November 2025
In this VETgirl online veterinary continuing education blog, Sarah Kolb, JD, BAS, CVT, VTS (CP – Exotic Companion Animals) breaks down how to recognize subtle pain behaviors across species, explores practical analgesic options, and highlights how every member of the veterinary team can make a significant difference in the welfare of their exotic patients. Exotic pets are masters at hiding pain — a survival strategy that keeps them safe in the wild but makes pain recognition a real challenge in clinical settings. Continue reading to avoid missing exotic companion animal pain!

Exotic Companion Animal Pain: Are We Missing It?

By Sarah Kolb, JD, BAS, CVT, VTS (CP – Exotic Companion Animals), Specialty Supervisor for VCA Veterinary Emergency Services and Veterinary Specialty Center in Madison and Middleton, WI

Exotic pets are masters at hiding pain, having evolved to mask weakness — a survival strategy that keeps them safe in the wild but makes pain recognition a real challenge in clinical settings. A “quiet” rabbit, a less vocal parrot, or a reptile that simply hides more often might seem normal to owners, yet these subtle changes can signal significant discomfort.

Because pain in exotic species often flies under the radar, it’s frequently underdiagnosed and undertreated. In this blog, we’ll break down how to recognize subtle pain behaviors across species, explore practical analgesic options, and highlight how every member of the veterinary team can make a major difference in the welfare of their exotic patients.

The Disappearing Act: Why Exotics Hide Pain

Pain in exotic species can be surprisingly difficult to detect. Prey species are biologically wired to hide signs of weakness — in the wild, showing pain can mean becoming someone else’s lunch. On top of that, validated pain assessment tools are limited. While scales like the Rabbit Grimace Scale and Mouse Grimace Scale exist, they’re not yet widely used in everyday practice. And finally, many owners mistake subtle behavior changes for personality quirks instead of red flags, which can delay care and prolong discomfort. Recognizing these challenges is the first step toward preventing exotic patients from silently suffering.

Photo courtesy of Sarah Kolb

Spot the Subtle: Reading Pain in Exotics

Pain in exotic pets rarely looks like what we expect in dogs or cats. Each species has its own subtle language of discomfort, and recognizing those quiet signals can make all the difference in diagnosis and care.

Rabbits & Rodents

Rabbits and rodents rarely vocalize when they’re in pain, so their discomfort often shows up as quiet behavioral changes. Bruxism (teeth grinding), a hunched or tense posture, decreased grooming, and reduced fecal output are classic warning signs. Even subtle shifts — like sitting in the back of the cage, squinting, or showing less interest in food — can signal discomfort. In rats specifically, increased Harderian gland secretions around the eyes may be a visible indicator of stress or pain, providing another subtle cue for careful observation.

Photo courtesy of Sarah Kolb

Pain may also alter normal social behavior. A normally interactive rabbit that suddenly withdraws, or a guinea pig that isolates from cage mates, may be experiencing distress. In clinical settings, watch for flinching or struggling during handling, reluctance to move after procedures, or a lack of curiosity.

When available, pain-scoring tools such as the Rabbit Grimace Scale or Mouse Grimace Scale can help quantify these subtle cues and support more consistent pain assessment.

Photo courtesy of Sarah Kolb

Birds

Birds are equally skilled at hiding discomfort, and signs of pain often blend in with stress or illness. In a parrot, sitting quietly at the bottom of the cage, fluffed feathers, a decrease in vocalization, or a change in posture may all indicate pain. Other red flags include wing droop, reluctance to perch, decreased appetite, or a sudden shift in attitude from interactive to subdued.

Species differences matter — raptors may show reduced movement or feeding, while psittacines often become withdrawn or stop talking. Some species (e.g., cockatoos and macaws) normally vocalize frequently, so a quiet bird can be an important clue.

Monitoring changes in normal routine — such as reduced preening, less interest in toys, or subtle feather picking — can also reveal discomfort. For hospitalized birds, tracking food intake and droppings provides an additional window into pain-related changes.

Photo courtesy of Sarah Kolb

Reptiles

Reptiles can be some of the most challenging patients to assess for pain. Their behavioral and physiologic responses are subtle and heavily influenced by environmental conditions. Decreased basking, reduced movement, dull or darker coloration, and increased hiding are often the only visible indicators that something’s wrong. Anorexia, open-mouth breathing without respiratory disease, or a rigid posture can also suggest discomfort.

Because reptiles rely on their environment to thermoregulate, pain may cause abnormal use of heat sources — such as avoiding basking areas or staying in cooler zones. After procedures or injury, a reptile that consistently favors one limb, resists handling, or exhibits slow righting reflexes should be evaluated for pain.

Photo courtesy of Sarah Kolb

Analgesic response can also vary by species and temperature. Reptiles metabolize drugs differently than mammals, and hypothermia can significantly alter pharmacologic effects. Early recognition of pain behaviors allows for timely intervention and improved recovery.

Beyond Just NSAIDs: Practical Analgesic Strategies

Once pain is suspected, managing it effectively requires a thoughtful, species-specific approach.

NSAIDs

Non-steroidal anti-inflammatory drugs such as meloxicam and carprofen are mainstays for rabbits and small mammals. When dosed appropriately, they can significantly improve mobility, appetite, and overall comfort. Because many exotic species metabolize NSAIDs differently than dogs and cats, dose adjustments and careful hydration monitoring are critical to prevent renal or gastrointestinal complications.

Birds can benefit from NSAIDs, but their higher metabolic rate may require more frequent dosing than in mammals. Meloxicam is commonly used in psittacine and raptor species, often requiring more frequent administration than in mammals. For reptiles, NSAID use remains less well-defined, and clinical judgment should guide therapy until more pharmacokinetic data are available.

Opioids

Opioids like buprenorphine and butorphanol are widely used across exotic species, though efficacy and duration vary significantly by taxa. In parrots, behavioral and nociceptive testing demonstrate measurable analgesic effects with both agents. Butorphanol is often preferred in birds due to their abundance of κ-opioid receptors, while buprenorphine may be more effective in mammals.

For reptiles, opioid response is inconsistent, largely due to temperature-dependent metabolism and limited receptor data. When used, careful observation of behavior and respiration is essential, as oversedation or prolonged recovery can occur.

Adjunctive Therapies & Supportive Care

Adjunctive therapies can make a profound difference in recovery and welfare. Local anesthetic blocks (e.g., lidocaine or bupivacaine, at adjusted doses) are useful for procedures like dental work and minor procedures. Gabapentin, though off-label, is increasingly used in rabbits and birds for neuropathic or chronic pain, with anecdotal evidence of improved comfort and reduced anxiety.

Environmental and husbandry-based strategies are equally important. Provide quiet housing, warmth, dim lighting, and minimal handling to reduce stress-induced pain exacerbation. Encourage familiar foods and hiding options to support normal behaviors and faster recovery.

The most effective approach is multimodal analgesia — combining pharmacologic and non-pharmacologic techniques to target multiple pain pathways. This approach minimizes drug doses, reduces side effects, and supports the patient’s natural coping mechanisms.

The Technician’s Edge: Recognizing and Communicating Pain

Technicians are often the first to notice when something isn’t right. Subtle changes — a rabbit that turns away from food, a bird that fluffs more than usual, a reptile that hides longer than expected — can easily go unnoticed during rounds. Veterinary nurses and technicians bridge the gap between observation and action, ensuring those small cues lead to meaningful intervention.

Photo courtesy of Sarah Kolb

Explaining what subtle signs really mean, and emphasizing follow-up, warmth, nutrition, and stress reduction at home, helps reinforce continuity of care. Technicians can empower clients by modeling gentle handling, demonstrating medication techniques, and normalizing discussion of pain in exotic pets.

Pain management is truly a team effort, and technicians play a key role in advocating for patients who can’t speak for themselves.

Photo courtesy of Sarah Kolb

Don’t Let Pain Go Unseen

Pain in exotic pets may be subtle, but it’s just as real as in dogs and cats. Recognizing it requires careful observation, knowledge of species-specific behaviors, and a proactive approach to analgesia. Veterinary teams play a critical role in noticing early signs, documenting changes, and advocating for effective pain management.

Engaging clients in the process is equally important — educating them on what to watch for and encouraging early reporting ensures timely care, improving welfare and outcomes. With thoughtful monitoring, multimodal analgesia, and clear communication, veterinary teams can bridge the gap between hidden suffering and comfort.

Resources
1. Guzman DSM. “Exotic Animal Pain Management.” Veterinary Clinics of North America: Exotic Animal Practice. 2023; 26(1):xiii-xiv. doi:10.1016/j.cvex.2022.10.001.
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3. Keating SCJ, Thomas AA, Flecknell P, et al. Evaluation of EMLA cream for preventing pain during tattooing of rabbits: changes in physiological, behavioural and facial expression responses. PLoS ONE. 2012;7(9):e44437. doi:10.1371/journal.pone.0044437.
4. Leach MC, Coulter C, Richardson C, et al. Assessment of post-operative pain in laboratory mice using behaviour and the Mouse Grimace Scale. PLoS One. 2012;7(4):e35656. doi:10.1371/journal.pone.0035656
5. Leach MC, Allweiler S, Richardson C, et al. Behavioural effects of ovariohysterectomy and oral administration of meloxicam in laboratory-housed rabbits. Res Vet Sci. 2009;87(2):336–347. DOI: 10.1016/j.rvsc.2009.02.001.
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