Is pain to blame for behavior changes?

“Cats, just like dogs, present behavioral changes in the home as a result of medical issues, such as osteoarthritis, dental diseases, cancer, diabetes-induced neuropathy, and feline hyperesthesia syndrome.”

A chronic pain diagnosis can often be the key to shedding light on a serious lifestyle behavioral problem a pet may be experiencing at home. Such an identification makes it easier to put a plan in place to manage the concern with a tool kit that can include medication, therapies, the expertise of a behavioral consultant, and even a dog trainer.

According to Jon Nauss DVM, cVMA, CRPM, CVMM, VBMC, medical director at Irvine Valley Veterinary Hospital Primary Care & Integrative Medicine in Irvine, Calif., sometimes all it takes is initiating a casual conversation during a routine consultation that prompts a pet parent to speak out, allowing the veterinarian to better understand the big picture.

“Listening is so important in veterinary medicine,” Dr. Nauss says, adding how “at-home observations” can aid veterinarians in putting pieces together for exam findings. Personally, I appreciate that look of recognition when I ask an owner if their pet is doing a particular thing at home, and their expression lights up, as if to say, ‘Yes! That’s it!’” Nauss says.

“Many behavior issues are related to chronic pain, which can be hard to identify for both pet owners and veterinarians alike,” he adds. “Many pets have chronic, or maladaptive pain, associated with things, like arthritis, dental issues, tight/restrictive muscles and fascia, amongst
other concerns.”

Nauss recommends a thorough myofascial exam to help in accurate diagnosis and comprehensive pain management plan, which may include medication, supplements, rehabilitation and physical medicine, and at-home care.

“We use therapeutic lasers and pulsed electromagnetic field therapy in our hospital, and, often recommend similar products that owners can use at home,” he says.

A cat lying down a pavement
Hands-on examination aids veterinarians in diagnosing patients. Pain scales, such as the Feline Grimace Scale, can help gauge chronic pain in cats. Photo courtesy Samantha Bachini-Chanco

Measuring pain

While veterinarians currently have a comprehensive tool box of drugs and therapies to customize treatment plans, their diagnosis of the pain an animal may be experiencing that could be causing behavioral-related issues, is currently based on hands-on examination responses and various quality of life (QoL) questionnaires and pain scales, such as the Glasgow Short Form Scale for acute pain, the Canine Brief Pain Index and the Feline Grimace Scale.

“We are on the cusp of seeing technology to help gauge chronic pain in pets becoming readily available,” says Duncan Lascelles BVSc, BSc, CertVA, PhD, DipECVS, DSAS (Soft Tissue), DipACVS, FRCVS, professor in small animal surgery and pain management and director of the Comparative Pain Research and Education Centre (CPREC) at the North Carolina (NC) State University.

“Technology is advancing rapidly, and making it easier and easier to capture data, such as video, or activity data. Analytical power using augmented and artificial intelligence is advancing quickly,” says Dr. Lascelles. However, he notes there are limiting factors to this, such as making biological and clinical sense of the massive volumes of data that can be captured and crunched. “This step needs to be done well if pet parents are going to have technology they can trust in to guide them as to how their beloved pet is doing. Unfortunately, as with any ‘new technology,’ there are currently a lot of spurious claims being made, but we are starting to see some very promising tools be developed.”

How behavioral therapists and dog trainers can help

Beyond the therapies and medications available to help with behavior-related issues, Nauss also points out the benefits of referring a client to a veterinary behaviorist or a dog trainer, depending on the diagnosis and behavioral issue that needs to be resolved.

“We often refer pet owners to behaviorists when we have exhausted our resources, or the patient is responding differently to what we would expect. Most veterinarians have a local referral network of specialists they use,” says Nauss. Because behavior referrals are becoming more common, Nauss says the wait times for appointments can be frustrating for pet owners.

Renowned veterinary behaviorist and author Nicholas Dodman BVMS, DVA, DACVAA, DACVB Diplomate ACVA and Diplomate ACVB, professor emeritus, Tufts University, endorses the trend to reach out to veterinary behaviorists sooner rather than later. Dr. Dodman recalls when he actively worked in clinics, calling in a veterinary behaviorist was often a last resort attempt to resolve serious issues.

“With regard to canine issues, many owners I consulted had been to see a trainer first, sometimes several, and, if there was no successful resolution, then they would visit their vet and ask for advice,” he says.

Dodman recalls a case of an older dog that developed nighttime separation anxiety. The dog would pace and whine through most of the night, which exhausted and confused its owners. It turned out the dog had a tumor at the neck of its bladder and was experiencing discomfort. “Treatment of the tumor with a nonsteroidal anti-inflammatory drug that had anti-cancer properties produced a dramatic turnaround, and the dog lived for quite a while after that and was able to sleep through the night,” Dodman says.

Understanding typical behavioral issues

Currently, Dodman focuses on canine behavior research studies, with the goal of improving canine welfare by helping owners decode their dogs’ behavior. He is co-founder of the Center of Canine Behavior Studies (CCBS), a non-profit he established with Chris Janelli, director of The Simon Foundation, Inc., a Connecticut no-kill animal rescue and adoption shelter.

The CCBS conducts research through questionnaires sent to their dog-owning membership. Their numerous published studies and research published in Journal of Veterinary Behavior: Clinical Applications and Research have shown that fear- and anxiety-based behavior problems are the most prevalent among companion dogs, followed by aggression-based problems.1

In a CCBS survey investigating the effectiveness of various professionals and behavior modification programs,2 the majority of owners found professional advice useful in treating their dog’s aggression. Moreover, seeking advice from a trainer, behavior consultant, or veterinarian was associated with an increased probability of improving behavioral issues.

In one study,3 just over one fifth of cases (22 percent), dogs were brought to a veterinarian in relation to their behavior issue. Of these, 15 percent were found to have a relevant underlying medical issue, the most common being pain, seizure, thyroid problems, or cognitive dysfunction. The survey indicated all dogs with behavioral problems should have their medical needs assessed before proceeding with retraining techniques, as these could prove to be a contributing factor.

The importance of puppy training

Other studies undertaken by the CCBS have focused on puppy training, highlighting the important takeaway dogs that had pre-adolescent training were less likely to have aggression, compulsive or destructive behaviors, and bark excessively.

In 2020-2021, CCBS also undertook a study4 involving three surveys with DogTV called “The Effects of Television Programming on a Dog’s Behavior” that determined the majority of owners found canine TV content to be beneficial as the dogs in the study were more content, quieter, less agitated, and coped better when left alone watching the channel.

The results of these studies are used to educate dog owners, veterinarians, and other professionals, with the aim of facilitating a harmonious relationship between dogs and their owners and thus reducing the numbers of dogs with behavioral problems being surrendered to shelter, putting them at risk of euthanasia.

Feline behavioral issues at home

Cats, just like dogs, present behavioral changes in the home as a result of medical issues, such as osteoarthritis, dental diseases, cancer, diabetes-induced neuropathy, and feline hyperesthesia syndrome. However, cats are further at risk of losing their homes as a result of lifestyle and environment changes because pet owners may not fully understand how home-based situations can impact a cat’s well-being.

According to cat behaviorist Rita M Reimers, ABBCT, when it comes to adult cats, the two biggest non-pain-related behavioral issues concern integrating cats in a home environment, and litter box usage. Reimers and Linda S. Hall, ABBCT, are co-founders of the Cat Behavior Alliance and hosts of the podcast 19 Catsand Counting.

“Cats are, by nature, very territorial and inherently cautious creatures. So, it’s natural for an incumbent cat to distrust newcomers in the household,” says Reimers.

Hall adds the importance of supervising initial interactions in a multi-cat household.

“Cats can’t be put together in a home and left to sort it out for themselves,” Halls explains. “It takes time and patience, and any signs of stress need to be dealt with to ensure harmony eventually reigns.”

Regarding litterbox issues, the Cat Behavior Alliance duo reiterates once a medical issue has been ruled out, there are many other reasons a cat may avoid the litterbox. It’s not uncommon in a multi-cat household to find a more dominant cat can be ambushing other felines and controlling the use of the litterbox.

“There can be an issue with the box placement, or the litter substrate itself, along with anxiety and stress relating to the living arrangements of both people and other pets in the home,” sayss Reimers. “It’s frustrating because litterbox issues and other problems such as inter-feline aggression can be resolved by getting a feline behaviorist on board.”

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Understanding innate feline behavior

Reimers further points out another big problem is often cat owners, especially first-timers, do not understand basic inherent feline traits. For example, it is common for kittens to bite and scratch.

“It may seem “cute and harmless” when they are kittens, but won’t be appreciated when they are adults with a full set of teeth and sharp claws,” she says.

“Consequently, pet parents need to be educated to understand kittens need to be taught by directing these behaviors to appropriate places, such as scratching posts and toys.” Reimers says such behaviors could be easier to address while pets are young. Further, such a basic understanding can go a long way in keeping that cat in its home and not surrendering it to a shelter. Reimers adds that veterinarians can play an important role by encouraging cat parents to read up on basic cat behaviors and understanding how cats react to stress, fear, anxiety, and illness.

Sandy Robins is an award-winning multi-media pet lifestyle expert, writer, and pet industry spokesperson. Robins has authored four books, including The Original Cat Bible. She is besotted pet parent to two very opinionated cats, granny to a goofy dog, and auntie to every pet in her neighborhood.


  1. /post/published-the-effectiveness-of-various-methods-for-the-treatment-of-canine-fears
  2. /post/the-effects-of-television-programming-on-a-dog-s-behavior