but it seems the medical plan is to throw pills at the individual symptoms in an effort to medically manage each symptom. Ok great whatever my Master’s is in Business so I trust medical professionals to do what is right since I’m not qualified in that field. I keep asking for a reason, run tests, do some diagnostics, I will pay you whatever it costs just find the root problem and we can make a plan to solve it instead of doping Camo up and praying he doesn’t notice he is losing control of his own body. I’m onto a theory that he had chronically high levels of vitamin A considering the “premium” food he ate as well as his love for boiled eggs, the beef liver joint supplements and the liberal use of pumpkin per advice from his doctor. How would you go about this if he were your patient? Is there a SOP to discover if he in fact does have vitamin A toxicity? Can he be tested for over accumulation of all fat soluble vitamins and if so, what kind of measures would you take to detoxify him of whichever ones he has as you hypothetical patient? Chelation? Carbon? Acupuncture? Please help us

Aug. 11, 2018

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Vitamin A toxicity is uncommon in dogs fed a commercial dog food and given supplements intended for dogs being used within the guidelines of use by the manufacturer; dogs are able to tolerate overdosage or overfeeding of up to 100 times the dietary requirements without showing any negative symptoms. There is no set SOP or guidelines for checking for vitamin A toxicosis but looking for any skeletal changes by x-ray and looking for general symptoms of toxicosis are indicative of toxicity. At this point, I cannot say what specially is occurring with Camo as I haven’t made an examination myself so I legally cannot diagnose or recommend any specific treatment even with a hypothetical patient as with your question; it would be valuable to see a Specialist and see what is discovered and then make a decision from there. Regards Dr Callum Turner DVM www.vetstream.com/treat/canis/diseases/vitamin-a-toxicity https://wagwalking.com/condition/vitamin-a-responsive-dermatosis (low amounts of vitamin A may cause skin issues in Miniature Schnauzers) www.zoetisus.com/products/dogs/vanguard-boral/ (oral kennel cough vaccine)

Aug. 12, 2018

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Average Cost

$3,800

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