Managing Heera’s Pain

What a little poodle taught me about caring for chronically painful dogs

I work with dogs experiencing challenging behaviors like separation anxiety, sound sensitivity, social difficulties, fear, overwhelm, reactivity, aggression and more. The majority of the dogs I work with also have significant, often hidden, medical challenges causing pain that is contributing to their behavior.

Dogs can experience all sorts of painful conditions, but in this article, I’m focusing on pain and dysfunction in the ‘moving body’ - the bones, soft tissues, nerves and connective tissue that support the body’s movements. 90% of the dogs in my caseload, and 75% of the dogs in my household, experience MSK or body-pain. Helping guardians recognise and treat their dogs body pain has, unfortunately, become a huge part of my work.

Even more unfortunately, our healthcare systems are not set up to navigate the complexities of a chronically painful body. I have spent the last 3 years fighting for my dog’s chronic pain to be adequately treated and what I have learned through that process has transformed how I approach all my cases.

That’s what I want to talk about here

Meet Heera: the poster boy of untreated chronic pain

This is my boy Heera - a sporty, sweet, sensitive 9 year old poodle. Before we understood the extent of Heera’s musculoskeletal issues, we experienced almost every behavior problem possible. He was extensively fearful, sound sensitive, aggressive towards dogs and people, was hugely averse to grooming, guarded resources, couldn’t go on waslk and suffered profound nervous system dysregulation. He was frequently lunging, barking, biting, and eventually shutting down completely: urinating and trembling in a wide-eyed huddle.

The truth behind Heera’s behavior is that he had been experiencing unrecognised pain and discomfort in his body from puppyhood. His current list of diagnoses includes lumbosacral stenosis, osteoarthritis, hip dysplasia and a partially torn CCL in his knee. He also has a hypermobility spectrum disorder - leading to unstable joints and stretchy skin. But for the majority of his life, no one knew he was painful.

When I told his vets about his behavior issues I was told “He is a young dog”, told “he is active” - he was. At 4 years old he was given psychiatric medications, without even a conversation about other potential causes, and we were instructed to ‘do more training’ and ‘get more exercise’. For years, I repeatedly put him in situations that triggered pain, interpreted his responses as fear, excitement or overwhelm, and then tried to train him through those experiences. Attempts to ‘countercondition’ or ‘desensitize’ has the opposite effect and eventually, he wouldn’t even eat food around me because food had become associated with being asked to do things that hurt.

This went on for years - with not one doctor considering pain - until, at 6 years old, our relationship, and then his body, started collapsing. Various unrecognised conditions finally caught up with us and he experienced repeated catastrophic injuries and pain flares that left him unable to walk. It was only at this point that I was forced to listen to what he has been trying to tell me all along, override veterinary recommendation, and fully believe that he was painful.

What does chronic pain management actually look like?

Since Heera was now unable to walk I was able to convince my Dr’s that there was something very wrong. However, like many, I was offered woefully oversimplified and inadequate solutions to a much more complex problem. A week of NSAIDs, or some physio is not going to cut it when we’re dealing with chronic pain that has gone untreated for years.

Luckily I’m a stubborn bitch and simply won’t take no for an answer. The process of getting everything diagnosed and under control took another 3+ years - a story for another time. But on the other side we have results that, honestly, kind of blow my mind. And it looks nothing like I expected it would:

Disclaimer: The medications and pain management plan discussed here are prescribed for Heera’s individual medical situation. They are not recommendations for another dog. Medication choices and doses need to be made with an appropriately qualified veterinary professional.

Medication: Heera currently receives 300mg gabapentin three times a day: morning, afternoon and nighttime as a baseline. I give him an extra 300mg for long car rides, bigger hikes, grooming/ vet care and other pain-flaring events. He also receives 250mg of acetaminophen twice a day. Once a month, he gets subcutaneous ketamine injections: we previously did these every five weeks, but noticed that the fourth week was becoming difficult for him, so his treatment schedule was adjusted. He is also taking a low dose of fluoxetine, which we are gradually reducing, because his need for it has significantly lessened as his pain becomes better controlled. This sounds like a lot, but I don’t expect Heera’s pharmaceutical support to end here. We’ve already discussed methocarbamol, amitriptyline and amantadine as possible future additions.

Nutrition and body condition: Heera’s diet is designed to keep him lean while maintaining as much muscle as possible. He receives joint supplements and fish oils, and we pay close attention to his weight because extra weight places additional demands on an already struggling musculoskeletal system. I supplement his food with extra fibre as squatting can be a painful position for him, and extra fibre helps everything move smoothly.

Environmental accommodations: Then there is his physical environment. Most importantly, every floor area is covered with rugs or carpet so that he isn’t slipping. We have ramps and steps up to sofas and beds so he isn’t forced to jump twice his height multiple times a day, and I’ve set up many comfortable resting spots that are extremely supportive and bolstered to encourage deep rest. Temperature regulation is surprisingly important because due to neurological dysfunction he easily gets too hot or cold, so I am always monitoring the weather and adjusting the temperature in the home. Space heaters, heated blankets, a toasty fire, and jumpers are used to keep his joints and muscles consistently warm.

Activity accommodations: Every day I think about where his body is going to be positioned, what movements I’m asking him to perform and whether an activity is likely to trigger a pain flare. Long car journeys, for example, can be difficult for him. Being confined on a lead and unable to move his body freely for extended periods can also cause problems. So where we take him, how we transport him and what we ask his body to do all become part of pain management. I don’t allow him to do movements that I know will hurt him, even if he thinks he can do it. This means no high arousal jumping, chasing and fetch: we help him, even when he doesn’t want the help, because I know more about his medical status than he does. When we do have a ‘higher-pain’ day, he gets additional medications and treatments to compensate.

Beneficial Movement: Protecting a painful dog doesn’t mean preventing them from moving. In fact, insufficient movement can make Heera significantly more painful. If he stays still all day, I will often see the consequences that evening or the following day. He needs at least one, but ideally two or three, shorter opportunities to move every day. I want him moving as freely as possible, on relatively even surfaces where he is less likely to twist or be destabilised. I’m constantly navigating the balance between too much, too little, and the right kind of movement.

Physical therapies: Heera also does strengthening, fitness work and physiotherapy under professional guidance. He receives PEMF treatments and massages from me and Sarah every day to help release chronically tight muscles and trigger points. We use heat as another tool. We use heating, fires, jackets and heated blankets to keep him comfortable, alongside targeted heat for tight muscles when appropriate. In the past we have used laser and ultrasound treatments, and plan on experimenting with acupuncture in 2027.

Stress management: Then there is stress. Pain and stress don’t exist in completely separate universes. If Heera spends his day reacting to noises, sleeping poorly, becoming uncomfortably aroused or experiencing situations in which his entire body becomes tense, his pain gets worse. So reducing unnecessary stress is part of treating his pain too. I pay attention to his sleep. I manage his exposure to sounds. I avoid putting him into situations where he is repeatedly becoming frightened, tense or overwhelmed. This is pain management.

Pain reprocessing: All our interventions support his body and mind to find safety, but his experience of pain didn’t end there. Heera lived with inadequately treated widespread body pain for over six years. Pain doesn’t just leave its mark on the body, it leaves memories, and even once we began managing his pain more effectively, those expectations didn’t simply disappear. We had to revisit situations that had previously been painful and discover that they could now be different. This process was delicate, slow, and deliberate - we were counteracting 6 years of painful experiences and, for the first time in his life, finding joy and ease. For me, this has become one of the most important pieces of supporting chronically painful dogs: re-building trust and optimism in a body and world that once hurt.

Relational healing: A similar process took place within our relationship. For years, Heera experienced situations in which things hurt. He developed fears and phobias around experiences he learned could be painful. His body had learned: This is going to hurt. But, perhaps even tougher for me to acknowledge: My human doesn’t notice when I’m in pain. My attempts to train through his pain and my interpretation of his pain as fear and panic, left cracks in our relationship that ran deep. A final piece of the puzzle involved repairing what was fractured between me and my little poodle. I learned how to communicate with Heera about his pain, to show him that I understood what was happening to his body, and he started to believe I was finally listening.

Putting it all together: I’ve learned that managing chronic pain is less about applying one magical treatment and more like conducting an orchestra. We’re making five, ten or twenty small interventions over time to facilitate deep transformation. None of the individual instruments is the symphony, but when all of them are playing together, something entirely different emerges.

Chronic pain specialists call this ‘multimodal pain management’, and my biggest takeaway, after writing this all out, is just how complex it all is. There are far more medications than I ever thought, and every part of his life is adapted to support his physical health and comfort.

It looks like a lot, and it is, but let me tell you about the miraculous changes we’ve seen on the other side.

When chronic pain is managed, a new dog emerges

Once we began properly managing Heera’s pain and the proverbial orchestra started playing together, 90% of the issues I had spent years trying to train away disappeared.

He stopped reacting to noise, started making friends easily. He could rest while other dogs moved and played around him. He began tolerating car rides, grooming and veterinary care. He could enjoy walks (even in the cold, wind and rain), splashes in rivers with his siblings, and sleeps deeply. It was like all the work we’d done for years finally clicked into place. Everything that was impossible was finally was within reach.

Most miraculously, for me, our relationship finally had a chance to recover. After about a year of this new approach, he stopped isolating himself. He started cuddling with me on the couch and sleeping pressed against me in bed, his little face on the pillow next to mine. When he is overwhelmed, or in pain, he comes to me to tell me about it and get my help in accessing the relief he needs - the results were beyond my wildest dreams.

Over the last four or five years, I’ve watched this relationship play out repeatedly. When Heera has a pain flare, the behaviors return. When we get his pain back under control, they disappear again. For Heera, pain management isn’t a small part of his behavior plan, it’s the majority of it.

What this means for sensitive dog guardians

Heera is not remotely an outlier within my work. I see versions of his story again and again in dogs with complex behavior challenges: particularly dogs who have already been through extensive training and even seen multiple veterinary behaviorists without expected progress.

Time and time again, the overwhelming factor is missed chronic pain.

If there is anything I want you to take from this article is is that two things:

1. It is unethical to attempt to modify behavior without thoroughly investigating and managing underlying pain (even in young, active and ‘healthy’ dogs)

Failure to properly identify and treat chronic pain does significant harm. It pushes guardians to seek behavior solutions to medical problems - attempts to train, counter condition, desensitise fracture the bond between the species. Psychiatric medications are piled on to create more receptivity to learning: effectively scorched earth for an already fragile GI systems. Dogs become more frantic, despondent or isolated until, if they are lucky, they eventually make their way to my clinic where we can start treating their pain, off-boarding psychiatric medications and mending relationships.

2. Investigating and managing chronic pain is multimodal, and much more complex than even most specialist doctors understand

Different types of pain require different approaches, and effective management may involve extensive, individualised, multimodal treatment plans that are continually assessed and adjusted. Most professionals are completely unaware of just how extensive these plans need to be, and reluctant to provide adequate analgesics for chronically painful dogs. That means we have to learn to advocate for our dogs: to keep asking questions, investigating, build the right team, and pushing for answers when something doesn’t add up.

At this point, if you bring me a dog with significant behavior challenges, I’ll bet you ten bucks there’s some form of pain or discomfort somewhere in their body. Based on what I see every day in my work, I’ll probably bet you another ten that adequately managing it will require more than the first, second, or even the third, intervention you’re offered.

If you’re caring for or work with dogs like Heera: believe them, even if no one else does.

Our dogs deserve for their pain to be understood, and every guardian deserves the life-changing experience of watching their sensitive dog finally heal

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If you’re still at the stage of wondering whether pain might be contributing to your dog’s challenging behavior, I already have lots of resources to help you. Hidden Hurt, which is completely free, explores how to recognize the subtle signs of pain in dogs. Clues to Care, which is available through my membership, goes into identifying the origins of your dog’s pain and diagnostic processes in even greater depth. There are also multiple free videos on my YouTube channel about identifying pain, medical advocacy and navigating the veterinary system.

Not sure where to start? Watch Hidden Hurt for FREE to learn:
- How pain shows up in our dogs behavior
- Why it is so hard to diagnose and treat pain in dogs
- How to know if your dog may be experiencing pain or discomfort
- Common undiagnosed causes of pain and discomfort
- How pain cannot be ruled out via a physical exam