Pain in dogs and how to recognize it – the Helsinki pain index for dogs

Dogs feel pain just as we humans do, but a dog suffering from pain may not show its pain clearly. Therefore, recognizing chronic pain is difficult. Luckily, measuring and assessing pain more reliably is possible using a pain index.

The pain index available through Pawesomer is The Helsinki Chronic Pain Index for dogs (HCPI). It is based on clinical research and therefore used world-wide. The digital version is available exclusively through Pawesomer.

Is your dog in pain?

Dogs are very good at hiding their pain, and cannot and do not communicate their pain like us humans. Therefore, slowly developing, chronic pain, is one of the hardest types of pains to detect. A whopping 1 in 5 dogs suffers from chronic pain!

Pain detection

There are two types of pain: acute and chronic. Acute pain causes clear and easily identifiable physical reactions and changes. In contrast, changes caused by chronic pain are small and they develop slowly over time. Consequently, chronic pain easily goes undetected and the connection between the behavioral changes as symptoms of pain is not made.

Read more about pain detection

The pain index for dogs

The pain index is a validated pain scoring tool used to recognize and monitor pain in dogs. It can also be used to track treatment and evaluate the overall health and well-being of the pet.

Read more about the pain index

Learn more about your dog

Using the pain index regularly helps you as an owner to learn more about the ways in which your dog expresses their pain. It also helps you recognize emerging pain and notice any changes earlier for best health results.

Read more about the benefits of the pain index

Based on research

The HCPI pain index is developed by the University of Helsinki Veterinary Teaching Hospital and is the result of years of clinical research. It is presently used and known world-wide. It has already been translated to 16 languages with more on the way!

Read more about the development of the pain index

Pain in dogs – how do you detect and recognize pain?

Acute and chronic pain in dogs

Dogs suffer from two types of pain: acute and chronic. Acute pain causes clear and easily recognizable physical reactions and changes. In contrast, changes caused by chronic pain are small and they develop slowly over time. As a result, they are more difficult to notice.

Chronic pain may go unrecognized for years. The symptoms may also be visible only at certain times, such as when your dog is tired. Pain caused by osteoarthritis is chronic pain.

Prolonged pain also exhausts your pet over time.

How to tell if your dog is in pain

It is a common misconception that a quiet dog is not in pain. However, chronic pain does not cause dogs to make sounds like acute, sudden pain does. In addition, some dogs are bred to ignore pain when working.

Chronic pain is highly individual. But, when we observe dog’s behavior systematically, we can identify changes caused by pain in spite of individual differences.

Pain causes different changes in dogs’ behavior. The nature and duration of the changes depend on whether the pain is acute or chronic. For example, dogs do not vocalize chronic pain.

To recap, chronic pain can cause different symptoms, which are seen as changes in pets’ behavior. However, no single change is a reliable sign of chronic pain.

With a pain index tool, you track changes in your dog’s behavior systematically and as a whole. As a result, this makes the interpretation of your dog’s pain more reliable. It also takes into account your expertise with your own dog, because you know them the best.

This makes it possible to identify whether the dog is in pain and to evaluate the intensity of pain. 

The pain index for dogs

The pain index is a validated pain scoring tool. Use it to recognize and monitor pain in dogs, track treatment and evaluate the overall health and well-being of your pet. The questionnaire includes questions on mood, playfulness, ease of walking and general movement.

As discussed before, chronic pain causes small changes in the dog’s behavior. The changes also appear slowly over a long period of time. Consequently, they are easy to dismiss or not notice and it can be difficult to see them as signs of pain.

Nevertheless, no single change or symptom can be regarded as a sign of chronic pain. This is why we must look at the changes and the overall situation as a whole, which makes interpreting the changes and pain more reliable.

The HCPI pain index for dogs is an easy-to-use tool for all dog owners. It takes into account your expertise with your own dog, because you know them the best. The use of the HCPI pain index for dogs therefore enhances the owner’s expertise.

Why use a pain index for dogs?

Learn to know your dog

The pain index helps you learn how your dog expresses it pain – even when the pain is not obvious. Additionally, if you begin using the pain index while your dog is still young and healthy, it is easier to see any possible future emergence of pain.

Spot any changes and pain early

Filling out the pain index several times a year makes it possible to detect pain that emerges slowly. As we’ve learned before, chronic pain manifests as small changes in your dog’s behavior. The changes are easy to dismiss and difficult identify as signs of pain. It is also easier to treat any problems if we catch them early.

Track the development of pain and your dog’s health

Use the pain index to track existing pain and treatment, including the efficiency of pain medication. For example, fill out the index before, during, and after treatment to see how it affects the score.

Research on pain in dogs and the pain index

We can use clinical research based measuring tools to detect and track chronic pain. The Helsinki Chronic Pain Index (HCPI) for dogs is developed in the University of Helsinki, Finland.

Pain in dogs and the origin of the pain index

The head researcher and developer of the Helsinki Chronic Pain Index is Anna Hielm-Björkman, Doctor of Veterinary Medicine and veterinarian at the University of Helsinki Veterinary Teaching Hospital.

Hielm-Björkman developed the pain index as part of her doctoral thesis. In her dissertation research, Hielm-Björkman noticed that dog owners easily recognized their dog’s pain symptoms, but often didn’t understand that they were signs of pain.

The pain index research

In one of Hielm-Björkman’s studies, they divided dogs suffering from hip dysplasia into two groups. One group had chronic pain, but the other did not. The researchers asked questions about the dogs’ behavior from the owners. In brief, these questions were thought to help track possible pain.

Eventually, 11 questions were chosen to be part of the pain index. These questions help track pain in dogs in the best possible way and are the easiest for the dog owners to understand.

In another study, Hielm-Björkman again divided dogs into two groups. One had pain medication and the other a placebo. A placebo does not include pain-killing ingredients and thus does not affect pain.

The researches then asked questions about pain behavior from the dog owners. They rated their dog’s pain on a scale with “no pain” and “the worst possible pain” as the endpoints. Based on the findings, pet parents were able to identify changes in their dogs’ behaviour, but were less succesful at identifying them as signs of pain. The HCPI pain index helps to bridge this gap.

This research is the basis of what shaped the idea and further, ongoing research of the Helsinki Chronic Pain Index.

Pet parents who use the pain index through Pawesomer can opt-in to contribute to the research! With their permission, pain index results are anonymously used to develop the index even further.

References and further reading

Click to view list

Katariina Mäki ja Anna Hielm-Björkman: Tunnistatko koirasi kivun?

Onko koirani kipukoira? (SporttiRakki)

Viljanen, Susanna. “Hiipivä kipu jää usein huomaamatta”.

Romppainen, Päivi. “Kipu muokkaa käytöstä”.  Poliisikoira-lehti 3/2018 

Hielm-Björkman, Anna (DVM, PhD, Docent, CVA, DogRisk-tutkimusryhmän johtaja, Helsingin Yliopisto) “Pain assessment in companion animals” / “(Chronic) pain assessment tools in dogs, a general overview”. Seminaari 1.7.2017 Wien.

Cachon, T., et al. ”Face validity of a proposed tool for staging canine osteoarthritis: Canine OsteoArthritis Staging Tool (COAST).” Vet J 235 (2018): 1-8. (PDF)

Canapp Jr, Sherman O., et al. ”Partial cranial cruciate ligament tears treated with stem cell and platelet-rich plasma combination therapy in 36 dogs: a retrospective study.” Frontiers in veterinary science 3 (2016): 112. (PDF)

Hielm-Björkman, Anna K., et al. ”Evaluation of methods for assessment of pain associated with chronic osteoarthritis in dogs.” Journal of the American Veterinary Medical Association 222.11 (2003): 1552-1558. (PDF)

Hielm-Björkman, Anna K., Hannu Rita, and Riitta-Mari Tulamo. ”Psychometric testing of the Helsinki chronic pain index by completion of a questionnaire in Finnish by owners of dogs with chronic signs of pain caused by osteoarthritis.” American journal of veterinary research 70.6 (2009): 727-734. (PDF)

Hielm-Björkman, Anna K., Amy S. Kapatkin, and Hannu J. Rita. ”Reliability and validity of a visual analogue scale used by owners to measure chronic pain attributable to osteoarthritis in their dogs.” American journal of veterinary research 72.5 (2011): 601-607. (PDF)

Walton, Myles Benjamin, et al. ”Evaluation of construct and criterion validity for the ‘Liverpool Osteoarthritis in Dogs’(LOAD) clinical metrology instrument and comparison to two other instruments.” PLoS One 8.3 (2013): e58125. (PDF)

Wernham, B. G. J., et al. ”Dose reduction of meloxicam in dogs with osteoarthritis‐associated pain and Impaired mobility.” Journal of Veterinary Internal Medicine 25.6 (2011): 1298-1305. (PDF)

Zamprogno, Helia, et al. ”Item generation and design testing of a questionnaire to assess degenerative joint disease–associated pain in cats.” (2010): 1417-1424. (PDF)