In a previous study,1 20% (231/1,153) of dogs examined as outpatients at a veterinary teaching hospital had evidence of pain, illustrating the importance of pain as a clinical sign in dogs. Pain can be classified as acute or chronic, with chronic pain described as “pain that persists beyond the normal healing time or pain that persists in conditions where healing has not or will not occur.”2 In recent years, the veterinary and human medical fields have grown increasingly interested in improving their understanding and treatment of chronic pain.
Interestingly, a previous study3 found that owners scored their cats' postoperative pain higher than the attending surgeon did, perhaps because owners witnessed signs of pain at home that the surgeon did not see in the clinic. This potential discrepancy between what is observed in the clinic versus at home, as well as potential differences between how owners perceive pain versus how veterinarians do, makes it crucial that veterinarians understand how owners assess severity of pain in their pets with chronic pain.
Further, in the human medical field, physician-patient communication has been shown to affect treatment outcomes, with more effective communication between providers and patients resulting in better outcomes, including better pain control.4 For example, a recent qualitative study5 found that for patients of a chronic pain clinic, improved provider-patient communication in the clinic better prepared patients to manage their care at home. Similarly, we believe that care for dogs with chronic pain could be enhanced by improving veterinarian-owner communication in the clinic. However, doing so requires that veterinarians understand owners' experiences revolving around owning a dog with chronic pain.
To our knowledge, few studies investigating dog owners' perceptions of chronic pain in their pets have been published. Therefore, the purposes of the study reported here were to develop a better understanding of how owners of dogs with chronic pain perceive their pet's pain, to determine what influences that perception, and to identify how a pet's pain impacts the owner's life. Four main research questions were developed: How do dog owners perceive when their pets are in pain and what influences this perception? What methods do owners use to help manage their pet's pain? From an owner's point of view, what is it like to care for a pet with chronic pain? How does a pet's chronic pain impact the owner's schedule, relationships, and overall well-being?
Qualitative research methods were used to explore these research questions in detail. Specifically, interviews were conducted with owners of dogs with chronic pain and then coded by 2 reviewers to identify major themes.
Materials and Methods
Owners of dogs with chronic pain who were clients of a veterinary clinic specializing in the treatment of pain in pets were solicited to participate in the study. Individuals who agreed to participate in the study underwent a telephone interview regarding their perceptions of and experiences with managing a dog with chronic pain. All interviews were conducted by a single individual (KND). This individual underwent 2 practice interviews with constructive feedback from the research team before speaking to study participants.
Owners of dogs that had had signs of pain for ≥ 3 months were identified by a veterinary pain specialist and were contacted by the interviewer through an initial telephone call to arrange an interview time. Owners who opted not to participate or who did not return attempts at contact were replaced until 10 owners agreed to participate.
A standard set of research questions was developed to assist in guiding the telephone interview with study participants. This consisted of a series of open-ended questions with prompts to elicit additional information, if needed. All interviews were recorded and subsequently transcribed by hand by the interviewer.
Two researchers independently read the transcripts to develop a general sense of the themes that arose during the interviews. They then developed codes for each theme, as described,6 and tagged all transcripts with appropriate codes. The independently coded interview transcripts were then compared by 2 additional researchers who analyzed the transcripts and codes to minimize any potential bias and maximize identification of all relevant codes. Similar codes were then consolidated into larger themes to gain an understanding of the data.
Results
Four major themes were identified through analysis of the telephone transcripts: changes in owner schedule, effects on owner relationships, necessary resources, and owner perceptions of their pet's pain.
Changes in owner schedule
Most participants reported changes in their daily schedule because of their dog's chronic pain. Most often, this resulted from the need to administer medications on a certain time schedule. For example, 1 participant stated that “it is imperative that [my dog] gets her meds, so I am pretty obsessed with making sure that at least one of my [sons] knows when to feed her and what her meds are.” Another participant mentioned having to spend longer periods walking their dogs because the dog with chronic pain was not able to walk as far as the others. One participant mentioned spending a few hours each week organizing the pet's medications and placing them in pill pockets, much like a weekly pill organizer for humans, to help save time throughout the week. The few participants who did not report a substantial change in their daily schedule mentioned the availability of support within the household, flexibility with medications, or the ability to work from home.
Long-term planning around holidays and vacations was generally more complex for participants, with approximately half the participants stating that they limited the vacations they took or did not take vacations at all owing to their pet's chronic pain. One participant indicated that work trips were not possible while owning a pet with chronic pain, and another participant reported not going on vacations, saying that vacations “would probably be really nerve-racking for me.”
Participants who did go away on vacation spoke about the need to educate pet sitters on how to care for the pet. None of the participants who reported going away on vacation said they boarded their dogs in a kennel while away. Most had pet sitters they trusted, but a few said they would only leave their pet with their veterinarian while away on vacation.
One participant reported taking the pet with when going camping, but having to schedule the pet's acupuncture appointment beforehand, which added another element to trip preparation. This individual also spoke about the need to educate friends who accompanied them on camping trips about their pet's needs, such as providing extra space around other dogs to avoid episodes of aggression.
Effects on owner relationships
When asked about support in caring for their pets at home, participants frequently mentioned receiving assistance from pet sitters. Participants also spoke about other members of the household and the importance of their role in the pet's care. In particular, participants frequently mentioned their children helping with the care of their dogs. One participant stated that “my daughter is a teen, so she stays up late. So, when [my dog] gets up to move and get a drink of water, she's there … [to] help her get up.” Another participant indicated that they actively involved their children in the pet's care by teaching the children to perform physical therapy exercises on the dog and rotating the responsibility for performing at-home exercises with the dog among the children. Alternatively, 1 participant mentioned the adverse impact on family dynamics of having a dog with chronic pain in the household, stating that “my kids are annoyed because I treat her better than the other dog that I've had longer.“
Surprisingly, although some participants mentioned the importance of emotional support, this appeared to be less important than physical support. When emotional support was mentioned, it was often in the context of close family members and friends. One participant stated that having family members and friends ask about the pet's health was helpful in providing support, but also mentioned the difficulties of others not understanding what it is like to have a pet with chronic pain, saying that “people won't listen to you when you say she's in pain.” One participant discussed how friends who had previously had a pet with pain had helped by providing emotional support. This individual stated that having discussions about the possible future need for euthanasia helped prepare them emotionally for what was to come.
Necessary resources
Financial—Most participants expressed that owning a dog with chronic pain was financially straining. As 1 participant put it, “we joke about it, but the boys are like, we would be able to have another car,” and many participants made light-hearted comments or jokes about the amount of money they spent on their dog. Others seemed uncomfortable discussing financial details of caring for a pet with chronic pain.
Many participants commented that it would have been helpful for their veterinarian to prepare them for possible outcomes regarding their dog's pain, including possible financial obligations. A few participants spoke about how they were unprepared for the expense of treatments and medications and stated that it would have been helpful to have a discussion with their veterinarian about potential costs during the decision-making process.
A small number of participants mentioned that their pet insurance would not cover the cost of chronic pain medications or treatments. Overall, this caused frustration and created more stress for these owners. However, 1 participant, who was successful in having costs covered by their pet insurance policy, thought it would be helpful for veterinarians to provide pet insurance information to their clients during puppy examinations.
Informational—In discussing perceptions of their dog's pain, participants mentioned that it would have been helpful for their veterinarians to discuss signs of pain early in the dog's lifetime and to educate them on what to watch for in the future. In addition, many participants mentioned that it was difficult to know when their pet was in pain. As 1 participant put it, “for dogs that don't complain, that suffer in silence, … what are the key symptoms? For a dog that doesn't whimper or worry or complain, how do you tell?”
Some participants mentioned that they thought veterinarians could communicate better with their clients regarding pain by providing information both in the examination room and through written literature such as pamphlets. One participant indicated that more information would be helpful, but not when given all at once, stating that “I would suggest that veterinarians choose carefully what they say initially. And then, give people things to read about and take some time to absorb the information.”
One participant mentioned that a particularly helpful communication strategy was text messages and emails the veterinarian sent between office visits. This individual thought this was a useful way for veterinarians to indicate they were available for questions and provide reassurance without having owners physically come in for an appointment. According to this individual, this type of frequent contact was “a great deal of mental relief. If I did not have that ability to reach out and just do a quick sanity text like that, I'm sure it would be a lot more stressful for me.”
Owner perceptions of their pet's pain
In all interviews, participants discussed what signs they looked for to determine whether their dogs were in pain, with nearly every participant mentioning that they knew their dog was in pain because of a change in activity. Most participants also said they knew their pet was in pain because of a physical change in their pet. As an example, 1 participant said, “If I touch her back and her skin ripples, I usually take that as sign that she is in pain.”
Finally, more than half the participants mentioned noticing behavioral changes indicating that their pet was in pain. For example, 1 participant stated that previously, “we would come home, she would be really excited and stand up on her hind legs and put a paw on each side of your hips and literally give you a hug. Over time, she lost that range of motion and she doesn't stand up anymore.”
When asked how they managed their pet's pain, all participants indicated that their pet was receiving pain medications, and most stated that the dog was receiving other treatments in conjunction with the pain medications, such as acupuncture, physical therapy, or water therapy. Less frequent methods included providing a special diet or dietary supplements, surgery, and use of assistive devices. One participant discussed the time and energy they put into building stairs to the beds in their home so that the dog could still lay on the bed. Other assistive devices included slings and ramps.
Many participants also spoke about limiting their pet's activity to minimize pain. As 1 participant said, “I try to be very in tune in terms of what his limits are on walks and don't allow him to push himself beyond what he can do.” In discussing why they limited their pet's activities, participants mentioned that their dog sometimes did not know its own limitations.
Participants also mentioned how limiting their pet's activity affected them personally, often speaking about the protective feelings they had toward their pet and their frequent worry about the pet's comfort. According to 1 participant, “it affects us that we are constantly keeping an eye on them to make sure they are okay.“ And, some participants discussed limiting their pet's activity even without the recommendation of their veterinarian.
Some participants also discussed how their own pain influenced their understanding of their pet's pain. Specifically, owners who were in pain or who had experienced pain in the past appeared more empathetic towards their pets when they experienced pain. As a participant with arthritis said, “Most dogs will get up and stretch their back legs and then stretch their front legs. She doesn't do that. And I remember not being able to get up and stretch in the morning and that was awful.”
Finally, 1 participant spoke about relating their pet's healing process to a human's healing process. This individual recommended that veterinarians ask owners “‘have you ever hurt your back, sprained your ankle? You take it easy for a while after that and stay off it. When you get back into it, you start slow.‘ I know dogs aren't humans, but a lot of our healing processes are similar.”
Discussion
Participants in the present study indicated that owning a dog with chronic pain often necessitated changes in their daily schedule and affected their relationships with other individuals. In addition, participants noted the financial impact of owning a dog with chronic pain and expressed a need for additional informational resources. Finally, participants most often recognized that their dogs were in pain because of changes in activity and behavior and most often managed their dogs' pain by administering medications and limiting the dogs' activities. Better understanding these ramifications on owners will, we believe, help veterinarians better support clients caring for dogs with chronic pain and help improve communication between veterinarians and owners.
There are often support systems in place for human patients with long-term illness, such as home health care, skilled nursing facilities, inpatient facilities, and similar systems. In contrast, individuals caring for a pet with long-term illness often take on the role of primary caregiver,7 which can have a physical and emotional toll. By knowing what support and resources owners of dogs with chronic pain need at home, veterinarians will be better able to help owners manage their pet's pain.
It is critical that veterinarians understand the influences on an owner's perception of their dog's chronic pain. For example, it is possible that owners with chronic pain themselves might have greater empathy for their pet's pain, as appeared to be the case in the present study. Also, a previous study8 found that empathy was correlated with positive attitudes towards dogs and greater recognition of pain in animals. Thus, a veterinarian should consider an owner's past experiences with pain when having conversations about an animal's pain because the owner's perception of their pet's pain influences both the treatment plan and goals of care.
One strength of the present study was the depth of the data collected. Qualitative studies that involve discussion-based interviews allow participants to bring up issues that matter the most to them. For the present study, by carefully guiding the conversation, the interviewer allowed participants to relate what factors had had the most impact on them in owning a dog with chronic pain. The flexible framework of the interview catered to the unique experiences of each participant. In contrast, interviewing participants through the use of a specific set of questions can result in the loss of valuable information.
Limitations of the present study were generally associated with its qualitative design. Because of the time-intensive nature of qualitative studies, small numbers of participants are typically enrolled, and the small sample size limits the extent to which findings can be generalized to a larger population. Nevertheless, qualitative studies are useful in generating general themes that can be tested in additional studies.9
Another concern related to the use of a qualitative study design is the possibility that bias could have been introduced by the interviewer. In particular, guiding of interviews is subjective in nature, and the interview structure could change among participants, depending on personal interests and experiences. Although precautions, including training of the interviewer prior to conducting any interviews, were included, the potential for bias cannot be eliminated.
Finally, participants in the present study were recruited from the clientele of a veterinary practice that specialized in the management of chronic pain in animals. Thus, the experiences of the participants in this study may not reflect the experiences of clients of primary care veterinary practices. However, we hope that our findings will be used to guide a larger study on owner perceptions of their pet's chronic pain. For example, questionnaires could be developed on the basis of the major themes identified in the present study that could then be administered to a larger population of owners of dogs with chronic pain.
Owners who participated in the present study mentioned that having a dog with chronic pain resulted in substantial changes both in their daily schedule (eg, to accommodate medication schedules) and in their long-term planning (eg, eliminating or limiting vacations). Participants reported relying heavily on other household members for physical support in caring for their pet, and a need for emotional support was mentioned less frequently than the need for physical support. Also, a few participants mentioned that others did not seem to understand what it was like to have a pet with chronic pain.
Nearly all participants spoke about the financial strain of owning a pet with chronic pain. Importantly, many expressed that veterinarians should help prepare owners early in the decision-making process for the cost of caring for a pet with chronic pain. Participants also indicated that their veterinarian was their primary resource for information on their pet's chronic pain. Some spoke about how it would be helpful for their veterinarian to provide literature or pamphlets for clients to take home to read between office visits. Additionally, participants stated that because it was difficult to identify pain in animals, it would be helpful for their veterinarians to educate clients on what to look for in their pet.
All participants in the present study used medications to help manage their pet's pain, but most also used additional therapeutic modalities and most mentioned limiting their pet's activity to protect them from experiencing pain. Finally, participants spoke about how they were protective of their pet and worried frequently about the pet's health and severity of pain. Some participants spoke about how they empathized with their pet as a result of their own experiences with pain and physical injuries.
Themes identified in the present study are important for effective veterinarian-client communication regarding the care of dogs with chronic pain. Understanding what occurs in-between veterinary office visits can be key in helping owners manage their dogs at home, especially because most participants received information about chronic pain primarily from their veterinarian. By understanding the impact of a pet's pain on the owner and how owners perceive pain in their pets, veterinarians can provide better care for their patients and clients.
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