Top 6 Signs of Neuropathic Pain
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Neuropathic pain can be easy to miss in veterinary practice, as its clinical signs can be subtle and difficult to distinguish from other conditions. A group of veterinary specialists across pain management, neurology, and behavior recently gathered to share what they have learned from their patients. A few of their most relevant insights are presented here.
1. Unpredictable Yelping or Screaming
When a patient’s history includes occasional screaming or yelping—suddenly, intensely, and with no discernible trigger—unpredictability itself can be a diagnostic signal. For Dr. Duncan Lascelles, a pain researcher and surgeon at North Carolina State University, a patient whose owner mentions sudden “shrieking” or “yelping” immediately raises the possibility of neuropathic pain. It is the quality of the pain, not just its presence, that is important to pay attention to.
2. Anxiety Without a Clear Cause
With nociceptive pain, a pet associates a specific movement or behavior with discomfort and adjusts accordingly, but neuropathic pain is unpredictable, which means the animal has no way to anticipate or avoid it. According to Dr. Christopher Pachel, a veterinary behaviorist in Portland, Oregon, that unpredictability drives anxiety. When an animal does not know when or if it is going to experience a painful sensation, it may become anxious. A sudden or unexplained onset of separation anxiety, noise sensitivity, defensive aggression, or restlessness is worth a deeper look.
3. A Grimace in Response to a Squeeze
Dr. Natasha Olby, a veterinary neurologist at North Carolina State University, has made deliberate head palpation a standard part of her neurologic examination for breeds predisposed to neuropathic pain conditions. She squeezes the head, applying gentle pressure on the calvarium, and watches for a grimace, flinch, or behavioral shift in response. Dr. Olby feels, if veterinarians routinely palpate the spine to look for pain, why would the head be any different? For some dogs, a head squeeze is a simple addition to the physical examination that can reveal pain that might otherwise stay hidden.
4. Disrupted Sleep
Pain disrupts sleep, and pet owners rarely connect the 2 without being asked. Dr. Clare Rusbridge, a professor of veterinary neurology at University of Surrey, makes the case for adding sleep trends to every pain history: clients should not be asked only about exercise and mobility. A pet that is restless at night, unable to settle, or crying out while sleeping is telling you something—so is a household full of people who are not sleeping well because of it.
5. Withdrawal From the Family
Dr. Tamara Grubb, veterinary anesthesiologist and pain management specialist, hears the same stories in the examination room on repeat: the once-cuddly cat that now hides under the bed, the dog that loved romping with the grandkids until it started biting and got booted to the back porch. Owners may point to personality shifts or aging to explain these changes, not realizing pain is the cause. By the time they are sitting across from the veterinarian, the bond may already be fractured over a disease that is manageable.
6. “Aggression” That Is Something Else
When a behavior label gets attached to a patient, it can be hard to dislodge. Tasha McNerney, a veterinary technician specialist in anesthesia and pain management, urges veterinary teams to ask what changed and when before accepting aggression as an explanation. Her example: a dog that wore sweaters comfortably for years and then started snarling when the sweater came out. The owner called it aggression. McNerney called it a red flag and worked with her clinician to uncover head and neck pain.
Why Specialists Are Choosing Pregabalin Over Gabapentin
“Gabapentin is everywhere in veterinary practice—but not because the evidence supports its use,” says Dr. Fred Wininger, a veterinary neurologist and neurosurgeon in St. Louis. Rather, it became ubiquitous before anyone seriously questioned it.
Pregabalin, he argues, is the stronger choice in virtually every clinical scenario: more stable pharmacokinetics, superior bioavailability, higher potency, and a twice-daily dosing schedule that supports owner compliance. “Anytime I could use gabapentin, I would choose pregabalin over it,” he says.
Dr. Wininger also prefers a veterinary-formulated product. He sees more consistent outcomes with veterinary products due to considerations such as flavored formulations and dosing suited to veterinary patient weight ranges.
The experts featured here contributed to Addressing Neuropathic Pain in Your Practice, a guidebook designed to help primary care veterinary teams recognize and manage pain in practice. Access the full guidebook at caninepainguide.com.
This content is provided by PRN Pharmacal. Clinician's Brief does not inherently endorse any product or organization advertised across its properties. The appearance of an advertisement on Clinician's Brief properties is neither a guarantee nor an endorsement of the product or advertising claims. Clinician's Brief is not responsible for the content promoted in this article or the referenced sources. Questions about the accuracy of the information presented or sources cited may be directed to the listed sponsor.
