Pain and Behavior
Last week, I had the privilege of presenting at the Australian Veterinary Association’s Annual Conference. My talk, Reactive Dogs: Practical Tips for GP Vets and Their Clients, explored practical ways general practitioners can support clients managing reactive behaviours. One of the most important themes—not just in my session, but across the conference—was the critical link between pain and behaviour. (Thank you so much to all who attended! If you missed the talk, it was recorded and should be available to attendees soon.)
Latest findings about pain and behavior
Dr Jen Nesbitt-Hawes presenting at the AVA conference, 2025. The slide title is 'Subtle Indicators of Pain'.
Pain is a contributing factor in up to 80% of behaviour cases (Mills et al., 2020, Pain and Problem Behavior in Cats and Dogs).
Behavioural change is often the first and only clue to pain—especially in cases like osteoarthritis, where pain manifests through changes in gait, posture, and habits
Pain is NOT an older dog condition. Congenital issues such as hip and elbow dysplasia are present from birth and worsening changes in mobility over time are not due to disease progression but the cumulative impact of pain over time. -Prof Duncan Lascelles, Diagnosing Osteoarthritis Pain in Dogs Through Behaviour, AVA Sydney 2025.
In fact, a study by Enomoto et al 2024 found a prevalence of radiographically detected osteoarthritis in 40% of dogs aged 0-4 years. 16-23% of all the young dogs in the study were found to have osteoarthritis and pain.
"In general, it is argued that clinicians should err on the side of caution when there is a suspicion that a patient could be in pain by carefully evaluating the patient’s response to trial analgesia, even if a specific physical lesion has not been identified" - Mills et al 2020
Why we might not be able to identify pain at the vet
Pain can easily go undetected in a clinical setting:
Stress responses (like adrenaline and cortisol surges) may mask symptoms.
Emotional state and distractions in the clinic reduce observable signs.
Protective behaviours or tension may prevent physical examination.
In these cases, video footage taken at home can be extremely helpful. Subtle changes in movement or posture are often clearer in a familiar environment.
Starting the conversation
Animals are remarkably stoic. Many will remain engaged, playful, and 'happy-looking' despite significant pain. Even when signs like limping are present, caregivers may not realise they indicate discomfort. That’s why education is key. When we tell people what to look for, they can recognise and monitor these signs.
To help with this, I have developed a checklist outlining some of the subtle signs of pain. This is not a validated pain scoring system, but a conversation starter designed to educate caregivers about signs they can look for that may indicate underlying pain. While the presence of these behaviours does not confirm pain, noticing several of them—especially if they’re new or increasing—may suggest that an animal could be experiencing discomfort and may benefit from further veterinary assessment or treatment trials.
The checklist is especially useful at:
6-month adolescent checks
Annual wellness exams
Geriatric checks
Behaviour consultations
When behaviour is not responding to appropriate positive reinforcement based training
You can download the checklist as part of my Free Content folder.
What Happens Next?
Once there is a suspicion of pain from a checklist, caregiver history, or referral from a concerned pet professional such as qualified trainer or groomer, further diagnostics should take place to attempt to confirm the presence of pain.
Veterinary evaluation of video captured by clients may be used to isolate conditions to a particular joint or area due to pathognomonic postural or gait changes.
The hunched back and straightening of stifle and hocks is a posture seen with pain in the hips, as the dog attempts to shift his weight forward.
Physical examination may help detect or isolate pain.
Radiographs may be used to confirm the presence of osteoarthritis or joint disease, however these are not always necessary. The radiographic appearance of the joint doesn't tell us as much about the animal's level of pain as their behaviour/mobility does. Radiographs are useful when surgery may be a potential treatment option. The absence of radiographic findings does not rule out pain.
Analgesic treatment trials can be used, assessing the patient before and after and looking for improvements. Analgesia trials should run for 6 weeks and may require trialling more than one medication.
Use of clinically validated scoring systems can be used to diagnose pain and assess improvement. Examples include: The Feline Musculoskeletal Pain Index for cats, and The Helsinki Chronic Pain Index and the Liverpool Osteoarthritis in Dogs (LOAD) for dogs
In Summary
Understanding pain as a factor contributing to behavioural change—especially in young animals—is essential. Recognising these signs early means we can act sooner, improving welfare and strengthening the human-animal bond.
Want to learn more or access the pain checklist?
👉 Visit www.petperspective.com.au
📩 Contact me at info@petperspective.com.au📱
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Let’s keep the conversation going—because the better we understand our patients, the better we can care for them.
