Robbie and Sally are inseparable. He is the last one to say goodnight to her, and the first one to greet her in the morning. Sally lives with Complex Regional Pain Syndrome, and Robbie is her service dog.
Chronic pain can arise from known or unknown causes. The common thread is that it is persistent and difficult to treat. Unlike acute pain, which typically alerts the sufferer to a specific cause that must be addressed, “chronic pain appears to have no inherent value for survival and is best thought of as a disorder,” according to the Society of Clinical Psychology: “Interventions for acute pain often fail for chronic pain, which suggests that there are different underlying pathophysiologic mechanisms and the need for distinct approaches to treatment.” Painkillers, ice packs, and analgesics help most of us relieve acute pain. Chronic pain, on the other hand, calls for fortitude in the face of an unrelenting physical experience.
Who is best equipped to help humankind through experiences of suffering to which we cannot give words? Dogs have helped their human counterparts survive arctic wastelands, overcome challenging terrains, and survive debilitating illnesses. They are naturally gifted with a drive to please their owners and an all-encompassing sense of love and loyalty. With special training, dogs can provide irreplaceable assistance to people who live with chronic pain.
This article details the history of support animals, the research surrounding their benefits for sufferers of chronic pain, the training and certification process for different types of support dogs, and a list of resources for finding a support dog or training your own pet as a service or therapy animal.
History and Research Supporting Assistance Dogs
In the 1860s, Florence Nightingale found animal companionship beneficial to her patients. Since then, dogs have been used in many capacities to help people recover from and manage illness, disability, and other conditions. Animal-assisted healing is part of a holistic treatment approach for many with chronic pain.
Therapy dog visits have been shown to be effective in treating fibromyalgia, a common type of unexplained chronic pain. In as little as twelve minutes, researchers found that these visits significantly reduced self-reported pain, fatigue, and emotional distress. Therapy dogs can decrease the heart rate, blood pressure and breathing rate; reduce the stress hormone cortisol; boost endorphins, the body’s natural painkillers; and benefit the immune system. Because chronic pain is, by definition, resistant to traditional pain therapies, researchers are constantly seeking new and diverse approaches to help chronic pain sufferers manage their conditions. Studies indicate emotional and psychosocial benefits of support animals, in addition to the task assistance that service dogs can provide.
People with chronic pain often have limited mobility, and trained service animals are especially well-suited to easing the challenges of daily life. For Meredith Butenhoff, a 16-year-old with Ehlers-Danlos syndrome–a genetic condition that affects connective tissue and causes lightheadedness and low energy–her service dog, a Black Lab named Sami, is invaluable. He helps her balance, stand up, and achieve a level of independence she wouldn’t otherwise be able to access. If she falls, he can go for help. With Sami at her side, Meredith is able to be more active. Beyond that, the emotional support has changed her life.
It is difficult for researchers to quantify the unique benefits that a dog’s unconditional love has on a patient who is suffering from pain. Any kind of assistance dog can provide relief and distraction from debilitating chronic pain, but the specific type of support sought will help a patient pinpoint the most beneficial type of animal assistance for their individual situation.
Types of Support Dogs and their Training and Certification
There are three types of support dogs that patients are commonly paired with. In order from the lowest level of training and certification to the most involved, they are Emotional Support Dogs (ESDs), Therapy Dogs, and Service Dogs.
Emotional Support Dogs
“Emotional support dogs are dogs that provide comfort and support in forms of affection and companionship for an individual suffering from various conditions,” the United States Dog Registry explains. In order to obtain an ESD, a patient needs a medical letter of recommendation.
Emotional support dogs are not covered by ADA regulations. However, the Fair Housing Amendment Act and the Amended Air Carrier Access Act both apply to ESDs. This means that they are permitted in certain types of housing that otherwise prohibit pets, and they must be allowed to accompany their owners in aircraft cabins.
There are few limitations on which dogs can be considered ESDs. For the purpose of reasonable housing accommodation under the FHA, these animals do not need specialized training and housing providers should not require any paperwork beyond the medical letter of recommendation. Their primary role is to provide companionship. Be wary of organizations offering registration kits to allow individuals to register their pet as ESDs. In most cases, these fees and kits are unnecessary for the accommodations available for ESDs.
Therapy dogs can be part of a prescribed course of treatment, and they are typically part of a therapy team: The owner who takes the dog through training and certification generally accompanies the dog on therapy visits to nursing homes, hospitals, and other institutions.
The American Kennel Club provides training for therapy dogs through socialization, behavior classes, therapy courses, and an evaluation process. A variety of organizations can provide final certification, including the Alliance of Therapy Dogs, Bright and Beautiful Therapy Dogs, Love on a Leash, Pet Partners, and Therapy Dogs International.
According to the AKC, “Therapy dog candidates should be naturally calm, friendly and affectionate to strangers. They also need to be well trained in basic obedience, able to easily adapt to novel noises, places, smells, and equipment. Therapy dog organizations also require that therapy dogs be healthy and have regular wellness check-ups and be well-groomed, clean and brushed at the time of all visits.”
After training, therapy dogs must complete a certain number of visits to achieve different levels of certification, and the organizations that host these visits–such as hospitals, schools, or clinics–assess the dog’s performance and suitability to therapeutic tasks.
Therapy dogs are the best solution for patients who do not want the responsibility of caring for an animal full-time, and instead wish to receive the therapeutic benefits of spending time with a pet in supervised, clinical environments.
The Foundation for Service Dog Support defines a service dog as “a dog that has been trained to perform tasks to assist an individual with disabilities. It is the ability to perform observable tasks, on command, that distinguishes a service dog from an emotional support dog, therapy dog or other working dogs. Some examples of tasks are balance and support, retrieving dropped objects, fetching medications and summoning assistance when needed.”
Those who need a full-time companion protected by the Americans with Disabilities Act should research service dogs, who undergo much more rigorous training than ESDs or therapy dogs–and therefore tend to be more costly. Training for a service dog is often in the range of $10,000-$20,000 and can take up to two years. Over this period of time, dogs are taught to be extremely responsive to their owners, to ignore any and all distractions, and to perform specific tasks that will help them to assist their human partner’s specific needs.
Service dogs can carry out complex tasks on behalf of chronic pain patients: calling emergency services in a crisis; reminding the owner to take their medication; retrieving items out of the owner’s reach; providing stability as the human partner sits, stands, or walks; opening doors or operating switches; and so on. Creative trainers are constantly expanding the range of tasks they teach dogs to help people with various conditions, and they share their insights to help other trainers implement the unique processes they use.
Some breeds are better suited to service dog tasks than others, and dogs who do not acclimate well to training are dismissed from their programs. Only the dogs who are consistently able to perform all the required tasks for their service mission can become certified. The International Association of Assistance Dog Partners requires a minimum of 120 hours of training along with a specific list of tasks and requirements. However, people with disabilities have the right to personally train their service dogs, and do not have to go through outside organizations for the training process.
Service dogs are guaranteed right of entry into public establishments, like restaurants, grocery stores, hospitals, medical offices, hotels, and other places of public accommodation–and none of these establishments are permitted to require certification or paperwork to prove a service dog’s legitimacy or status. The ADA specifies that “There are individuals and organizations that sell service animal certification or registration documents online. These documents do not convey any rights under the ADA and the Department of Justice does not recognize them as proof that the dog is a service animal.” Contact the DOJ or seek legal counsel if your service dog is unfairly denied entry anywhere.
Resources for Finding and Training Support Dogs
There are many resources for finding a companion service dog or a therapy dog. Additionally, there are many resources to assist those who would like to get a certification for their pet to become a licensed therapy dog. The following list provides useful information on some of the organizations that can help you in your search. For more information on what is available to you locally, you are encouraged to reach out to your local ASPCA or Humane Society chapter. Local trainers and care providers may be willing to work with you to help subsidize the acquisition of a service animal.
Assistance Dogs International is a coalition of not-for-profit assistance dog organizations that helps individuals find a dog to match his or her needs.
Alliance of Therapy Dogs is a national therapy dog registry with over 14,000 members across North America, and can assist those in certifying their potential therapy dog.
Bright and Beautiful Therapy Dogs is a nonprofit organization which evaluates, tests, trains and qualifies owners and their well-behaved dogs as therapy dog teams.
Canine Assistants trains service dogs to assist children and adults with physical disabilities or other special needs in a variety of ways.
The Foundation for Service Dog Support provides training for service dog teams, support and encouragement for people who need service dogs and increased community awareness about the role of service dogs in public spaces.
Heeling Allies privately trains Mental Health Service Dogs, Emotional Support Dogs and Skilled Companion Dogs that enrich the lives of qualified individuals living with certain psychological, neurological and developmental impairments.
Love on a Leash is a nonprofit dedicated to providing an avenue for volunteer pet therapy teams to engage in meaningful and productive animal-assisted therapy.
Pawsitivity is a nonprofit organization dedicated to rescuing dogs and training them as service dogs.
Pet Partners provides trained handlers and their pets to facilities looking to incorporate therapy animals into their programs. The website also provides a list of links broken down by state for finding a program to become a registered therapy pet handler.
Therapy Dogs International is a volunteer organization dedicated to regulating, testing and registration of therapy dogs and their volunteer handlers for the purpose of visiting nursing homes, hospitals, other institutions and wherever else therapy dogs are needed.
Find additional therapy dog organizations on the American Kennel Club’s extensive list of partners, and a list of resources about assistance dogs from the International Association of Assistance Dog Partners. Assistance Dogs International offers a program search to help people around the world find service dog organizations they can work with.
As thousands of families have already learned, dogs have the unique capacity to offer a form of assistive companionship that no human can emulate. No one should ever feel alone in their chronic pain experiences. That is why assistance animals and support organizations exist–to make your life brighter, easier, and more bearable day by day.