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Topic:Pain Management
Pain management in horses involves various strategies and interventions designed to alleviate discomfort and improve the well-being of equine patients. It encompasses pharmacological approaches, such as the use of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and other analgesics, as well as non-pharmacological methods like physical therapy, acupuncture, and environmental modifications. Effective pain management aims to address both acute and chronic pain conditions, which can result from injuries, surgeries, or diseases such as laminitis and arthritis. This page aggregates peer-reviewed research studies and scholarly articles that explore the mechanisms, efficacy, and safety of different pain management techniques in horses, contributing to the understanding and advancement of equine veterinary care.
Comparison of first and second acupuncture treatments in horses with chronic laminitis. Laminitis is a common but critical disease that causes severe pain and disability in horses. The etiology and pathogenesis of laminitis remain inconclusive and a multimodal therapeutic approach is generally indicated. Acupuncture has been used as a treatment option; however, the required number of treatments is still controversial due to the lack of objective scientific evidence. Objective: The objective of this study was to determine if the response to a second acupuncture treatment differed from the response to the first acupuncture treatment in horses with chronic laminitis. Methods: Fourte...
Pressure algometry for assessment of abdominal wall sensitivity in horses after ventral midline coeliotomy. To assess the clinical course of abdominal wall sensitivity after ventral midline coeliotomy in horses by determining mechanical nociceptive thresholds (MNTs) during hospitalization, and to determine the inter-observer reliability of pressure algometry on the abdominal wall. Methods: Observational, cohort study. Methods: A total of 13 horses presenting with signs of abdominal pain/colic undergoing ventral midline coeliotomy and 10 healthy horses without an abdominal incision. Methods: Measurements were performed on days 1, 3, 5, 7 and 9 postoperatively using a pressure algometer. Measurement s...
A “modified Obel” method for the severity scoring of (endocrinopathic) equine laminitis. Laminitis is a common equine disease characterized by foot pain, and is commonly diagnosed using a five-grade Obel system developed in 1948 using sepsis-related cases. However, endocrinopathic laminitis is now the most common form of the disease and clinical signs may be mild, or spread across two Obel grades. This paper describes a modified method which assigns scores to discreet clinical signs, providing a wider scale suitable for use in a research setting. Methods: The "modified Obel" method was developed using an iterative process. First, a prototype method was developed during the detaile...
Effect of fentanyl on thermal and mechanical nociceptive thresholds in horses and estimation of anti-nociceptive plasma concentration. There are few investigations relating anti-nociception to plasma concentrations of fentanyl in horses. The study objective was to evaluate analgesic efficacy and duration in horses and determine the minimum anti-nociceptive plasma concentrations. Eight horses were treated with saline (P) and fentanyl (F=2.5μg/kg; F=5μg/kg; F=10μg/kg) given IV over 5min, with a wash-out period of 10 days. To evaluate thermal (°C) and mechanical (N) nociceptive threshold single stimulations were applied prior to (baseline) and 10, 30, 60, 90, 120, 180, 240, 300, 360, 420, 540min and 22.5h after treatment. Pl...
Evaluation of the effect of experimentally induced cartilage defect and intra-articular hyaluronan on synovial fluid biomarkers in intercarpal joints of horses. Inflammatory and degenerative activity inside the joint can be studied in vivo by analysis of synovial fluid biomarkers. In addition to pro-inflammatory mediators, several anabolic and anti-inflammatory substances are produced during the disease process. They counteract the catabolic effects of the pro-inflammatory cytokines and thus diminish the cartilage damage. The response of synovial fluid biomarkers after intra-articular hyaluronan injection, alone or in combination with other substances, has been examined only in a few equine studies. The effects of hyaluronan on some pro-inflammatory m...
Are There Shared Mechanisms in the Pathophysiology of Different Clinical Forms of Laminitis and What Are the Implications for Prevention and Treatment? Laminitis is a consequence of primary disease processes elsewhere in the body. The key pathophysiologic events are insulin dysregulation in endocrinopathic laminitis, ischemia in supporting limb laminitis, and inflammation in sepsis-related laminitis. These apparently disparate mechanisms converge to cause lamellar attachment failure through epithelial cell adhesion loss and stretch, possibly mediated by common growth factor signaling pathways. Tissue damage through mechanical distraction, inflammation, pain, and a proliferative epithelial healing response are features of acute laminitis regar...
Performance comparison of 159 Thoroughbred racehorses and matched cohorts before and after desmotomy of the interspinous ligament. Racehorses may perform poorly because of impinging dorsal spinous processes (DSPs) of the thoracolumbar vertebrae. No study has looked objectively at the long-term outcome of racehorses undergoing desmotomy of the interspinous ligament as a treatment for horses with poor performance caused by impinging DSPs. The aim of this study was to examine objectively, by using pre-operative and post-operative racing records, the effectiveness of desmotomy of the interspinous ligament (DISL) in improving the performance of racehorses with impinging DSPs. Medical records of all horses undergoing desmotomy ...
Is There Still a Place for Lidocaine in the (Postoperative) Management of Colics? Intravenous lidocaine is widely used to prevent or treat postoperative ileus in horses. Clinical studies that support this approach are flawed and contradicted by others. Also, physical obstruction could be more important in causing postoperative reflux than postoperative ileus in the horse. The antiinflammatory properties of lidocaine and the role of inflammation from intestinal handling in the genesis of postoperative reflux are questionable. Because of cost and questionable efficacy of lidocaine, a well-designed clinical trial is required to support its continued use. However, lidocaine cou...
Is Electrical Nerve Stimulation the Answer for Management of Equine Headshaking? Horses with trigeminal mediated headshaking (TMHS) have a decreased activation threshold of the trigeminal nerve and clinical signs are suspected to be a manifestation of trigeminal neuralgia. Electrical nerve stimulation (ENS) is used for management of neuralgia in humans and appears to work via gate control theory. Use of an equine specific percutaneous ENS program in over 130 TMHS horses has resulted in approximately 50% success return to previous work. Electroacupuncture may also be useful in the management TMHS. Optimization of ENS procedures for TMHS is likely to require a greater unders...
Behavioral Signs Associated With Equine Periapical Infection in Cheek Teeth. No studies have focused on dental pain signs associated with periapical infection in cheek teeth (CT) of horses. Moreover, the ability of owners to recognize signs of dental pain in horses has not been reported. We hypothesized that periapical infection will usually induce pain that manifests in the behavior of the horse. Removing the infected tooth will reduce the expression of such behaviors. Owners of 47 horses whose CT had been removed because of periapical infection participated in this study. They filled an internet-based questionnaire including 23 questions about eating behavior, bit be...
Oral Administration of Meloxicam Suppresses Low-Dose Endotoxin Challenge-Induced Pain in Thoroughbred Horses. Nonsteroidal anti-inflammatory drugs such as flunixin meglumine have been used to treat signs of systemic inflammatory conditions, but it is also known to have the side effect to small intestine mucosa. It may be considered to be due to inhibition of both cyclooxygenase (COX)-1 and COX-2. On the other hand, meloxicam is widely used in equine clinical practice and an effective nonsteroidal anti-inflammatory drug with the preferential inhibitory effect on COX-2. However, it has not yet been evaluated in equine systemic inflammation. The aim of this study was to evaluate the effect of meloxicam a...
Use of non-contrast-enhanced computed tomography to identify deep digital flexor tendinopathy in horses with lameness: 28 cases (2014-2016). To describe the use of non-contrast-enhanced CT to identify deep digital flexor (DDF) tendinopathy in horses with lameness attributed to pain in regions distal to the metatarsophalangeal or metacarpophalangeal joints. Methods: Retrospective case series. Methods: 28 client-owned horses. Methods: Medical records were searched to identify horses that underwent non-contrast-enhanced CT with or without high-field MRI as part of an evaluation for lameness localized to areas distal to the metacarpophalangeal or metatarsophalangeal joint in ≥ 1 limb. Horses were included in the study if they had ≥...
Ground Reaction Forces: The Sine Qua Non of Legged Locomotion. Legged locomotion results from the feet pressing against the ground to generate ground reaction forces (GRFs) that are responsible for moving the body. By changing limb coordination patterns and muscle forces, the GRFs are adjusted to allow the horse to move in different gaits, speeds, and directions with appropriate balance and self-carriage. This article describes the typical GRF patterns in each gait, the adaptations that produce turning, and the GRF patterns used to unload the painful limb when the horse is lame. The intent is to provide information that is of practical interest and value ...
Therapeutic developments in equine pain management. Many drugs and non-drug modalities are used to manage pain in horses, but evidence regarding efficacy and safety remains limited. This manuscript will first briefly review tried and tested techniques, e.g. the use of non-steroidal anti-inflammatory drugs, in the management of pain. Newer approaches to administering medications such as oral use of detomidine, which was previously only administered by injection, will also be discussed. Finally, introductory information on newer therapies, for example acupuncture and chiropractic manipulation, that the veterinarian may consider for the management...
Pharmacological Regulation in the USA and Pharmacokinetics Parameters of Firocoxib, a Highly Selective Cox-2, by Pain Management in Horses. The objective of the study was to conduct a review of the pharmacological regulation and pharmacokinetic parameters of firocoxib when administered orally or intravenously in horses. A search for literature was done in SCOPUS and PubMed for studies that had to evaluate the pharmacological regulation as well as the pharmacokinetic parameters of firocoxib when administered in horses. The nonsteroidal anti-inflammatory drugs have analgesic, anti-inflammatory, antipyretics, and antiendotoxic effects. The newly developed is selective to COX2 characterized by less adverse effects in veterinary patien...
Musculoskeletal problems associated with lameness and poor performance in cutting horses: 200 cases (2007-2015). OBJECTIVE To describe the chief complaints by owners and the types and prevalences of musculoskeletal problems associated with lameness or poor performance in cutting horses. DESIGN Retrospective case series. ANIMALS 200 client-owned cutting horses examined at the Texas A&M University Veterinary Medical Teaching Hospital between January 1, 2007, and December 31, 2015, because of lameness or poor performance. PROCEDURES Medical records were reviewed, and data were collected regarding signalment, history, findings on physical and lameness examinations, results of diagnostic procedures perfor...
Efficacy, chondrotoxicity and plasma concentrations of tramadol following intra-articular administration in horses undergoing arthroscopy: preliminary findings. Intra-articular administration of analgesics is performed to ensure good perioperative pain management avoiding undesirable systemic effects. To evaluate the effect of intra-articular injection of tramadol on postoperative pain after arthroscopy in horses and to determine whether tramadol had a local effect. Before the in vivo study, an in vitro test was performed aiming to evaluate the viability of equine chondrocytes after exposure to various concentrations of tramadol. The concentration identified as most appropriate was used to treat the horses' joints. Twelve horses affected by osteochond...
Morphine, but not methadone, inhibits microsomal prostaglandin E synthase-1 and prostaglandin-endoperoxide synthase 2 in lipopolysaccharide-stimulated horse synoviocytes. Osteoarthritis (OA) is one of the main locomotor disorders in horses. Although nonsteroidal anti-inflammatory drugs are the first-line treatment for OA, opioids could also be used. In previous studies, opioids showed promising anti-inflammatory and analgesic effects. In this study, we aimed to investigate the effects of two opioids (morphine and methadone) against inflammation in lipopolysaccharide (LPS)-stimulated synoviocytes by analyzing microsomal prostaglandin E synthase-1 (mPGES-1) and prostaglandin-endoperoxide synthase 2 (PTGS2) expression. Synoviocytes were obtained from the joints at...
Pain assessment in horses after orthopaedic surgery and with orthopaedic trauma. Objective pain assessment is important to guide and tailor therapy in clinical practice. This study describes the clinical applicability and validity of two pain scales, the Composite Pain Scale (CPS) and the Equine Utrecht University Scale for Facial Assessment of Pain (EQUUS-FAP) in horses with orthopaedic trauma or after orthopaedic surgery. A cohort follow-up study was performed using 77 adult horses (n=43 with orthopaedic trauma or injury; n=34 controls). Composite and facial expression-based pain scores were assessed by direct observations of pairs of two independent observers. All horse...
Clinical applicability of detomidine and methadone constant rate infusions for surgery in standing horses. To determine the required rate of a detomidine infusion (loading dose 5 μg kg; initial rate 12.5 μg kg hour) added to a constant infusion of methadone (0.2 mg kg; 0.05 mg kg hour) for sedation in standing horses and ponies undergoing elective surgeries with appropriate local anaesthetic techniques. Methods: Prospective, clinical study. Methods: Adult, healthy, client-owned, non-food-producing horses or ponies sedated for elective standing surgeries longer than 45 minutes. Methods: At baseline (in the stables before administration of sedative agents), at 10 minutes after sedation and every 5 ...
Using Movement Sensors to Assess Lying Time in Horses With and Without Angular Limb Deformities. Chronic musculoskeletal pathologies are common in horses, however, identifying related effects can be challenging. This study tested the hypothesis that movement sensors and analgesics could be used in combination to confirm the presence of restrictive pathologies by assessing lying time. Four horses presenting a range of angular limb deformities (ALDs) and four nonaffected controls were used. The study comprised two trials at separate paddock locations. Trial A consisted of a 3-day baseline phase and 2 × 3-day treatment phases, during which two analgesics were administered to two ALD horses...
Effectiveness of Simulated Horseback Riding for Patients With Chronic Low Back Pain: A Randomized Controlled Trial. A simulated horseback riding (SHR) exercise is effective for improvement of pain and functional disability, but its comparative effectiveness with the other is unknown. Objective: The authors aimed to demonstrate the effect of a SHR exercise in people with chronic low back pain. Methods: A randomized controlled trial. Methods: Community and university campus. Methods: A total of 48 participants with chronic low back pain were divided into 2 groups, and SHR exercises (n = 24) or stabilization (STB) exercises (n = 24) were performed. Methods: The exercises were performed for 30 minutes, 2 days p...
Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking. Trigeminal-mediated headshaking results from low-threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal-mediated headshaking. Objective: To investigate head-shaking behavior in affected horses after IV magnesium sulfate infusion. Methods: Six geldings with trigeminal-mediated headshaking. Methods: Prospective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextros...
Comparison of three acute colic pain scales: Reliability, validity and usability. A valid, reliable and usable scale is needed for assessing severity of acute abdominal pain in horses. The study aim was to compare three different scales: (1) the equine acute abdominal pain scale (EAAPS); (2) a scale described by Mair and Smith (2005; M and S); and (3) a numerical rating scale (NRS). Forty brief films of horses (35 of colic cases and five of control horses) were randomly presented to 46 equine veterinarians from different countries. Participants, randomly divided into three groups, each used one scale. Five randomly selected films were shown twice for determining intra-obser...
Buffering mepivacaine with sodium bicarbonate speeds and potentiates analgesia of median and ulnar nerve blocks performed on horses. The objective of this study was to determine if buffering mepivacaine HCL (mepHCl) with sodium bicarbonate (NaHCO3) would significantly decrease the time to onset of analgesia when performing median and ulnar nerve blocks in naturally lame horses. Median and ulnar nerve blocks were performed on the naturally lame limb of nine horses during two separate study periods, with a minimum washout period of three days between study periods. Nerve blocks were performed by administering mepHCl alone or mepHCl mixed with NaHCO3 (nine parts 2 per cent mepHCl to one part 8.4 per cent NaHCO3). Lameness was ...
Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies. Trigeminal-mediated headshaking is a little-understood neuropathic facial pain condition of the horse. The condition may affect around 1% of the equine population to a degree of severity sufficient to require veterinary attention. As a pain condition, this represents a significant welfare issue. Horses are usually more severely affected at exercise which can leave them unable to perform, or even dangerous to ride and handle. With little known about the condition and variable response to treatments, severely affected horses are often euthanized. This review article considers the literature on t...
