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Random episodes of pain episodes of pain
Wednesday, June 15, 2011

Vicki asks:  After surgery for IVDD my dog will occasionally have random episodes of pain every three to six months. He jumps up, cries out in severe pain, turns around and looks at his rear end. It takes about a day for it to go away. Is this typical, why is it occurring, and what can be done about it?

Painful episodes are one of the more frustrating presentations we deal with.  Unfortunately, there are so many potential causes of pain that it can be a difficult hunt to go on. 

It would be important to have a good exam performed by your veterinarian to try and localize the source of the pain (neurological, orthopedic, abdominal, soft tissue, etc.).  Depending on their exam findings it may be warranted to perform additional diagnostic (radiographs, ultrasound, blood work, etc.). 
Potential causes related to IVDD surgery include residual compression of the spinal cord and/or nerve roots, and paraesthesia secondary to abnormal healing of the nerve tissue.
Sometimes it is difficult and risky to remove all fragments of disk material with surgery.  Therefore, when your dog assumes certain positions there is the potential that the residual fragments irritate the spinal cord and/or nerve roots.
The other potential cause for the episodes is paraesthesia.  Paraesthesia  is a sensation of tingling, pricking, or numbness of the skin with no apparent long-term physical effect. The manifestation of paresthesia may be transient or chronic.  In cases of severe spinal cord injury I have seen dogs go on to develop paraesthesia.  The fact that your dog had absent deep pain sensation prior to surgery is consistent with a severe spinal cord injury.  Therefore, in the healing process there is the potential for signals to get “crossed” and result in paraesthesia. 
If the painful episodes are not increasing in severity or frequency, associated with neurological deficits, and your veterinarian is not able to identify any other causes a drug to discuss a trial course of is gabapentin (Neurontin).  If the gabapentin helps some, but not adequately, another drug to consider in the same category (but more expensive) is pregabalin (Lyrica).

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