Neuropathic pain is common in humans and there are several different ways it can manifest. People with peripheral neuropathies commonly complain of numbness in their extremities and there’s often a characteristic pattern that is described as a “stocking and glove” distribution. It can feel similar to when a limb “falls asleep” - that numbness or pins-and-needles sensation that can be felt after a limb is bent or compressed in an awkward position for a period of time. In some cases, these patients also experience weakness, though not always. In veterinary patients, recognizing these signs is much more challenging. Animals cannot describe sensations like numbness, and these changes are not directly observable. As a result, if a pet is experiencing numbness alone, we may never know. However, in addition to numbness and occasional weakness, there is often an associated pain component - which is the primary focus of this discussion.
In humans, neuropathic pain can be described in a variety of ways, and it can fluctuate in both intensity and character from day to day. Patients often describe sensations such as burning, shooting, or stabbing pain. Others report tingling - which might sound mild or insignificant, but can actually be quite distressing when it's persistent or intermittent. Another way to imagine this type of discomfort is to compare it to the sensation of a phone set to vibrate - an intermittent buzzing feeling. Imagine that sensation continuously occurring on the underside of your foot or hand - it can be distracting and uncomfortable. Because animals cannot communicate these sensations, it is not surprising that they may, instead, exhibit behavioral changes as a way of expressing their discomfort.
These behavioral changes are often what prompt clients to seek veterinary care. Owners may report signs such as excessive licking, chewing, or biting - sometimes to the point of self-injury. Other changes can include hiding behavior, increased sensitivity to touch, reluctance to walk in previously tolerated areas, or new-onset trembling, shaking, or lethargy. Even subtle or nonspecific behavioral shifts may be significant. When these concerns are raised, it is important to consider pain - particularly neuropathic pain - as a potential underlying cause.
Clinically, common signs that raise suspicion for neuropathic pain include licking or chewing any part of the body, changes in movement or willingness to play, lethargy, and generalized behavioral changes. Even if pain cannot be definitively proven, it is often appropriate to pursue an empirical treatment trial to assess whether clinical signs improve. In many cases, patients present for unrelated issues, and underlying discomfort is discovered during evaluation. For example, a cat presenting with inappropriate urination may also have diabetes and exhibit a plantigrade stance, suggesting possible neuropathic discomfort. This highlights the importance of proactively considering pain management - particularly in patients with conditions like diabetes or other endocrine disorders.
Any new sensitivity in a patient - such as a previously tolerant dog becoming reactive to touch along the back or paws - should prompt consideration of pain as an underlying cause. One particularly important manifestation is self-injurious behavior, which is defined as any action directed toward the animal’s own body that results in injury or discomfort. Excessive grooming is a common example, though it has many potential medical differentials. Regardless, neuropathic or orthopedic pain should always be included on the differential list.
A thorough orthopedic and neurologic examination is essential whenever feasible. Additionally, behavioral and pain-related conditions often overlap, requiring a multimodal approach to treatment. Veterinary behaviorists frequently collaborate with pain management specialists, as these cases may require diagnostic nerve blocks, trials of analgesics, and concurrent use of anti-anxiety medications. Pain and anxiety can coexist and exacerbate one another, so both must be addressed. Treating underlying anxiety, fear-based behaviors, or aggression - such as growling, snapping, or biting - is critical. If either the pain or the emotional component is left untreated, overall outcomes are likely to be limited, and the patient’s quality of life will remain compromised.
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