Laurie's Blogs.

By Tania Costa, VT, CCRP, CMT

Canine Wellness Centre - Toronto, Canada

http://caninewellness.com

This case study will help to illustrate how the ill effects of unrelieved stress can lead to pain and medical issues.

Muffin, a F/S 6 year old dachshund, was owned by an elderly couple. The couple had to move to a nursing home and Muffin was given up for adoption. She was immediately adopted by a family with 3 small children and a new baby.

Muffin is brought into your practice because she is exhibiting signs that have the owners worried. Muffin is displaying depression, inappetence, anxiety, restlessness, and hyperacusis (does not like sound). Muffin was always a dog that was very good with children, but she now has begun snapping at them when they try to play with her. She is especially upset when someone tries to pick her up.

Thought process:  

This breed is predisposed to IVDD however another consideration could be stressors in her new environment causing the pain response. 

Although sometimes used synonymously with physical pain, suffering can also originate and manifest psychologically. Suffering has been described as “a negative emotional state which derives from adverse physical, physiological, and psychological circumstances, in accordance with the cognitive capacity of the species and the individual being, and its life’s experience.” Suffering can be defined as a set of negative emotions such as fear and pain and recognized operationally as states caused by negative reinforcers. Thus, suffering can manifest as physical or mental experiences or both1.

When animals are faced with prolonged stressors, a pattern of nervous and hormonal activity produces a variety of physiological changes which help the animal adapt. In assessing criteria for suffering, psychological stress, which is fear stress, should be considered as important as suffering induced by pain2.

It is critical that those working with animals understand that just because they do not think the person, event, or thing is to be feared does not mean that the fear is not real to the pet. A pet's perception is its reality and that is what the pet will act on.

Animals that have been through the shelter system are a good example. When these dogs or cats demonstrate fearful or anxious behaviour, it is common for pet owners to say that the pet “must have been abused”. While this is possible, what must be equally considered is that many fearful and anxious animals are born with these behavioural pathologies. These behaviour’s, often referred to as shyness or fearfulness by different researchers, have been found to be highly heritable. The more quickly the problems are recognized and dealt with the more likely the animal can be helped. Ignoring the problem only extends the animal's suffering and that should be unacceptable3.

Patho-functional exam:

Full spinal evaluation from Cervical to sacrum to localize a possible disc lesion (assessment of pain using a 1-10 pain scoring system)- no pain noted

Evaluation of all joints ROM- WNL

Neurological and orthopedic evaluation- Normal

Review of behavioral and physiological signs of pain (dilated pupils, abnormal movement, abnormal gait, and possible medical issues and grooming, appetite, coat, urination/defecation issues)- all normal

Aggression noted when dog is picked up.

Discussion:

An animal that has frequent experiences of stress or fear/anxiety especially if they can not get away from the stressor can cause fear induced stimuli, and will begin to suffer from stress and its effects.  Fear and anxiety is physiologic which involves autonomic arousal and stimulation of the hypothalamic, pituitary adrenal axis (and resulting stress hormones) Long term stress can cause physical changes whereby there is increased susceptibility to disease due to the suppression of the immune system, functional changes in the brain, and, when extreme conditions persist, permanent damage can result3. In turn sick animals can be more sensitive to external noxious stimuli, and respond to pain from nonnoxious stimuli.  

Therapeutic interventions should include strategies to reverse glial cell activation and central sensitization, thereby reducing this hyperalgesic state.  To withhold analgesics can lead to ‘sickness syndrome’ and in this situation the use of nonpharmacologic methods to manage pain should be utilized.  

These would include providing a stress free and protective environment (shelter, food warmth and bedding, elimination of triggers that cause ‘stress’)

It is important to note that the immune system can be affected as it detects pain or injury in 3 ways.  1. Through blood borne immune messengers originating from the site of pain 2. Nociceptive induced sympathetic activation and resulting stimulation of immune tissues.  3.  Through endocrine signaling that triggers the auto-phase reaction.  

A departure from an animal’s normal behaviour is an important indicator that it is undergoing pain and distress. 

When stressors are not removed the body can be affected in various ways:

1.Morphologic changes (hair loss, or poor coat, weight loss, myopenia and accelerated aging). 

2.Hypo/hyperalgesia where nocioception is enhanced or reduced

3.Myopathy

4.Fatigue, suppressed immune function

5.Impact to normal GI function (decrease of gastric emptying, intestinal contractility, increased gut permeability, reduced water absorption, and increase the colonic inflammatory response(4))

6.Hypertension

7.Decrease in growth

Assuming the pain is a result of the stress of being in a new home (old home was presumed quiet, this home has noisy children and a lot of stimulus which would increase the stress response and create maladaptive pain from stress) So this dog is suffering from pain and distress.  

Some of the more easily recognizable signs are:

• •Changes in temperament or attitude; a friendly, docile animal becomes aggressive or unresponsive
• •Restlessness; pacing, changing position frequently
• •Decreased activity; reluctance to move, does not respond normally when approached
• •Change in posture; hunching, huddling, crouching, stiff movement, head down
• •Protecting a part of the body; growls or attempts to bite when that body part is approached or touched
• •Abnormal vocalization, especially when a painful area is touched; whimpering, squealing.
• •Change in appetite and water consumption leading to weight loss and dehydration (in small rodents, dehydration causes rapid weight loss)
• •Self-mutilation, excessive licking of the area, biting, scratching, rolling, kicking
• •Changes in hair coat appearance; decreased grooming leading to rough-looking coat, greasy appearance, piloerection (hair erect), loss of hair (baldness, hair shafts broken)
• •Changes in facial expression; sleepy appearance, avoidance of light
• •Discharge from eyes (tears, pus, blood) or nose (runny)
• •Changes in bowel movement or urination; diarrhea with soiling around the anus, or lack of bowel movements (constipation)
• •Sores, reddened areas on the skin, open wounds
• •Increased body temperature
• •Changes in respiration rate or character; rapid, shallow breathing

Treatment Plan:

Quality Of Life, for animals, should always include the “five freedoms”:

1.Freedom from thirst, hunger, and malnutrition

2.Freedom from discomfort

3.Freedom to express normal behaviour

4.Freedom from fear and distress

5.Freedom from pain, injury, and disease

In this case the solution for Muffin is that she is suffering from the home she has been placed in, it may be better to find an appropriate adoptive family with a quieter environment to help remove the stress from Muffin’s world.

References:

1.Ferdowsian H and Merskin D. Parallels in Sources of Trauma, Pain, Distress, and Suffering in Humans and Nonhuman Animals. Journal of Trauma & Dissociation. 2012 13:4, 448-468.

2.Grandin T and Deesing M. Distress in Animals: Is it Fear, Pain or Physical Stress? American Board of Veterinary Practitioners - Symposium 2002; May 17, 2002, Manhattan Beach, California.

3.Tynes VV. The physiologic effects of fear. Veterinary Medicine. Aug 1, 2014.

4.Bhatia V, Tandon RK Stress and the gastrointestinal tract. J Gastroenterol Hepatol 2005;20 (3):332-339