Pain Awareness Month: Rethinking Pain in Veterinary Care
September is the Pain Awareness Month and it brings us the chance to think more deeply about what is pain exactly and if are we truly treating it in its wholeness. According to the International Association for the Study of Pain, pain is defined as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." It means that pain is not simply a nociceptive signal traveling up a nerve, as it is influenced by emotions and this emotional dimension is where much of veterinary pain management is often overlooked.
The 2022 AAHA Pain Management Guidelines for Dogs and Cats describes pain along a spectrum from acute, adaptive pain (i.e. nociceptive and inflammatory, serving the protective purpose of prompting an animal to avoid further damage and allowing healing) to chronic, maladaptive pain (i.e. neuropathic and functional, where the nervous system itself becomes sensitized and pain persists independent of ongoing tissue damage) (Gruen et al., 2022). This is why pain in our animal patients is also multimodal as physical, neurological, and emotional systems are involved, and all three shift the animal's behavior, mood, and quality of life.
Chronic pain is more common than many pet parents and even some vets realize. Osteoarthritis, for example, has an estimated prevalence approaching 40% in dogs and over 50% in cats (Gruen et al., 2022) and when it comes to cats, who are the masters in masking pain through subtle behavioral changes rather than overt vocalization, it often goes unrecognized until mobility, appetite, sociability, or general wellbeing have already declined.
The AAHA guidelines emphasize a shift from reactive "damage control" pain management toward proactive, multimodal care, treating early, reassessing often, and involving the whole care team and the owner as active participants in recognizing pain-related behavior changes.
In conventional veterinary practice, NSAIDs and opioids are normally the main therapies used in pain protocols (Gruen et al., 2022), but a genuinely multimodal and holistic approach recognizes that most of the patients benefit from additional support. For this reason, in this article, we are going to address some of the various holistic tools to manage pain in our beloved pets.
Let’s talk briefly about some of my favorites:
Reiki - my favorite pain therapy
Reiki is a Japanese energy-healing therapy that has positive results for pain, as showed in human and in veterinary research studies. For example, the study by Pacheco et al., 2021, which was a blinded, placebo-controlled trial in bitches undergoing ovariohysterectomy, dogs receiving a single postoperative Reiki session had significantly lower short-form Glasgow Composite Pain Scale scores at 4 hours and lower visual analog scale pain scores at 4 and 8 hours than control or simulated-Reiki ("placebo") groups and none of the Reiki-group dogs required rescue morphine, compared to 30% of controls and 40% of the placebo group. My own research, which was also blinded, placebo-controlled, randomized trial of six weekly distant Reiki sessions in adult dogs (8+ years) also found statistically significant owner-reported pain reduction after the third (P = .05) and sixth (P = .02) sessions compared to controls, with 70.6% of Reiki-group dogs showing excellent or moderate improvement (Barbieri, 2025, J Am Holist Vet Med Assoc).
And what about Homeopathy?
It can also be successfully used in pain management, and in fact, in my clinical practice, I use it frequently, especially for musculoskeletal pain and post-operative pain. Among the most popular homeopathic remedies is Arnica montana, widely used to reduce swelling, bruising, and deep muscle soreness following physical trauma or intense overexertion. For joint discomfort, Rhus toxicodendron is frequently chosen to relieve stiffness and arthritic pain that characteristically ease with gentle movement but worsen during rest. Meanwhile, Ruta graveolens specifically targets connective tissues, offering relief for strained tendons and ligaments. Beyond these three, we also have Hypericum perforatum for shooting nerve pain, and Bryonia for sharp joint pains aggravated by the slightest motion.
And there is also a big variety of nutraceuticals and herbal medicines that have positive effects on pain management. I will name some of my favorites and most used below:
Palmitoylethanolamide (PEA): This is my favorite nutraceutical to manage pain. It is an endogenous lipid mediator that modulates mast cell activity and glial-driven neuroinflammation, which are mechanisms increasingly implicated in the chronic, maladaptive pain state. According to Britti et al, 2017, a formulation combining palmitoylethanolamide with quercetin reduced inflammation and pain behavior in rodent models of inflammatory and osteoarthritic pain. Additionally, another trial with 58 dogs, conducted by Rocca et. al, 2023 showed that dietary integration with palmitoyl-glucosamine co-micronized with curcumin was able to maintain meloxicam-induced pain relief in dogs with severe OA chronic pain.
Curcumin and Boswellia serrata: These two herbal remedies are also increasingly used for osteoarthritic pain. A randomized, double-blinded trial in dogs, by Caterino et al, 2021, found that a combination of Boswellic acid and Curcuvet® added to a conventional nutraceutical (glucosamine, chondroitin, omega-3s) produced measurably improved ground reaction forces on force-plate gait analysis compared to the nutraceutical alone, with effects still visible 60 days after treatment ended. In human osteoarthritis, a randomized, double-blind, placebo-controlled trial of curcuminoids combined with boswellic acid showed significant improvement in WOMAC pain and function scores relative to placebo (Haroyan et al., 2018).
Other pain support. Omega-3 fatty acids also have good evidence base among nutritional interventions for canine OA pain (Vandeweerd et al., 2012), and are formally listed among non-pharmacologic options in the AAHA decision tree. And we cannot forget to mention the Bach Flowers remedies, that are helpful to manage the emotional states related to the pain process and should be used in accordance with the animal’s needs.
So, as we can see, pain is much more than a symptom to be suppressed, it is a complex experience involving the body, the nervous system, emotions, behavior, and the animal’s environment. Recognizing this complexity allows us to move beyond a one-dimensional approach and toward truly multimodal pain management. Reiki, herbal medicines, nutraceuticals, homeopathy and Bach Flowers can offer support within an individualized treatment plan, giving us the opportunity to reduce suffering and to improve comfort, contributing for a better quality of life.
References
Gruen ME, Lascelles BDX, Colleran E, et al. 2022 AAHA pain management guidelines for dogs and cats. J Am Anim Hosp Assoc. 2022;58(2):55-76. doi:10.5326/JAAHA-MS-7292 (PubMed)
Pacheco L, Marangoni M, Rodrigues EO, Pacheco KOM, Freitas GC. Postoperative analgesic effects of Reiki therapy in bitches undergoing ovariohysterectomy. Cienc Rural. 2021;51(10):e20200511. doi:10.1590/0103-8478cr20200511 (SciELO)
Barbieri CR. Impact of distant Reiki on owner assessment of health and wellbeing of adult dogs: a blinded, placebo-controlled, randomized trial. J Am Holist Vet Med Assoc. 2025;78:11-19. doi:10.56641/WAGB9632 (AHVMA)
Caterino C, Aragosa F, Della Valle G, et al. Clinical efficacy of Curcuvet and Boswellic acid combined with conventional nutraceutical product: an aid to canine osteoarthritis. PLoS One. 2021;16(5):e0252279. doi:10.1371/journal.pone.0252279 (PubMed)
della Rocca G, Schievano C, Di Salvo A, et al. Palmitoyl-glucosamine co-micronized with curcumin for maintenance of meloxicam-induced pain relief in dogs with osteoarthritis pain. BMC Vet Res. 2023;19(1):37. doi:10.1186/s12917-023-03594-4 (PubMed)
Britti D, Crupi R, Impellizzeri D, et al. A novel composite formulation of palmitoylethanolamide and quercetin decreases inflammation and relieves pain in inflammatory and osteoarthritic pain models. BMC Vet Res. 2017;13(1):229. doi:10.1186/s12917-017-1151-z (PubMed)
Haroyan A, Mukuchyan V, Mkrtchyan N, et al. Efficacy and safety of curcumin and its combination with boswellic acid in osteoarthritis: a comparative, randomized, double-blind, placebo-controlled study. BMC Complement Altern Med. 2018;18(1):7. doi:10.1186/s12906-017-2062-z (PubMed)
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