The Pain Your Pet Cannot Explain
Neuropathic pain is one of veterinary medicine's most underdiagnosed conditions. Unlike the acute pain of a cut or a broken bone — which resolves as tissue heals — neuropathic pain arises from damage or dysfunction within the nervous system itself. It can persist long after the original injury has healed, or it can exist without any obvious tissue damage at all. Studies in human medicine suggest that chronic neuropathic pain is dramatically undertreated; the situation in companion animals is likely similar, in part because dogs and cats cannot describe the burning, electric, or shooting sensations that characterise this type of pain.
What Causes Neuropathic Pain in Companion Animals
Any condition that damages or compresses peripheral nerves or the spinal cord can produce neuropathic pain. Common underlying causes include intervertebral disc disease, degenerative joint disease (where nerves passing near inflamed tissue become sensitised), spinal cord injuries, nerve root compression, diabetes mellitus (diabetic neuropathy), and post-surgical nerve damage. Chronic otitis in dogs and cats can generate neuropathic components as the nerves supplying the ear become persistently irritated. Feline herpesvirus has also been associated with neuropathic facial pain in cats. The list is broader than many owners expect, which is why persistent or unusual pain behaviours warrant a thorough neurological workup rather than simple analgesia alone.
Recognising the Signs
Because neuropathic pain presents differently from nociceptive (tissue-damage) pain, owners often miss it or attribute the signs to behavioural problems. Key indicators include:
In Dogs
- Spontaneous vocalisation, particularly at night or during rest, not linked to movement.
- Excessive licking, chewing, or scratching at a specific area with no visible skin lesion.
- Hypersensitivity to light touch — flinching or snapping when stroked in certain areas.
- Reluctance to be handled or groomed in regions that were previously tolerated.
- Changes in posture, such as a hunched back or reluctance to hold the head normally.
- Anxiety, restlessness, and difficulty settling.
In Cats
- Rolling skin or rippling along the back (see also Feline Hyperaesthesia Syndrome).
- Sudden biting or attacking at the tail or flanks.
- Overgrooming to the point of self-trauma.
- Hiding and withdrawal that is disproportionate to any identifiable illness.
- Unusual vocalisations, particularly in older cats.
Allodynia — pain caused by stimuli that would not normally be painful, such as gentle touch — is one of the hallmark features of neuropathic pain and is detectable by a careful neurological examination.
Diagnosis: A Process of Exclusion and Assessment
There is no single blood test or imaging finding that confirms neuropathic pain. Diagnosis relies on a thorough history, physical and neurological examination, and systematic exclusion of other pain sources. MRI can identify structural lesions compressing nerve tissue. Nerve conduction studies and electromyography (EMG), available at specialist centres, can evaluate peripheral nerve and muscle function. Pain scoring tools adapted for veterinary use — such as the Glasgow Composite Measure Pain Scale for dogs — assist in quantifying pain severity over time. A consistent pain diary kept by the owner is genuinely useful and worth maintaining between appointments.
Management Strategies
Effective management of neuropathic pain nearly always requires a multimodal approach, because no single drug addresses all of the mechanisms involved.
Pharmaceutical Options
- Gabapentinoids (gabapentin, pregabalin): These are the most widely used first-line agents for neuropathic pain in both dogs and cats, acting on calcium channels to dampen abnormal nerve signalling. Gabapentin is generally well tolerated, though sedation is common at higher doses.
- Tricyclic antidepressants (amitriptyline): Used particularly in cats with chronic neuropathic pain, these drugs modulate pain pathways in the central nervous system.
- NSAIDs: Most useful where inflammation contributes to nerve sensitisation; less effective for purely neuropathic mechanisms.
- Tramadol: Has a modest role, particularly where opioid pathways are involved.
- Maropitant: Emerging evidence suggests it may have central analgesic properties beyond its primary antiemetic function.
Non-Pharmaceutical Approaches
- Physiotherapy and rehabilitation: Gentle movement, massage, and TENS (transcutaneous electrical nerve stimulation) can desensitise affected areas and improve function.
- Laser therapy (photobiomodulation): Growing evidence supports its use in reducing peripheral nerve sensitisation.
- Acupuncture: Used by a number of veterinary pain specialists as an adjunct, with some evidence for benefit in chronic pain states.
- Environmental modification: Reducing stimuli that trigger pain responses — certain textures, temperatures, or handling patterns — can improve day-to-day comfort.
Working With Your Vet
Neuropathic pain management is a long-term commitment. Response to treatment should be assessed at regular intervals using consistent pain scoring, and medications adjusted accordingly. Always consult a veterinary neurologist or a veterinary pain specialist if your pet's pain is not responding to initial management. Inadequate pain control not only reduces quality of life but can perpetuate central sensitisation — a process whereby the nervous system becomes progressively more reactive over time, making pain harder to treat. Early, aggressive intervention is nearly always preferable to a wait-and-see approach.
- Keep a daily pain and behaviour diary to track patterns and responses to treatment.
- Attend all follow-up appointments; dosing adjustments are usually necessary.
- Report any new or changing behaviours promptly — they may signal evolving neurological disease.
- Do not discontinue gabapentinoids abruptly; taper under veterinary supervision.