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

Dogs feel pain just as we humans do, but how they show their pain is another story. A dog suffering from pain may not show its pain clearly, and that is why chronic pain is often not recognized at all. Measuring and assessing pain is possible using a chronic pain index for dogs. Monitoring your dog’s condition with a pain index helps you support your dog’s health and well-being as effectively as possible.

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, whereas changes caused by chronic pain are small and they develop slowly over time. That is why they are more difficult to notice. Chronic pain may go unrecognized for years, or the symptoms may be visible only at times, for example when your dog is tired. Pain caused by osteoarthritis, for instance, is chronic pain. Prolonged pain exhausts your dog.

Even if you don't see anything indicating pain, your dog may still be in pain.

⁠—Katariina Mäki, PhD (Animal Science) and Anna Hielm-Björkman, DVM, PhD, docent, CVA (IVAS), leader of the DogRisk research group

How to tell if your dog is in pain

pain in dogs and how to recognize dog's pain
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.

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.

There is no single, clear way to recognize chronic pain, but we can detect pain by focusing on changes in dogs’ behavior. Often, a dog owner will benefit from advice and tools for identifying pain because no single change or symptom is a reliable sign of chronic pain. The behavior of a dog and all the changes will be followed systematically and as a whole, which makes it possible to identify whether the dog is in pain and to evaluate the intensity of pain. 

Chronic pain is highly individual, but when a dog’s behavior is observed systematically, changes caused by pain can be identified in spite of individual differences. Pain can also emerge slowly, which makes it even more difficult to spot the changes.

Measuring chronic pain in dogs

Chronic pain can be tracked with measuring tools that are developed through clinical research. Anna Hielm-Björkman, Doctor of Veterinary Medicine and veterinarian at the University of Helsinki Veterinary Teaching Hospital, has developed one of these tools, which has already been translated into 11 languages. 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.

This research led to the development of the Helsinki Chronic Pain Index (HCPI), a pain index for dogs. Pain assessment in the HCPI is based on pain scoring. With a multiple-choice questionnaire, the owner assesses their dog’s behavior holistically. The assessment’s result is a figure, which tells the level of pain in your dog.

Previously, the HCPI pain index for dogs was only available in paper format at veterinarians, but now all dog owners can use it digitally on Pawesomer. Therefore, it is even easier to follow your dog’s pain and its development as the pain index results are saved on Pawesomer, and pain data can be interpreted with informative graphs, for example. At the same time, you can keep a record of your dog’s medication and recovery.

pain in dogs: quote from PhD Hielm-Björkman, veterinarian

The vet meets the pet only once, but the owner spends time with it every day. To be able to take care of an animal as an individual, it is important to respect the knowledge and know-how of the owner.

⁠—Anna Hielm-Björkman, Veterinarian at the University of Helsinki Veterinary Teaching Hospital

The HCPI pain index for dogs is designed to be an easy-to-use tool for all dog owners. Naturally, the tool is meant to detect pain, but it also helps dog owners know their dog from a young age and support their dog’s health before problems develop. The use of the HCPI pain index for dogs enhances the owner’s expertise.

Why use a pain index for dogs?

measuring pain in dogs: the dog pain index

Chronic pain can cause several different symptoms, which can be seen as changes in dogs’ behavior. However, no single change is a reliable sign of chronic pain. With a pain index, changes in your dog’s behavior can be tracked systematically and as a whole, making the interpretation of your dog’s pain more reliable. Identifying and tracking pain can support your dog’s health in many ways.

Learn to know your dog

  • Chronic pain manifests as small changes in your dog’s behavior
  • Dog owners easily recognize their dog’s pain symptoms but often don’t understand that they are signs of pain

Spot any changes early

  • Recognize slowly developing pain by filling the pain index questionnaire occasionally – a couple of times per year is enough
  • Changes may occur insidiously
  • A problem that is caught early is easier to treat

Track the development of pain and your dog’s health

  • Monitor your dog’s ageing and the development of pain conditions that have already occurred
  • Assess response to pain medication by filling the pain index questionnaire before and after treatment

Because chronic pain often develops slowly over time, it may not show as a clear change for the pet owner. This is when the HCPI pain index for dogs helps you recognize chronic pain, but it is naturally an excellent tracking tool for any patient in pain. The pain index for dogs can be used to assess response to pain medication and track the development of a pain condition. The HCPI pain index for dogs is also a valuable tool when a dog owner has to consider euthanasia.

Research on pain in dogs

Pawesomer’s HCPI pain index for dogs was developed as part of Anna Hielm-Björkman’s doctoral thesis research in 2007. Hielm-Björkman is a Doctor of Veterinary Medicine and veterinarian at the University of Helsinki Veterinary Teaching Hospital. She has a long history of studying pain and its recognition in dogs. 

In one of Hielm-Björkman’s studies, dogs suffering from hip dysplasia were divided into two groups according to whether they had chronic pain or not. After this, the dog owners were asked questions about their dog’s behavior which were thought to help track possible pain. Eventually, Hielm-Björkman chose 11 questions that helped track pain in dogs in the best possible way and, at the same time, they were easy for the dog owners to understand.

In another study, Hielm-Björkman divided dogs into two groups: one received pain medication and the other was given a placebo. A placebo does not include pain-killing ingredients and thus does not affect pain. The dog owners were then asked questions about pain behavior, and they rated their dog’s pain on a scale with “no pain” and “the worst possible pain” as its endpoints.

In the studies, Hielm-Björkman noticed that dog owners easily recognized their dog’s pain symptoms but often didn’t understand that the symptoms were signs of pain. These studies led to the development of HCPI, the Helsinki Chronic Pain Index for dogs. The HCPI pain index for dogs is a multiple-choice questionnaire with 11 questions that helps you assess pain in your dog. The HCPI pain index for dogs is the most widely used pain index in the world that is based on clinical research.

Belshaw, Z. & Yeates J. (2018). Assessment of quality of life and chronic pain in dogs. The Veterinary Journal 239, 59–64.

Hielm-Björkman Anna: (Chronic) pain assessment tools in dogs, a general overview (Lecture in seminar “Pain assessment in companion animals”, Vienna, July 1, 2017) 

Hielm-Björkman, Anna: “Assessement of chronic pain and evaluation of three complementary therapies (gold implants, green lipped mussel and a homeopathic combination preparation) for canine osteoarthritis, using randomized, controlled, double-blind study designs”. Helsinki : University of Helsinki, 2007. 115 p.

Katariina Mäki ja Anna Hielm-Björkman: Tunnistatko koirasi kivun? (In Finnish)

“Assessing Chronic Pain in Dogs.” Today’s Veterinary Practice. Retrieved from: (Accessed October 3, 2019)

Lue lisää koiran kivusta

Koiran kipu on vaikea huomata. Maxin lonkkaongelmiin havahduttiin ensimmäisen kerran koiran ollessa viisivuotias. Eläinlääkärillä selvisi, että Maxilla on rakenteellinen vika lonkissa ja alkavaa nivelrikkoa. 

Yliopistollisen eläinsairaalan eläinlääkäri Anna Hielm-Björkman on myös kipututkija ja DogRisk-tutkimusryhmän johtaja. Hän tutkinut koirien kipua urallaan jo pitkään.

Koirat ovat luonnostaan uteliaita eläimiä eivätkä ne yleensä osaa varoa ampiaisia. Yleensä ampiaisen pisto koiralla syntyykin juuri pään alueelle, jopa suuhun, kun koira tutkii ja haistelee ympäristöään.

Koiran hot spot on melko yleinen vaiva. Hot spoteja esiintyy varsinkin kesäaikaan, jolloin kosteus ja lämpö pääsevät hautomaan ihoa ja turkkia.

Kilpirauhasen tuottamat hormonit säätelevät elimistön aineenvaihduntaa. Kilpirauhashormonien yli- tai alimäärä johtaa elimistön hormoniepätasapainoon.

Koira ei oksenna ilman syytä. Koiran oksentamisen syy kannattaa aina selvittää, jotta mahdollisiin sairauksiin pystytään puuttumaan