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When evaluating dogs and cats for pain, it is also important to be aware that there are different kinds of pain and altered sensation. Neuropathic pain has been defined as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” (Shilo and Pascoe 2014). It is considered a chronic pain state that results from peripheral or central nerve injury and can be due to acute events such as amputation or systemic disease such as diabetes. As opposed to functional pain, neuropathic pain is believed to serve no purpose. Nociceptors are not involved, and the mechanisms underlying the syndrome are unclear. The relief of neuropathic pain is generally considered extremely challenging.

The possibility of phantom limb pain, where the patient perceives pain in a limb that is no longer present, should also be considered as a possible outcome of amputation (Shilo and Pascoe 2014). Since animals cannot report what they are experiencing verbally, and limited diagnostic capabilities may prevent us from being able to clearly recognize these conditions in animals, it will be even more incumbent upon the caretaker to be extremely observant for signs of pain in animals.

Table 4.2 Behavioral signs of pain in dogs and cats (Mills et al. 2020; Bacon et al. 2019; Godfrey 2005; Bennett and Morton 2009; Slingerland et al. 2011).

Dogs	Cats
More common	General signs
Anorexia Avoidance behaviors Hiding Aggression Hunched body posture Whining or howling Decreased social interactions Changes in activity level Changes in temperament or mood Reluctance to move or change position when recumbent or Increased restlessness and frequent changes in position Tense facial muscles with ears pulled back from the face and a grimace May attempt to bite at or lick a painful area May rub painful areas against walls, doors, or other objects Increased heart rate, respiratory rate, and/or blood pressure	Avoidance or flight behavior Restlessness or agitation Hunched posture Squinting eyes Reluctance to move Vocalization (including purring) Gait changes Decreased appetite Changes in grooming behavior Tail flicking Changes in interactions with people Decreased tolerance to handling Aggression when certain body parts are manipulated Aggression when attempting to move or lift
Less common	Signs of pain associated with degenerative joint disease
Pica Housesoiling Noise sensitivity Clinginess Excessive licking	Decreased walking, running, jumping, or climbing Increased sleep Decreased play Stiff movement or a shuffling gait Appearance of weakness Difficulty jumping Altered temperament Inappropriate elimination