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pain management

Grunting a sign of pain

Neuro Corner Answers

Dr. Andrew Isaacs
DVM Diplomate ACVIM (Neurology)
Dogwood Veterinary Referral Center

Primary interests include intervertebral disc disease, seizure management, luxations/fractures of the spine, and surgery for brain tumors



Hello, I have a 3 year old Shih Tzu who has been diagnosed with IVDD. She has spent the last three days at the vet and has been given steroids.

She was sent home yesterday with steroids but no other medication.

She has some movement in her back legs and can get around some on her own. Whenever she moves or is moved to go outside she tenses up her stomach and grunts. Is this a sign of  pain? She does not yelp or whine so I am unsure if this is a sign of pain or just part of the IVDD. My vet says he does not think she is in pain. What should I do? Thanks, Ty.


It sounds like she has the potential to be in some discomfort. It is not going to hurt to ask your vet for some pain meds on top of the steroids.

Typically, we like to use gabapentin +/- tramadol. By no means do I want to second guess your vet, but it wouldn’t hurt to see if the meds help with the grunting as a trial to see if she is uncomfortable as long as your vet does not see any contraindications.

The use of a GI tract protectant in cases that are receiving NSAID’s  or steroids would definitely be warranted under the supervision of the patient’s veterinarian.

Pain Medications with a disc episode

Never have any patience with pain during a disc episode. When the pain medication prescription is correct, pain is in control in 1 hour. Expect comfort dose to dose.

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Emergency pain meds effective 1 hour

Emergency Pain Management Information

  • The anti-inflammatory drug (steroid or a non-steroid NSAID) may take 7-30 days to relieve all painful inflammation.
  • A combo of pain meds provide comfort from pain while the anti-inflammatory is at work.
  • Expect pain meds to provide relief In 1 hour upon correct mg dose + times per day given.
  • Pain meds are effective for about 8 hrs.
  • Recovery suite limits the potential to re-damage the healing disc to go on to loose nerve function. 

Pain? Alert your vet❗️

Pain meds can be effective in 1 hour. There is no one-size-fits-all pain relief. Make sure the medications are fully controlling pain from dose to dose with no break-through in pain. Continued feedback to your vet is vitally important until the pain medications have been properly adjusted for your dog.

Pain med combo

A two or three-way combination of pain meds is often necessary to address each source of pain during a disc episode . Most often 3x/day (every 8 hrs) dosing is Rx'd to provide round the clock comfort. Expect when the correct Rx for your dog is given, then pain would be in control within an hour or less.

Anti-inflammtory drugs

These drugs can take from 7-30 days to rid the body of all painful swelling. Your vet will choose from two classes (non-steroids/NSAID or steroids). ❗️There is a danger to mix steroids with NSAIDs.❗️ A 4-7 day washout is prudent if there is an emergency to switch from one to the other class: NSAID ⤄ NSAID or NSAID ⤄ steroid). ⚠️Stomach protection is used with all anti-inflammatories to avoid bleeding ulcers.

Med Chart

Don’t miss a dose especially if more than one person cares for your dog. Document things to see patterns. Handy info, when you discuss things with your vet. Download the chart PDF today. It includes a sample and a blank chart to personalize for your dog's meds.

Drug Directory

There are no safe meds. Just meds which are used in a safe manner by the vet. And coupled with owners who are knowledgable about each med their dog takes. The Mar Vista Veterinary web page has an excellent drug look up directory.

Med Card

Handy to keep a reference card in your wallet. Useful for keeping all meds straight as you discuss things with your vet.

Acupuncture - Laser

These two therapies can help stimulate nerves to self repair. CAUTION: During conservative treatment, anytime out of the recovery suite is a dangerous time for the early healing disc. Movement of the back/neck can increase a disc tear with escape of disc material into the spinal cord. Pain again and the need to start from square one. For an animal with very mild neuro deficits, transporting to therapy has to be carefully weighed against what benefit would be gained VS risk to the early healing disc. Look for a mobile vet who makes house calls.


Learn more detail about commonly used drugs to manage pain. Your vet has many options with other pain meds in his effort to find the right combination to give full comfort from pain your dog deserves.
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