Cushing’s disease itself is not typically a painful condition for dogs. The hallmark signs, including excessive thirst, frequent urination, increased hunger, a pot-bellied appearance, and panting, cause discomfort and reduced quality of life but are not generally associated with sharp or acute pain. That said, Cushing’s disease creates several secondary problems that can cause real pain, and knowing what to watch for makes a significant difference in keeping your dog comfortable.
Why Cushing’s Itself Doesn’t Cause Obvious Pain
The core problem in Cushing’s disease is too much cortisol circulating in your dog’s body. Cortisol is actually one of the body’s own anti-inflammatory hormones, so ironically, the excess may mask pain signals that your dog would otherwise feel. The most visible effects of all that cortisol, like a swollen belly, thinning skin, and hair loss, are uncomfortable but not painful in the way an injury or infection would be.
Muscle weakness is extremely common. As many as 85% of dogs with Cushing’s are considered weak by their owners and veterinarians. This weakness comes from the gradual breakdown of muscle fibers under chronic cortisol exposure, and it’s what gives many Cushing’s dogs their characteristic pot belly and difficulty getting up from a lying position. A study published in the Journal of Veterinary Internal Medicine specifically noted that this muscle weakness is “nonpainful,” with owners and veterinarians confirming that affected dogs did not appear to be in pain. Some dogs also develop an unusually stiff, stilted gait, but even this was described as nonpainful in clinical evaluations.
So if your dog seems slower, more lethargic, or reluctant to play, that’s the disease affecting their energy and muscle strength rather than causing pain directly. It still diminishes their quality of life, but understanding the difference helps you and your vet target the right problems.
Secondary Conditions That Do Cause Pain
While the disease itself may not hurt, it sets the stage for several complications that genuinely do.
Bladder Stones
Dogs with Cushing’s are 10 times more likely to develop calcium-containing bladder stones than dogs without the condition. Bladder stones cause painful urination, straining, blood in the urine, and sometimes urinary blockages. Because Cushing’s dogs already urinate frequently and in large volumes, it can be easy to miss the early signs. If your dog starts straining to urinate, crying during urination, or producing only small amounts of urine despite frequent attempts, bladder stones are a real possibility.
Skin Infections
Chronically elevated cortisol suppresses the immune system and thins the skin, making bacterial skin infections (pyoderma) common in Cushing’s dogs. These infections can be itchy, sore, and genuinely uncomfortable. Thin skin also tears and bruises more easily, which means even routine activities like jumping off furniture or scratching an itch can cause small wounds that heal slowly.
Ligament Injuries
Long-term cortisol excess weakens connective tissues. Veterinary endocrinology references note that chronic hypercortisolism can worsen common orthopedic problems like cruciate ligament tears and kneecap instability. Research in both humans and animals links prolonged cortisol exposure to changes in the elastic fibers and structural proteins within ligaments, reducing their ability to handle stress. A torn cruciate ligament is acutely painful and causes sudden lameness, so any new limping in a Cushing’s dog warrants prompt attention.
High Blood Pressure
Many dogs with Cushing’s develop systemic hypertension. While your dog won’t complain of a headache, sustained high blood pressure can cause damage to the eyes, kidneys, and heart over time, contributing to general malaise that’s hard to pinpoint but real.
When a Pituitary Tumor Causes Head Pain
About 80 to 85% of canine Cushing’s cases are caused by a small tumor on the pituitary gland at the base of the brain. Most of these tumors stay small and cause no neurological problems. But when a pituitary tumor grows large enough to press on surrounding brain tissue (becoming what’s called a macroadenoma), it can cause genuine pain.
A study of 97 dogs with detectable pituitary masses found that 25% showed signs of pain or heightened sensitivity to touch, particularly around the head and neck. Among those dogs, half had pain localized to the cervical (neck) region, and about one in five had pain around the head. Dogs showing this kind of pain were 3.3 times more likely to have visible brain compression on imaging. The pain likely results from the tumor pressing on surrounding brain structures and is considered referred pain, meaning it’s felt in the head and neck even though the source is deeper inside the skull.
Other neurological signs of a growing pituitary tumor include changes in mental state (seeming dull, confused, or “not themselves”), compulsive pacing or circling, unsteadiness, vision loss, and seizures. If your dog with Cushing’s starts showing any of these behaviors, especially in combination, the tumor may be growing and causing real discomfort.
Can Treatment Cause Discomfort?
The most commonly prescribed medication for Cushing’s works by reducing cortisol production. In clinical studies, about 13 to 19% of dogs experienced side effects, most of them mild to moderate. The most frequent issues were temporary loss of appetite, vomiting, diarrhea, and lethargy. These are signs of the cortisol level dropping too low, essentially tipping your dog into the opposite problem (too little cortisol instead of too much). This can cause stomach upset and general unwellness that your dog likely finds unpleasant.
In rare cases, cortisol drops severely enough to cause a crisis involving dehydration and electrolyte imbalances, which is a veterinary emergency. This is why dogs on Cushing’s medication need regular blood work and monitoring, especially in the first weeks of treatment. If your dog becomes suddenly weak, stops eating entirely, or has repeated vomiting or diarrhea after starting medication, contact your vet promptly.
How to Gauge Your Dog’s Comfort
Dogs are notoriously good at hiding pain, and the lethargy caused by Cushing’s can make it even harder to tell whether your dog is hurting or simply tired. Veterinary researchers developed a quality-of-life tool specifically for dogs with Cushing’s syndrome, called CushQoL-pet, which breaks the disease’s impact into three main areas: your dog’s demeanor (depression, low energy, reluctance to play), their clinical signs (thirst, urination, hunger), and their physical appearance (coat quality, skin condition, body condition).
You can use these same categories as a simple framework at home. Track changes week to week in how your dog acts, how much they drink and urinate, and how their body looks. A dog who is drinking excessively but still eager to greet you at the door and enjoys short walks is in a very different place than one who lies in the corner, resists being touched, or whimpers when moving.
Specific pain signals to watch for include flinching or crying when touched (especially around the head, neck, or belly), reluctance to move that goes beyond normal tiredness, sudden lameness, straining or vocalizing during urination, and restlessness or inability to settle into a comfortable position. Any of these suggests something beyond the baseline discomfort of Cushing’s and points to a secondary problem that your vet can often treat directly.