We know that rabbits have the same neurophysiological mechanisms as humans to produce pain and therefore have the capacity to feel pain in the same manner as ourselves. Often, rabbits do not cry out or make sudden movements like humans, dogs or cats when painful areas are palpated. Signs of pain in the rabbit are often more subtle. Since rabbits are prey animals, meaning that hold a place in nature that places them in a position to be preyed upon by other animals, they have developed mechanisms to deal with that lot in life that might mask signs of illness or pain. Rabbits can become very still, pull their body up tight or lie very flat, and barely blink their eyes when they are frightened or anxious. This can give the appearance that they are “calm” to those individuals that don’t know how to read this body language. In this state rabbits may not respond to palpation of painful areas of the body or the response may be so subtle it is almost undetectable. Rabbits, like other companion animals, are being taken to veterinarians in increasing numbers. Over the last two decades there has been an explosion of knowledge about their medical and surgical care in the veterinary community. Rabbits are living longer and thus have the potential to experience the discomfort of illness or surgery at some time in their lives. Veterinarians have an increasing number of safe choices for managing pain in rabbits. The first step for pain management is to recognize the signs of pain in the rabbit.

Signs of Pain in Rabbits

Rabbits are often in a state of heightened anxiety or fear when they visit a veterinary office, particularly if they are not familiar with the office or there has been a long car ride to get there. It is more likely that signs of discomfort will be detected more readily when a rabbit is in his safe, home environment where he is not trying to spend time hiding. It is vital that caregivers learn their companion rabbit’s normal behavior and pay close attention to any changes that take place that are out of the ordinary. Reporting these changes to a veterinarian will be vital in determining care for a rabbit.

The following are signs that have been associated with pain in the rabbit. Remember that not all these signs are SPECIFIC for pain and some may also occur with nonpainful conditions. However, all these signs are abnormal and should be cause for further investigation.

• Abnormally “hunched” appearance when sitting 
• Alert but reluctant to move 
• Moves slowly or with effort 
• Eyes partially closed when there is activity around that should create interest (in a new or active environment a rabbit’s eyes should normally be open and round in shape) 
• Limping 
• Unusual or sudden aggression, particularly when handled if this was not the case before 
• Loss or decrease in appetite or water consumption 
• Tooth grinding 
• Hiding (when it is not usual behavior)/facing the corner or pressing the head in a corner 
• Shows no interest in the surroundings (loss of curiosity) 
• Crying or “grunting” when moving/defecating/urinating or being handled/examined 
• Coat is unkempt due to loss of interest in grooming 
• Taking a long time to eat 
• Dropping food out of the mouth

If moderate or severe pain is not managed in a rabbit, then over time there are a number of serious and possibly life threatening side effects that may develop which include:

• Gastric (stomach) ulcers 
• Cardiomyopathy (heart muscle disease) 
• Alterations in the gastrointestinal (GI) flora which may lead to a shut down of the GI tract or other disease
• Drop in body temperature 
• Renal ischemia (lack of blood supply causing damage to kidney)

Importance of Analgesia in Rabbits

Domestic rabbits maintain the physiology and behavior of a prey species and they experience pain in the same manner as other companion animals. Even though a rabbit may be handled frequently, he will respond to pain and stress in the same manner as his wild ancestors and as seen above if moderate to severe pain is not managed it can have serious consequences. Therefore it is ESSENTIAL that pain relief be used appropriately in rabbits in order in improve the quality of their lives and the treatment success. I believe that rabbits should be given the benefit of the doubt and if the condition that is diagnosed or the surgery that is performed would be painful in humans or other companion mammals, then it should be assumed that it is painful in rabbits and pain management should be used.

Common situations in rabbits where pain management is used include: surgical intervention, gastrointestinal disease, dental disease, trauma, and arthritis.

Analgesic Choices

There are a great many excellent and safe choices for analgesia in the rabbit. I have listed the most common ones below.

Safe, quiet, comfortable environment
I cannot say enough about providing a safe, quiet, comfortable environment for a rabbit to help minimize stress and the intensity of pain. Excessive noise, handling and lack of safety can intensify the level of pain any animal or human might be feeling. Having a hiding or safe protected area is important any time but particularly so when a bunny is not feeling well. It should be an area that is easily uncovered by the caregiver (such as an upside down cardboard box with a hole cut in the side which can be gently lifted) so the rabbit isn’t disturbed greatly when he needs to be seen. 

Keep noise to a minimum including barking dogs and running, noisy children. Don’t have a rabbit’s living area right next to the stereo or the TV. Minimize handling, especially picking up the rabbit and carrying him around while he is ill. Keeping litter boxes clean and having appropriate amounts of hay and fresh foods available is also important. Please see more about proper rabbit care.

Drugs (oral, injectable or transdermal) Opioids
These drugs are related to morphine and there are several safe and effective candidates in this category. They are most often used for bone pain and as part of a pre and post surgical pain management protocol. These drugs are most often given by injection, but some can be given orally or as a transdermal patch on the skin.

Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
These drugs are the most commonly used analgesics and include meloxicam, carprofen and others. NSAIDs are the most common analgesics used for chronic pain. They have both analgesic and anti-inflammatory properties so they are often used with mild to moderate pain. NSAIDs appear to be well tolerated in rabbits for long periods of time. They can be given orally or by injection.

Other pain medications
There is currently investigation into many other pain medication drugs such as tramadol. It is likely that more and more drugs will become available as veterinarians report their experiences using these products and more scientific research is performed.

Drug combinations
Many times it is necessary to use more then one type of analgesic to treat a painful condition. In some cases, rabbits become resistant to the effects of a drug that has been used for a while and it may be necessary to change to a different analgesic.

Local Anesthetics
Local anesthetics can be administered in the form of topical creams or drops or by injection into the skin. The most common uses of local anesthetics in the rabbit include minor skin procedures (skin biopsies, small tumor removals, IV catheter placement), ophthalmic procedures (tear duct flushing and thorough eye exam) and nasoesophageal tube placement (the drops are put in the nose so the small tube can be placed in the awake patient without discomfort). Local anesthetics are not meant to be used for long term analgesia and their duration of action is fairly short.

Epidural Anesthesia
Epidural anesthesia is performed by injecting an anesthetic agent into the spinal fluid of a sedated rabbit which produces numbness from the injection site backwards down the spine.  This is what is commonly used currently with women experiencing childbirth. Epidural anesthesia is currently most useful to control postoperative pain after an abdominal surgical procedure, particularly GI surgery. This would be a short-term anesthesia and would have to be administered and monitored in a veterinary clinic.

Acupuncture
Acupuncture as a form of analgesia goes back thousands of years. It is well established in humans and in the veterinary community that this form of therapy can be very effective in controlling pain under certain conditions. It is a form of therapy that is worth investigating particularly for chronic or persistent pain.

Chiropractic/Acupressure/Massage
All of these modalities can have a place in relieving pain. Gentle side-to-side rocking massage of the belly can be useful particularly in cases of gastrointestinal disorders where gas is produced. Chiropractic adjustments may help joint or spinal pain and acupressure used appropriately may relieve mild to moderate pain in a variety of areas.

Conclusion

Rabbits definitely benefit from the use of analgesia in painful conditions. The humane choice is to use analgesia in the painful rabbit. It is important for caregivers to work with their veterinarian to provide important observations on how their companion rabbit is responding to analgesic treatments and to also provide the most comfortable environment for their bunny’s recovery. Rabbits deserve the same humane pain management care that we would expect for ourselves!