A 12-year-old, 25 kg (BCS 3/5), intact female German Shepherd was evaluated for sudden manifestations of intense fearful behavior with no apparent triggering stimulus. The dog had a history of aggressive behavior towards conspecifics and, more recently, fearful behavior in response to loud noise. Furthermore, the dog suffered from bilateral hip dysplasia and had recently been diagnosed with multiple severe spinal compressions at both lumbar and thoracic levels. Various attempts to treat pain were made, with no success. Soon after, the dog began to display intense fearful behavior without apparent reason. At first, these behaviors occurred only in unfamiliar indoor environments. However, they rapidly generalized to other contexts, to the point of being displayed almost constantly. A behavioral evaluation was requested. CBC, serum biochemical analysis, thyroid profile, and echocardiographic examination were unremarkable. The dog’s behavioral diagnosis consisted of pain, generalized anxiety, and noise sensitivity. Gabapentin dosage was doubled (24 mg/kg BID) and a fentanyl patch was applied to the dog’s back for three consecutive days. No improvement was observed. Hence, clomipramine was added to gabapentin at a starting dosage of 0.6mg/kg BID and titrated to 1mg/kg after 21 days. After 1 week the owner reported an initial reduction in the frequency and intensity of the fearful behavior which completely disappeared after 1 month of treatment. Mild urinary retention was observed as a possible collateral effect of clomipramine. Gabapentin dosage was decreased to 20mg/kg BID. With due monitoring of behavioral and physiological parameters, clomipramine and gabapentin administration will not be interrupted.