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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.
Lameness due to pain associated with the distal interphalangeal joint: 45 cases. This paper describes the clinical and radiographic features, and response to treatment, of 45 horses which showed lameness that was improved by intra-articular anaesthesia of the distal interphalangeal (DIP) joint. Although many horses had poor conformation of the foot of the lame limb, the majority showed no localising clinical signs suggestive of involvement of the DIP joint. Lameness was usually unilateral. No horse with bilateral lameness responded to treatment. Palmar digital nerve blocks frequently improved or alleviated lameness, although in some horses palmar (abaxial sesamoid) nerve b...
Pulsed radio frequency therapy of experimentally induced arthritis in ponies. The effect of pulsed radio frequency therapy (PRFT) was evaluated on seven ponies with no arthritis and in 28 ponies in which arthritis was created using intra-articular amphotericin B to induce synovitis in the right middle carpal joint. The ponies were divided into five treatment and two control groups. Two levels of arthritis were created and two dosage levels of PRFT were evaluated. The effect of PRFT on arthritic and nonarthritic joints was measured by comparing synovial fluid parameters, the degree and duration of lameness, the range of carpal motion, and carpus circumference, for treate...
Proximal suspensory desmitis: clinical, ultrasonographic and radiographic features. Clinical, ultrasonographic and radiographic features of proximal suspensory desmitis in the forelimb and the hindlimb are described. Acute cases may present with slight, localised, oedematous swelling, heat, distension of the medial palmar (plantar) vein and/or pain, whereas chronic cases or those rested immediately after onset of lameness usually have no detectable clinical signs suggestive of the source of pain. In these cases local analgesia is required to identify pain in the proximal metacarpal (metatarsal) region. Transverse ultrasonographic images of the suspensory ligament usually yiel...
Mid-metacarpal deep digital flexor tenotomy in the management of refractory laminitis in horses. Deep digital flexor tendon transection at the mid-metacarpus was performed in 20 horses with severe acute or chronic laminitis that was not responsive to conventional treatment. Sixteen horses improved within 72 hours, one horse worsened, and two horses were unaffected by the surgery. Eleven horses survived less than 1 month after surgery and six horses survived longer than 6 months. Three horses surviving longer than 6 months have remained lame and no horse has returned to athletic performance. Transection of the deep digital flexor tendon at the mid-metacarpus may decrease the pain associate...
Chemical restraint and analgesia in the horse. Chemical restraint in the standing horse is used for a variety of procedures in veterinary medicine. The choice of agent depends on the physical status, temperament, and size of the patient; the procedure to be performed; and safety for the patient, veterinarian, and owner. The combination of certain agents may provide more desirable restraint and analgesia than does the use of individual agents. The use of analgesics in the horse is not without side effects, some of which may be detrimental to the patient's condition. Analgesics should be chosen with these untoward effects in mind. Draft bree...
Testicular seminoma associated with torsion of the spermatic cord in two cryptorchid stallions. Two adult horses had colic attributable to spermatic cord torsion and strangulation of abdominally retained neoplastic testes. Both horses had caudal abdominal soft tissue masses palpable per rectum. One horse was treated successfully by surgical removal of the testis, and the other was euthanatized without treatment. Histopathologic diagnosis of the involved testes was testicular seminoma. Spermatic cord torsion of an abdominally retained testis should be considered in the differential diagnosis of signs of abdominal pain in cryptorchid stallions, especially those with a palpable caudal abdom...
Chronic proliferative synovitis of the equine metacarpophalangeal joint. Chronic proliferative synovitis of 27 metacarpophalangeal joints in 16 horses is described. The diagnosis was based on a history of lameness and, or, poor performance, pain on flexion of the metacarpophalangeal joint, the response to intra-articular anaesthesia, and plain and contrast radiography. Radiographic findings included concavity of the distal dorsal metacarpus proximal to the sagittal ridge, and an increase in size of the synovial tissue adjacent to the proximal, dorsal attachment of the joint capsule. Mineralisation of the synovial tissue was present in some joints, and chip fracture...
Naloxone-induced abdominal distress in the horse. Endogenous opioid peptides have been implicated in the regulation of pain perception, behaviour, gastrointestinal activity and other physiological responses. However, the functional role of these peptides in the horse has yet to be elucidated. The opioid antagonist, naloxone, is often administered to infer endogenous opioid effects. In the present study, naloxone (0.75 mg/kg bodyweight) was administered to eight Thoroughbred racehorses and a number of behavioural and autonomic responses were measured. Naloxone produced rapid onset diarrhoea, restlessness, abdominal checking, tachycardia, tachy...
Nonulcerative keratouveitis in five horses. Five horses with severe nonulcerative keratouveitis had corneal lesions characterized by a pink stromal infiltrate that initially appeared in the stroma near the limbus. Unremitting iridocyclitis also was evident. In 3 horses, microscopic lesions consisted of marked corneal stromal fibrosis, with mild to severe inflammatory cellular infiltration. Corticosteroids and mydriatic/cycloplegics applied topically and corticosteroids and nonsteroidal anti-inflammatory medications administered parenterally were used with varying degrees of success to control pain and retain vision.
A computer-derived protocol using recursive partitioning to aid in estimating prognosis of horses with abdominal pain in referral hospitals. In order to determine which variables are useful and accurate in estimating prognosis in horses with abdominal pain, data were analyzed from 231 horses presented at a veterinary teaching hospital. Using multiple stepwise discriminant analysis in a recursive partition model, we obtained a decision protocol that identified survivors and nonsurvivors. The prevalence of survivors was 61% in this population. The sensitivity, specificity, and positive and negative predictive values of this model were 71, 83, 87 and 65%, respectively. This decision protocol was validated by Jackknife classification a...
Intra-abdominal hemorrhage associated with a granulosa-thecal cell neoplasm in a mare. A 9-year-old American Saddlebred mare was referred because of abdominal distention and signs of abdominal pain. Copious peritoneal fluid obtained by abdominocentesis appeared to be frank blood. Rectal and ultrasonographic evaluation of the abdomen revealed a large mass at the distal tip of the right uterine horn. The mare was euthanatized and necropsied and the mass was determined to be a granulosa-thecal cell neoplasm. The most common clinical sign of granulosa-thecal cell neoplasm is infertility or abnormal sexual behavior. Hemoperitoneum is infrequently associated with neoplasms in horses.
Recurrent torsion of the spermatic cord and scrotal testis in a stallion. A stallion was twice referred for evaluation of scrotal swelling and signs of pain. The first admission followed a 3-year period of recurrent signs of left-sided scrotal pain and swelling. After the removal of the left testis because of testicular torsion, the stallion was returned to service. The conception rate was 82% for the next breeding season. Two years after initial surgery, the stallion again was evaluated because of acute signs of right-sided scrotal pain and swelling. Right-sided testicular torsion was detected and corrected, and the testis was sutured in place. The stallion's conce...
Clinical use of epidural xylazine in the horse. Xylazine was administered into the epidural space of nine horses to facilitate various perineal manipulations (ie rectovaginal laceration repair, replacement of prolapsed rectum and urethral extension). The resulting caudal analgesia was sufficient for all procedures. The duration of analgesia from a single injection of epidural xylazine (0.17 to 0.22 mg/kg bodyweight) was at least 3.5 h. No horses were ataxic during or after the treatment. This trial demonstrates that xylazine given into the epidural space of horses provides prolonged regional analgesia which is sufficient for clinical use.
Lameness diagnosis and treatment in the Standardbred racehorse. Lameness of the Standardbred racehorse is a function of rigorous training programs, year-round racing schedules, hard racetrack surfaces, and the draft load. In this article, principles of lameness diagnosis and treatment are reviewed, with emphasis upon common or unique problems of the trotter and pacer. The role of physical therapy as an adjunct to medical and surgical treatment of lameness is described. Options for management of chronic pain are discussed, and a limited glossary of descriptive terms that are unique to harness racing is provided.
Carbon dioxide laser ablation for treatment of limbal squamous cell carcinoma in horses. Limbal squamous cell carcinoma in 4 horses was treated successfully, using carbon dioxide laser ablation. Tumors were removed, with minimal to no postoperative inflammation or discomfort to the horses. Carbon dioxide laser ablation represents a promising new option in the treatment of limbal squamous cell carcinoma in horses.
Pharmacodynamic evaluation of the peripheral pain inhibition by carprofen and flunixin in the horse. Carprofen, flunixin meglumine and placebo in the form of a physiological solution of sodium chloride were tested in an open randomised cross-over trial for analgesic efficacy in horses with two external skin-stimulation systems. Both systems, the withers model and the "heating element" model, were compared in order to find an optimal way to measure pain perception after stimulating the skin with high temperature. No analgesic effect of flunixin or carprofen could be demonstrated when using the withers model. In the "heating element" model, a 1.1 mg/kg i.v. dose of flunixin meglumine failed to ...
Femoral capital physeal fractures in 25 foals. The medical records of 25 horses 1 year of age or younger affected with femoral head and neck fractures during an 18 year period were reviewed. Each fracture involved the capital physis. The foals were 11 days to 12 months of age (mean, 5 months). No femoral capital physeal fractures occurred in horses older than 1 year of age during the same period. The history in each case included acute onset of severe unilateral hindlimb lameness, 3 hours to 2 months (mean, 12 days) before presentation. Injuries observed were violent falls, struggles, and kicks. Crepitation, swelling, pain with manipulatio...
Ileocecal intussusception in horses: 26 cases (1981-1988). The case records of 26 horses with ileocecal intussusception over a 7-year period were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with ileocecal intussusception was 1 year and ranged from 2 weeks to 19 years. There was no apparent gender or breed predisposition to this disease. An acute form of ileocecal intussusception was diagnosed in 19 horses with signs of moderate to severe abdominal pain of less than or equal to 24 hours' duration, and a chronic form was diagnosed in 7 horses with signs of intermittent, mild to moderate abdo...
Hoof injuries. Major surgery for wounds of the foot, compared with other parts of the body, requires a more detailed preparation and a more persistent aftercare. To approach severe hoof wounds with a routine applicable to drainage of a subsolar abscess is doomed to failure! Yet, in dealing with referral cases of hoof wounds, particularly those that have become chronic, the author has observed that the principles have been ignored and/or the routines inadequate. The hoof has a suitable capacity to heal, with complete reformation of hoof structures, if a healing environment is maintained for a long enough peri...
Methods of stimulating acupuncture points for treatment of chronic back pain in horses. Horses with chronic back pain of 2 to 108 months' duration were treated using acupuncture (n = 15), laser acupuncture (n = 15), or injection acupuncture (n = 15). Horses were treated once a week for 8 treatments (mean) with needle acupuncture, 11 treatments with laser acupuncture, or 9 treatments with injection acupuncture. After treatment, 37 horses had alleviation of clinical signs of pain and could train and compete: 13 horses treated with needle acupuncture; 11 horses treated with laser acupuncture; and 13 horses treated with injection acupuncture. Seemingly, the 3 types of acupuncture wer...
Production of patellar lesions by medial patellar desmotomy in normal horses. Medial patellar desmotomy was performed on one (treated) hindlimb, and a sham operation on the other (control) hindlimb, of 12 normal horses. The horses were examined for lameness before medial patellar desmotomy and at months 1, 2, and 3. The femoropatellar joints were examined radiographically and arthroscopically at month 3. All horses were lame on the treated limb at months 1, 2, or 3. Radiographic changes, including fragment formation at the distal aspect of the patella and bone production at the attachment of the middle patellar ligament on the patella, were present in 11 horses at month...
Chronic ileocecal intussusception in horses. Ten young horses with signs of simple partial obstruction of the small intestine were found upon surgical exploration of the abdomen to have chronic intussusception of the distal ileum into the cecum. Poor general physical condition, intermittent or continual abdominal pain of varying degree, depression, and poor appetite were consistent clinical findings. Rectal palpation in eight animals was suggestive of an incomplete or intermittent obstruction of the small intestine. Laboratory determinations were not helpful in making a diagnosis. Dilatation and hypertrophy of the distal jejunum and ileu...
Strangulating volvulus of the ascending colon in horses. Of 57 horses with strangulating volvulus of the ascending colon, 42 were mares (including 21 postparturient mares), 8 were stallions, and 7 were geldings. Volvulus occurred most frequently in the summer (n = 24) and spring (n = 17). Pain was evaluated as severe in 41 horses, moderate in 9, and mild in 4. The abdominal fluid from 30 horses varied from clear yellow in 19 horses, to cloudy yellow in 3 horses, and serosanguineous in 8 horses. Protein content and nucleated cell count in the abdominal fluid were 2.5 +/- 1 g/dl and 1,000 +/- 900 microliters, respectively. Fifty horses had greater tha...
Treatment of solar prolapse using the heart bar shoe and dorsal hoof wall resection technique. This paper describes the treatment of 10 horses suffering from acute laminitis using the heart bar shoe and a dorsal hoof wall resection technique. All cases had progressed to prolapse of the tip of the pedal bone covered by solar corium through the horny sole; in one case the exposed tip of the distal phalanx became visible. Nine cases of distal phalangeal rotation and one case of distal displacement of the distal phalanx (sinking) are described. Two animals were destroyed because of the degree of lameness, one remains slightly lame at the trot and the remaining seven have returned to their p...
Incisional hernias in the horse. Incidence and predisposing factors. Medical records of 210 horses that survived ventral midline celiotomy for at least 4 months were examined and owners were queried to determine factors contributing to incisional hernia formation. The incidence rate of incisional hernias within 4 months was 16%. Factors significantly associated with occurrence of incisional hernias were incisional drainage, closure of the linea alba with chromic gut suture material, previous midline celiotomy, excessive incisional edema, castrated male sex, postoperative leukopenia, and postoperative pain (colic). Factors not significantly associated with occur...
Caecal intussusception in two ponies. One case of caecocaecal intussusception (case 1) and one case of caecocolic intussusception (case 2) in ponies are described. Case 1 showed mild abdominal discomfort for seven days followed by sudden death whereas case 2 showed continuous moderate pain for three weeks. At post mortem examination, case 1 showed intussusception of the base of the caecum into the body whereas in case 2, the entire caecum had invaginated into the right ventral colon. Histopathological examination showed that the lesions in both animals had been present for a long time.
Effects of pharmacological agents on gastrointestinal motility. The control mechanisms of gastrointestinal motility are complex. Extrinsic neurohormonal effects modulate an intrinsic system, often called the "gut brain," composed of nervous and neuropeptide components. To exert pharmacologic influence on GI motility, use is made of agents that mimic the external control system. Agents that stimulate opioid receptors, block adrenoceptors, block or facilitate acetylcholine action, or antagonize the action of prostaglandins are used to effect changes in GI motility. The major indications for pharmacologic intervention are to increase motility in constipation,...
Comparison of detomidine, butorphanol, flunixin meglumine and xylazine in clinical cases of equine colic. Detomidine hydrochloride, butorphanol tartrate, flunixin meglumine and xylazine hydrochloride were evaluated in a blind multi-centre clinical trial in 152 horses with abdominal pain. The drugs were administered as follows: detomidine 20 or 40 micrograms/kg bodyweight (bwt); butorphanol 0.1 mg/kg bwt; flunixin meglumine 1.0 mg/kg bwt; xylazine hydrochloride 0.5 mg/kg bwt. Each centre compared responses to the two doses of detomidine with those to one of the other analgesics. The drugs were administered intravenously (i.v.) after clinical assessment of the degree of sweating, kicking, pawing, he...
Field trial evaluation of detomidine as a sedative and analgesic in horses with colic. In this uncontrolled clinical study 12 investigators cooperated to evaluate the analgesic and sedative effect of detomidine (DORMOSEDAN; Farmos Group Ltd; Finland) in 234 horses with abdominal pain caused by colic. The study was designed to use each animal as its own control and to evaluate its response to the drug over a 60 min period. Detomidine was given intravenously (i.v.) once in 169 cases (167 horses, 1 mule, 1 donkey) at a dose of 20 micrograms/kg bodyweight (bwt), and to 65 horses at 40 micrograms/kg bwt. The higher dose was used predominantly in horses with severe pain which were mor...
