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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.
Management of lacerations and avulsion injuries of the foot and pastern region and hoof wall cracks. The causes, clinical signs and various approaches to treatment of injuries involving the foot and pastern regions are reviewed, and the prognosis for each type of injury is discussed.
Electroacupuncture in the treatment of chronic lameness in horses and ponies: a controlled clinical trial. Electroacupuncture was used to treat lameness in horses and ponies with chronic laminitis (n = 10) or navicular disease (n = 10). A clinical trial was conducted with random allocation of equal numbers of animals to control and treatment groups. Acupuncture was performed three times per week for four consecutive weeks. The degree of lameness was assessed by 1) a grading scheme, 2) measurement of stride lengths and 3) analysis of weight distribution using a force plate. Although seven out of ten animals with chronic laminitis improved clinically during the trial, there were no statistically sign...
Clinical examination of the equine foot. The foot is the most common source of limb pain. The problems vary from simple to quite complex. An accurate diagnosis is dependent upon a thorough and detailed knowledge of anatomy and of what is available in the way of ancillary examination techniques. The correction of most foot problems requires an appreciation of a multitude of factors and a thorough knowledge of farrier science.
Diagnosis and treatment of the navicular syndrome in horses. Navicular syndrome can be treated in a variety of ways. This is related to the fact that it has a variety of causes. Prognostically, most horses will improve with treatment. One can expect about 50 per cent of the horses to become useably sound for 1 year, no matter what treatment is used. The disease is progressive, and affected horses eventually will need to be retired because of lameness. The author's therapeutic approach is to utilize shoeing as the primary therapy. Shoeing is performed to correct structural problems and to ensure that shoeing is physiologically sound. Nonsteroidal anti-in...
Pathophysiology of navicular syndrome. Navicular syndrome is a degenerative disorder of the distal half of the flexor surface of the proximal sesamoid bone that is predisposed by faulty foot conformation. In horses that become symptomatic, the faulty conformation results in sustained application of nonphysiologic pressure by the deep digital flexor tendon against the flexor cortex of the bone. This force stimulates an intense bone remodeling response in order to attenuate the pressure. An unfortunate sequela of this response is active hyperemia and edema formation in the medullary cavity of the bone. The edema is organized by fibro...
[Anesthesia of horses in the standing position]. Painful interventions can be performed on horse in standing position by means of sedative analgesia, also called standing-position anaesthesia. Combinations of anaesthetics are quite often used, in that context, for the purpose of producing analgetic effects stronger and more reliable than those that would be obtainable from one anaesthetic alone. The following combinations were comparatively tested for their analgetic and sedative effects and their effects upon the organism: Chloralhydrate with Ursonarkon (oxazolidone), Chloralhydrate with Rompun (xylazine), Chloralhydrate with morphine hydro...
A comparison of methods for proximal palmar metacarpal analgesia in horses. Three techniques for inducing analgesia of the proximal metacarpal region were evaluated for the frequency of inadvertent injection into the middle carpal and carpometacarpal joints. Using methylene blue solution as a marker dye and 30 fresh cadaver specimens each, three clinicians performed either 30 infiltrations at the origin of the suspensory ligament (method A), 30 palmar and palmar metacarpal nerve blocks at the proximal end of the metacarpus (method B), or 30 palmar and palmar metacarpal nerve blocks at the distal aspect of the accessory carpal bone (method C). The frequency of inadvert...
Narcotic analgesics, their detection and pain measurement in the horse: a review. Narcotic analgesics produce pharmacological effects by interacting with specific opiate receptors. At least five major types of opiate receptors have been recognised. These include mu (morphine) and kappa (ethylketazocine) receptor types. Narcotic analgesics which interact with mu receptors produce locomotor and autonomic stimulation at doses that produce little or no analgesia. Therefore, use of these drugs as analgesics in equine medicine has not been very satisfactory. Theoretical considerations suggested that the role of kappa agonists in equine analgesia be investigated. Using a pure kapp...
Hemoperitoneum caused by rupture of a juvenile granulosa cell tumor in an equine neonate. A neonatal foal was examined because of apparent abdominal pain and distention, anemia, and hemoperitoneum. Exploratory laparotomy was performed, and a large spherical mass, which had ruptured, was found in the area of the left ovary. Left salpingo-oophorectomy was performed. The mass was determined to be a juvenile granulosa cell tumor.
Attempts to prevent equine post neurectomy neuroma formation through retrograde transport of two neurotoxins, doxorubicin and ricin. Digital neurectomies, performed to relieve pain and lameness, are often complicated postoperatively by formation of painful neuromas. In this study attempts were made to deliver lethal doses of neurotoxin to the cell bodies of the transected digital nerve fibres via long-distance retrograde axon transport and, thereby, prevent the regenerative changes that lead to neuroma formation. After applying doxorubicin in various ways to the digital nerve stumps of ponies, degenerating or necrotic neurones appeared only sporadically in the spinal ganglia. Although doxorubicin was largely ineffective in ...
The use of intraneural doxorubicin in association with palmar digital neurectomy in 28 horses. Painful neuroma formation after palmar digital neurectomy in the horse is common. Experimentally, injection of doxorubicin (Adriamycin) into the proximal transected nerve stump has been shown to prevent axon sprouting and neuroma formation for up to 5 months. This procedure was used in 28 horses with navicular disease, preexisting painful neuroma, or wing fractures of the distal phalanx. At 1 month, 16 horses had incisional complications. At 1 year, 15 horses were sound. Eight horses were lame, although three were improved. Three horses required a second surgical procedure, two of which became...
Keratomas in horses: seven cases (1975-1986). The diagnosis of keratoma in 7 horses and their treatment and outcome were evaluated. Horses were 2 to 20 years old, of various breeds, and were intact or castrated males. All were lame, and 6 horses had had previous injuries of the affected hoof that had not responded to prior treatments. Only 1 hoof was affected in each horse. Keratomas were beneath the hoof wall (6 horses) or sole (1 horse). Radiographically, a circular or semicircular defect with a discrete margin was present in the distal portion of the third phalanx in 3 horses. Grossly, keratomas were firm solitary masses (1.5 to 5 cm d...
Subchondral cyst-like lesions in the distal portion of the radius of four horses. Four horses with subchondral cyst-like lesions in the medial radial facet of the distal portion of the radius were examined. Joint effusion and signs of pain from flexion of the antebrachiocarpal joint were not observed, but lameness was observed in 3 of the 4 horses. Regional nerve blocks and intra-articular anesthesia were used to localize the lesions, and conservative treatment resulted in soundness for performance.
Some observations on lameness associated with pain in the proximal metacarpal region. The carpus and metacarpus of 40 horses which were free from lameness and 40 horses with lameness associated with the metacarpophalangeal joint or more distal limb were examined radiographically (Group A). The opacity of the proximal third of the third metacarpal bone was regular, with a uniform trabecular pattern. Osseous cyst-like lesions (OCLLs) were identified in the radial carpal bone (1), the ulnar carpal bone (2), the second carpal bone (15) and the fourth carpal bone (1). Thirty-one of 638 horses (4.8 percent) with forelimb lameness had pain localised to the proximal metacarpal region u...
Evaluation of equine locomotion during different degrees of experimentally induced lameness. I: Lameness model and quantification of ground reaction force patterns of the limbs. Force plate data from walking horses were used to evaluate the locomotion of a group of six horses during experimentally induced lameness in a forelimb or a hindlimb. By tightening or loosening screws in modified horseshoes the resulting pressure pain on the sole enabled induction and release of three different degrees of supporting lameness within a period of 2 h. The ground reaction force (GRF) patterns of the different recording sessions were compared with control data of the same horse as well as with the 'standard' horse data using a quantitative evaluation procedure involving 93 GRF para...
A clinical perspective on lameness originating in the carpus. Clinical experience continues to expand our understanding of the pathophysiology of pain and injury within the carpal joints. The anatomical and physiological capacity of the equine carpus to neutralise loading stress plays a significant role in the prevention of carpal injury. The ability of joint surfaces to dissipate axial force by transfer to the interosseous ligaments is the principal means by which carpal injury is avoided. In the medial aspect of the intercarpal joint and the dorsal aspect of the radial carpal joint, however, the effects of chronic maximal stress and isolated acute supr...
Hydramnios causing uterine rupture in a mare. An 18-year-old mare, 285 days pregnant, was evaluated for apparent abdominal pain of 8 hours' duration. A large volume of sanguinous fluid was obtained on abdominocentesis, and digital vaginal examination revealed a dilated cervix and blood in the uterus. Abdominal palpation per rectum revealed the uterus to be large and distended with fluid. Ultrasonography revealed a dead fetus on the floor of the cranial portion of the abdomen. The mare was euthanatized, and necropsy confirmed that the uterus had ruptured, and that the fetus, within its chorioallantois, was in the abdomen. The amniotic sac ...
Objective assessment of detomidine-induced analgesia and sedation in the horse. The effects of detomidine, a veterinary sedative analgesic, were studied in the horse. Novel objective techniques were employed to assess the analgesic and sedative potency of this compound. Intravenous doses of 0.010, 0.020 and 0.040 mg/kg were administered to eight adult Thoroughbred racehorses according to a double-blind crossover design. Analgesia was measured by determining the latency to onset of the skin twitch and hoof withdrawal reflexes following noxious thermal stimulation of the withers and fetlock, respectively. Sedation was assessed by quantifying spontaneous locomotor activity i...
A modified Cloward’s technique for arthrodesis of the normal metacarpophalangeal joint in the horse. A modified Cloward's technique was performed for arthrodesis of one metacarpophalangeal (MCP) joint in eight horses. Dorsal arthrotomies were performed medial and lateral to the common digital extensor tendon and two 16 mm holes were drilled through the joint. A perforated cylindrical stainless steel basket filled with cancellous bone was impacted into each hole. The limbs were supported in casts for 8 weeks. The joints were examined and radiographed at 4 weeks, 8 weeks, 6 months, and 10 months. One horse was euthanatized at week 14 to assess the progress of the arthrodesis. In the other seven...
Initial treatment of colic. This article discusses some of the rationales for the medical management of colic during the initial treatment period. The issue of colic pain control and the masking of clinical signs that may indicate severe gastrointestinal disease is addressed. Therapeutic considerations related to dehydration, metabolic imbalances, hemostatic disorders, antimicrobial therapy, fecal consistency, gastrointestinal decompression, and regulation of intestinal motility are reviewed.
Selected aspects of the clinical pharmacology of visceral analgesics and gut motility modifying drugs in the horse. Comparison of the visceral analgesic effects of xylazine, morphine, butorphanol, pentazocine, meperidine, dipyrone, and flunixin in a cecal distention model of colic pain indicated that xylazine produces the most relief from abdominal discomfort. Repeated administration of xylazine may reduce visceral pain so effectively that the seriousness of abdominal disease is obscured. Xylazine decreased propulsive motility in the jejunum and pelvic flexure of healthy ponies. Morphine and butorphanol also gave relief from visceral pain in the cecal distention model. Morphine may inhibit colonic, and buto...
Alternative diagnoses in the colic patient. Despite clinical signs compatible with obstruction or ischemia of the gastrointestinal tract, the clinician occasionally is unable to identify a gastrointestinal cause for colic. In this article, disorders not originating from obstruction or ischemia of the gastrointestinal tract but causing real or apparent abdominal pain are presented as alternative causes of colic. In addition, colic of gastrointestinal origin may be the primary inciting factor or a secondary complication of an alternative disorder, causing colic-like signs. Recognition of alternative diagnoses relies on a thorough and cons...
Decision for surgery. Based on the clinical impression and the current knowledge of the clinical variables (rectal examination, abdominal distention, abdominal fluid, intractable pain) most likely to differentiate between medical and surgical cases, three decision trees are provided as a guide to making the management decision in a horse with abdominal pain. Prior elimination of horses with limited life expectancy because of age or function or where financial constraints are present is understood. It must be emphasized that most of the information presently available originates from referral centers where the preva...
Incomplete palmar fracture of the proximal extremity of the third metacarpal bone in horses: ten cases (1981-1986). In 4 adult horses, simple, nondisplaced, incomplete fracture of the proximal extremity of the third metacarpal bone (MC3) was identified radiographically only on the dorsopalmar projection. Lameness was slight to moderate. Although nerve blocks of the foot and fetlock did not alter the lameness, high palmar regional nerve block improved the gait in 1 of the 2 horses on which it was performed. Pain on palpation or swollen distal accessory (inferior check) ligament, flexor tendons, and suspensory ligament were not found in any horse. The fracture was localized to the palmar surface of the proxim...
Dose related effects of the kappa agonist U-50, 488H on behaviour, nociception and autonomic response in the horse. Current opiate receptor theory suggests that kappa agonists should provide good analgesia without producing marked central nervous system stimulation. U-50,488H is an experimental narcotic analgesic that is a selective kappa agonist. In the present study, U-50,488H produced good analgesia in horses using both the skin twitch and hoof withdrawal reflex assays. Further, the analgesia was relatively long lasting (120 mins) compared to other mu-agonists tested in horses. The locomotor response to U-50,488H was less than observed with ethylketazocine and butorphanol, and has yielded the smallest lo...
Incomplete longitudinal fracture of the proximal palmar cortex of the third metacarpal bone in horses. Seven horses, 2 to 4 years of age, were examined because of moderate-to-severe forelimb lameness, mild effusion of the middle carpal joint (3 horses), and pain on palpation of the origin of the suspensory ligament (4 horses). The lameness was abolished by anesthetic infiltration of the middle carpal joint in six horses. In four of them, a high palmar nerve block also abolished the lameness. A linear radiolucency in the proximal end of the third metacarpal bone (McIII) was interpreted as an incomplete longitudinal fracture. In one horse, distinct intramedullary sclerosis limited to the palmar c...
Colopexy of the large colon in four horses. Colopexy of the left ventral colon to the abdominal wall was performed in 4 horses with recurrence of large-colon displacement or volvulus. Horses were discharged between 5 and 27 days after surgery. At follow-up evaluation (mean, 10.5 months; range, 7 to 13 months) of the horses, none had recurrence of signs of abdominal pain, and all had normal body weight. Three horses were exercised regularly; signs of abdominal pain were not observed.
Exploratory celiotomy for gastrointestinal disease in neonatal foals: a review of 20 cases. The medical records of 20 neonatal foals in which exploratory celiotomies were performed for gastrointestinal disease were reviewed. In all 20 foals, persistent pain and/or progressive abdominal distension were the primary clinical findings influencing the decision to operate. However, ancilliary laboratory data were important to the proper medical management of these foals during anaesthesia and following surgery. Surgical diagnoses of the 20 foals included ileus (nine foals; 45 per cent), small colon obstruction (five foals; 25 per cent), large colon displacement (three foals; 15 per cent), ...
Bypass surgery for the treatment of small intestinal ileus in the horse. A report of three cases. The medical management of three horses with simple and strangulating small intestinal obstructions was unsuccessful and was therefore supported by surgical bypasses. Jejunocecostomies were used to treat horses with postoperative paralytic ileus that was unresponsive to medical management. These horses had abdominal pain, gastric distention, heart rate elevations greater than 60/minute, and small intestinal distention on rectal palpation. Two horses experienced weight loss which responded to bypass removal. The bypass effectively decreased the need for intravenous fluid administration and repea...
