I’ve been a veterinary orthopedic specialist for twenty years. In that time, I’ve seen thousands of dogs with pain-generating conditions — arthritis, disc disease, cancer, post-operative recovery, traumatic injuries. And I’ve had the same conversation, hundreds of times, with owners who bring their dog in for “a limp” and leave knowing their dog has been in significant pain for months.
“But he was still eating,” they say. “He still wanted to play.”
He was still eating because pain rarely eliminates appetite in dogs until it’s severe. He still wanted to play because the drive to engage with you — his person — can override substantial pain. He was compensating, and you couldn’t see it. Not because you weren’t paying attention. Because you’re human, and your species is optimized for face-based emotional detection, not canine biomechanics.
The Masking Problem #
Dogs evolved as prey animals before they were predators. Even as domesticated companions, the ancient instinct to mask weakness persists. In the wild, the limping animal is the one the pack or the predator targets. That survival logic is baked into the nervous system at a level that training can’t touch.
In clinical practice, this manifests as the “stoic dog” phenomenon. I see Labrador Retrievers with complete cruciate ligament ruptures that are still fetching balls. I see Golden Retrievers with Grade 3 arthritis who greet visitors at the door with apparent enthusiasm. The pain is real — it’s there in the joint radiographs, in the synovial fluid analysis, in the muscle atrophy — but the behavioral presentation doesn’t match what owners expect pain to look like.
What does pain actually look like in dogs? Some of the most reliable signals are the ones nobody tells you to watch for:
Changes in sleep architecture. A dog in chronic pain sleeps more but rests less. They shift positions frequently, unable to find comfort. Their deep sleep periods shorten. The sleep that does occur is often accompanied by muscle tension rather than the full-body relaxation you see in a pain-free dog.
Altered social dynamics. Dogs in pain often become subtly less affiliative. They still want contact, but on their terms. They seek less rather than being sought. This is so gradual it’s almost never noticed until you look backward from a diagnosis.
Gait changes that precede limping. True limping — weight-bearing reduction sufficient for visual detection — represents a meaningful threshold. Below that threshold, there are weeks or months of subclinical gait changes: shifts in step frequency, subtle toe-touching patterns, asymmetric loading that reduces force on the affected limb by 10-15% before it becomes visually apparent. These changes are real, clinically significant, and invisible without instrumentation.
The “slowing down” attribution. I’ve lost count of how many times owners have told me their middle-aged dog “has just been slowing down lately — must be getting older.” Nine times out of ten, when I do a thorough orthopedic workup, I find a pain-generating condition. Aging doesn’t cause behavioral slowing in otherwise healthy dogs. Pain does.
The Diagnostic Gap #
The challenge in veterinary practice isn’t identifying pain once a dog is in the clinic. A thorough physical examination — palpation, range-of-motion assessment, gait analysis, pain provocation testing — gives us good information in a controlled setting.
The challenge is the 23 hours and 45 minutes per day the dog isn’t in the clinic.
Pain is dynamic. It changes with activity, weather (barometric pressure genuinely affects arthritic joints), medication timing, time of day. A dog who looks comfortable at a 2pm appointment may have had significant pain at 4am and again after the morning walk. The single-point-in-time clinical assessment is valuable but limited.
For years, the best we could offer owners was: “Watch for the following signs, and call us if you notice them.” We gave them a list. They tried. They missed things, because the things we were asking them to watch for are hard to see.
What Changes with Continuous Monitoring #
I was skeptical when I first heard about The Ruff. I’ve seen wellness devices come and go, and most of them generate noise rather than signal. I agreed to consult on the pain algorithm validation because I wanted to understand what they were actually measuring.
What I found was rigorous. The clinical validation process — blinded pain scoring by certified specialists, cross-referenced with sensor data from hundreds of dogs across multiple pain contexts — was the kind of methodology I’d expect from a peer-reviewed study, not a consumer product. The correlation between device scores and clinical assessment wasn’t perfect (nothing is), but it was clinically meaningful.
More importantly, the device captures what I can’t: the 3am pain episode, the post-walk pain spike, the gradual week-over-week trend change that indicates disease progression. When an owner comes in with a Perfect Paw pain timeline, I have a 30-day history of their dog’s pain experience. That changes the clinical conversation entirely.
I’ve had patients where the device flagged elevated pain scores for three consecutive nights, prompting the owner to schedule an appointment, and the workup revealed an early-stage disc herniation that would otherwise have presented as an acute emergency weeks later. Early intervention in disc disease dramatically improves outcomes. We intervened early because the dog couldn’t hide from the sensor.
The Conversation with Owners #
The most valuable thing I’ve seen from widespread wearable monitoring is the conversation it enables. When I can show an owner a 30-day pain trend chart and say, “Look — your dog’s scores have been creeping up since January. This isn’t new; it started here,” the response is different from “I think he might be arthritic.” Data changes how people process information.
I’m also more candid with owners now about the inadequacy of their own pain detection — not to make them feel guilty, but to reset expectations. You’re not a bad owner because you missed your dog’s chronic pain. You’re a human without the right instruments. Now you have better instruments.
The dogs I’m most worried about are the ones whose owners haven’t heard this message yet. The ones still attributing behavioral changes to “getting older.” The ones who will present to me in six months with a condition that was detectable — and treatable — a year ago.
If you have an aging dog, a dog with known joint issues, a dog who’s had orthopedic surgery, or simply a dog you love and want to understand better: continuous pain monitoring is no longer a luxury. It’s the standard of care we’ve been unable to offer until now.
Dr. James Park practices veterinary orthopedic surgery in New York, NY. He serves as a veterinary advisor to Perfect Paw and contributed to the clinical validation of The Ruff pain detection algorithm.