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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.
Analgesic efficacy of tapentadol in chronic joint disorders in horses: plasma serotonin concentration and adrenocortical response as biomarkers of pain-induced stress. The study aimed to evaluate the analgesic efficacy of tapentadol in horses, by determining plasma serotonin concentration and adrenocortical response, as biomarkers of pain stress in chronic joint disorders. Thirty-six horses (20 females and 16 males) were divided into three groups of 12 subjects each: group A, osteoarthritis (OA), grade 3-4 lameness; group B, OA, grade 5 lameness; and group C, no OA, no lameness, were enrolled. The orthopedic examination included flexion tests, and radiological and ultrasound examinations. The degree of lameness has been estimated from 0 to 5 according to the...
Role of cannabidiolic acid or the combination of cannabigerol/cannabidiol in pain modulation and welfare improvement in horses with chronic osteoarthritis. Cannabidiol (CBD) is a non-psychotropic cannabinoid obtained from hemp (Cannabis sativa L.) used for pain management in companion animals including horses. The present study aimed to evaluate the efficacy of cannabidiolic acid (CBDA) and cannabigerol/cannabidiol oil (CBG/CBD) oral administration in alleviating pain in adult horses affected by chronic osteoarthritis (OA). Twenty-four horses (10 geldings and 14 mares), aged between 11 and 18 years old, were equally divided into two groups. One group received CBDA 15% oil and the other group received CBG/CBD oil (CBG20%-CBD10%) for 14 consecuti...
Impact of equine interactions on human acute pain perception: Two cross sectional studies. Research has demonstrated the effectiveness of Animal-Assisted Therapy, usually involving dogs, as a way to reduce pain in inpatient and outpatient populations. Here two studies investigate the effectiveness of interacting with horses for reducing human acute pain perception. Unassigned: In Study 1, a blood-pressure cuff was used to administer acute ischaemic pain to 70 adult participants, who were allocated to one of three groups: Equine Assisted Psychotherapy (EAP), Horse Interaction without EAP (HI), and a Control (no horses present). All participants engaged in an activity (finding a horse...
Radical surgical excision of extensive perianal melanomas on standing horses: Twenty cases. To report a radical surgical technique for perianal melanomas involving the anal margin in standing horses. Methods: Observational retrospective study. Methods: Twenty client-owned horses presented for surgical excision of extensive (≥4 cm) perianal melanomas. Methods: Demographic data, surgical technique, intraoperative, immediate- and late-postoperative complications were reviewed. Results: All horses (median age 15, Q1-Q3 12 to 17.3 years) were operated under standing sedation and epidural anesthesia. Median hospitalization period was 6.5 days (Q1-Q3 5 to 8.3 days). The anal margi...
Monitoring of Non-Lame Horses and Horses with Unilateral Hindlimb Lameness at Rest with the Aid of Accelerometers. The aim of this study was to determine whether horses exhibiting unilateral hindlimb lameness unload (rest) the lame limb more than the contralateral limb. The resting/unloading of the hindlimbs and the time spent lying down were measured using accelerometers. Ten non-lame horses and 20 lame horses were recruited for participation and monitored for 11 h overnight with accelerometers (MSR145, sampling rate: 1 Hz, and measuring range: ±15 g) attached to the lateral metatarsal and metacarpal regions of each limb. Metatarsal and metacarpal orientation were used to determine whether the limb was u...
Application of the horse grimace scale in horses with dental disease: Preliminary findings. Dental disease is a common but often under-recognised condition in horses, possibly due to an inability to recognise clinical signs of oral discomfort. Some dental disorders are reportedly more painful than others, but there is no current metric by which dental pain can be objectively assessed. This study aimed to determine whether a facial expression-based pain scale offered an objective and reliable method for assessing dental pain in horses. It was hypothesised that dental disorders affecting the periodontium would produce high pain scores. Twelve horses with dental disease were evaluated f...
Gold-Induced Cytokine (GOLDIC) for the Management of Knee Osteoarthritis: A Systematic Review. Gold-induced cytokine (GOLDIC) is a novel orthobiologic approach utilizing gold particles to produce a serum rich in immunoregulating cytokines and growth factors, which is being explored for its potential in tissue regeneration and treating musculoskeletal issues like knee osteoarthritis (OA). This study aims to review its mechanism of action along with the outcomes of , preclinical, and clinical studies, with a secondary focus on documenting clinical trials related to its use in OA of the knee. A systematic search was conducted in four databases (Embase, Scopus, PubMed, Web of Science) for...
Evaluation of the Rostral Inferior Alveolar Nerve Block via the Mental Foramen in Equids: In Vivo Efficacy Testing. The use of proper sedative and regional anesthetic protocols is essential when performing equine dental surgical procedures under standing sedation. The efficacy of the rostral inferior alveolar nerve block via the mental foramen has not been previously studied. Aims of this study included determining the efficacy of the block, investigating whether any region (labial mucosa, alveolar mucosa, or teeth) was more reliably anesthetized, and if differences in efficacy existed between bilateral and unilateral blocks. In this blinded trial, 10 horses each were randomly assigned to receive a left uni...
Lidocaine’s Ineffectiveness in Mitigating Lipopolysaccharide-Induced Pain and Peristaltic Effects in Horses. The present study involved seven horses in a randomized crossover clinical trial to evaluate the effect of lidocaine on horses with induced endotoxemia. Horses received intravenous lidocaine (1.5 mg/kg bolus, followed by 0.05 mg/kg bwt/min) or placebo (0.9% sodium chloride at the same manner) one hour before LPS administration (0.03 μg/kg, IV infusion over 30 min). We monitored clinic and hematologic parameters, abdominal auscultation, ultrasound, and pain over time. No relevant clinical differences existed between treatments regarding peristalsis, abdominal pain, or any other parameters befo...
Improvement of gastric disease and ridden horse pain ethogram scores with diet adaptation in sport horses. Gastric disease is highly prevalent in sport horses and may lead to poor performance, cause behavioral changes and impact welfare. Objective: Assess whether diet affects gastric disease and pain expression during riding, and whether it has an impact on physiological and locomotor variables during an exercise test, including jumps. Methods: Nine healthy show-jumping Warmbloods trained at the same stable. Methods: Prospective observational cohort study. The horses receiving a pelleted diet, high in sugar and starch (>30%), were examined at T0 and after 12 weeks (T12) of changing to a cooked...
Investigating conditioned pain modulation in horses: can the lip-twitch be used as a conditioning stimulus? Study objective was to evaluate whether the application of a lip twitch could be proposed as conditioning stimulus in the context of a novel Conditioned Pain Modulation (CPM) assessment paradigm for use in horses. The study was a prospective, experimental, randomized trial. Twelve healthy horses were evaluated in two experimental sessions. The lip twitch was used as the conditioning stimulus in both sessions; electrical stimulation was used as the test stimulus in one session, while mechanical and thermal stimulations were used in the other. Differences between thresholds recorded before and d...
Local anaesthetic delivery through indwelling retrobulbar catheters for ocular pain control in horses. Equine corneal disease is common and painful. Current pain mitigation strategies are often suboptimal, especially early in the disease. Objective: To evaluate the effects of local anaesthetic delivery via indwelling retrobulbar catheter on corneal sensitivity, pupil size, pupillary light responses (PLRs), and ocular motility in normal horses. Methods: Randomised, controlled crossover experiment. Methods: One eye was randomly selected from seven horses. A 20-gauge catheter was placed in the retrobulbar space and injected with 10 mL of 0.5% bupivacaine or 0.9% saline. Cochet-Bonnet esthesiomet...
Lameness of horses is effectively ameliorated with a low volume of mepivacaine administered as a palmar digital nerve block. To determine the effect of 1.5 mL 2% mepivacaine, 0.75 mL 2% mepivacaine, and a combination of 0.75 mL 2% mepivacaine with epinephrine (1:200,000 solution) administered over each palmar digital nerve (PDN) to 6 horses with naturally occurring lameness caused by digital pain. Methods: In a crossover study design, 6 horses with forefoot-related lameness were randomly assigned to 1 of 3 groups. Each group received, on different study days, a PDN block using 1.5 mL of 2% mepivacaine, 0.75 mL 2% mepivacaine, or 0.75 mL of a combination of 2% mepivacaine and epinephrine (1:200,000 solution) injected...
A blinded crossover study design to evaluate midazolam as an adjunct for equine standing sedation for routine oral examinations. This study aimed to evaluate the effects of including midazolam to a common equine standing sedation protocol for routine oral examination. Twelve horses underwent two examinations at least seven days apart. Horses were randomly assigned to receive midazolam intravenously (IV) (0.02mg/kg) or a placebo injection of saline (2-2.5mL IV). Five minutes later, detomidine (0.01mg/kg) and butorphanol (0.01mg/kg) were administered IV and horses were placed in standing stocks. A veterinarian blinded to the treatment protocol used a descriptive scoring system to assess degree of ataxia, acceptance of spe...
Noseband type and tightness level affect pressure on the horse’s face at trot. Poor noseband adjustment could create high pressures that may risk pain or tissue damage. Objective: To quantify sub-noseband pressures dorsally over the nasal bone and ventrally over the mandibular rami for a Cavesson, Swedish (crank), Drop and Flash noseband at five tightness levels (2.0 to 0.0 finger equivalents). Methods: In vivo experiments. Methods: Eight high-level dressage horses were ridden at the trot in a straight line by their usual riders. Two small pressure mats, attached to the noseband over the nasal bone and the mandibular rami, collected force (N) and pressure (kPa) data from...
Pharmacokinetics and thermal anti-nociceptive effects of oral morphine in horses. Morphine is an effective analgesic in horses, however, IV administration at therapeutic doses has been shown to produce dose-dependent neuroexcitation and unwanted gastrointestinal effects. The analgesic effects of morphine have, at least in part, been attributed to the morphine-6-glucuronide (M6G) metabolite. Oral administration to horses results in comparable M6G concentrations to that achieved following IV administration of a therapeutic dose without the adverse effects. The anti-nociceptive effects have not yet been reported. In the current study the thermal anti-nociceptive effects of sin...
Effect of repetitive transcranial magnetic stimulation on trigeminal-mediated headshaking in 17 horses. Trigeminal-mediated headshaking is a neuropathic facial pain condition in horses. No treatment has been entirely successful. Repetitive transcranial magnetic stimulation (rTMS) is used in human medicine as a treatment for various neuropathic pain conditions, and good results have been achieved in cases of trigeminal neuralgia. Objective: Apply rTMS to horses with trigeminal-mediated headshaking (TMHS) and to evaluate tolerability, application of the setting, and success rate. Methods: Seventeen horses with nonseasonal signs of TMHS. Methods: Other underlying causes of headshaking were ruled ou...
Early recognition of pain: improving colic outcomes in horses in Senegal. Limited knowledge exists on recognition and treatment of equine abdominal pain in low- and middle-income countries. This study aimed at finding indicators for recognizing abdominal pain, evaluating responses to clinical and behavioral changes, and assessing the impact of timely referral on colic outcomes in a suburban region of Senegal. The final goal was to identify factors that may be leveraged to improve the outcome of horses presented for abdominal pain in Senegal. Unassigned: Retrospective, observational cohort study. Unassigned: Data from 26 foals and 40 adult horses referred for acute a...
Comparison of a hand-held high-end resolution infrared thermography (FLIR P640) and a smartphone infrared thermographic device (FLIR One) for the assessment of skin surface temperature after anaesthetising the median nerve in Healthy horses. Accuracy of a median nerve block is normally assessed by testing skin sensitivity on the medial and dorsal aspects of fetlock and pastern. The present study evaluated subjective and objective analysis of skin surface temperature obtained with two different infrared (IR) thermography cameras (a high-end [FLIR P640] and a smartphone IR thermography device [FLIR One®]) before and after anaesthesia of the median nerve. Thermographic images were obtained at 0, 30, 60 and 90 minutes after performing a median nerve block with 2% mepivacaine hydrochloride. The subjective analysis of thermographic ima...
Bupivacaine and liposomal bupivacaine do not produce prolonged perineural anesthesia in a lameness model and are detectable beyond clinical effect in conditioned Thoroughbreds. To determine (1) the dose of liposomal bupivacaine (LB) to eliminate grade 2 of 5 lameness, the (2) duration of analgesia of LB versus bupivacaine hydrochloride (BH), and (3) LB pharmacokinetics versus BH. Methods: A reversible lameness model was validated in conditioned Thoroughbred horses (n = 12), aged 3 to 10 years. A dose-response trial compared subjective and objective lameness following abaxial sesamoid block with 25 mg BH/nerve or 30, 60, or 133 mg LB/nerve (n = 3/group). The LB dose that eliminated lameness and reduced lameness for the longest was used for blinded, randomized, crossov...
Development of an ultrasound-guided radiofrequency ablation technique in the equine cadaveric distal limb: histological findings and potential for treating chronic lameness. Radiofrequency (RF) relieves chronic pain in humans, but it is unexplored in horses affected by chronic lameness. This study aims to describe the technique and the histological effects of ultrasound (US)-guided radiofrequency ablation (RFA) of palmar digital nerves (PDNs) in horse's fetlock and pastern, . Unassigned: After assessing the US anatomy of lateral and medial PDNs in fetlock and pastern ( = 10 horses; 20 forelimbs), US-guided RFA was performed on these sites in cadaveric forelimbs ( = 10) applying four different settings with increasing invasiveness ( = 40 total treatmen...
Parasympathetic tone activity, heart rate, and grimace scale in conscious horses of 3 breeds before, during, and after nociceptive mechanical stimulation. Parasympathetic tone activity (PTA) in response to nociceptive stimulus in conscious non-sedated horses is unknown. Objective: Study PTA, heart rate (HR), and horse grimace scale (HGS) at rest and during mechanical nociceptive stimulation. Methods: Ninety healthy young adult horses (females, males): 30 each of Friesians, Quarter Horses, and Warmbloods. Methods: Prospective control study. The study consisted of habituation to equipment (Day 1), baseline recordings (Days 2 and 3), and nociceptive testing applying mild pressure to the metacarpus (Day 4). Parasympathetic tone, HR, and HGS were rec...
Enhancing the Horse Grimace Scale (HGS): Proposed updates and anatomical descriptors for pain assessment. The use of grimace scales enables the clinical identification of changes in the facial expressions of animals caused by pain. The Horse Grimace Scale (HGS) is one such tool, comprising a pain coding system based on facial expressions and assessing six Facial Action Units (FAUs). Each FAU is accompanied by descriptions and anatomical details to assist the evaluator. However, the morphological descriptions for certain FAUs in the HGS are not sufficiently detailed, potentially hindering accurate interpretation. This study is an analytical investigation aimed at enhancing the morphoanatomical deta...
Nerve entry points in the mimic musculature of the horse head. Facial expressions are important in pain recognition in horses, but current observation-based pain scales remain subjective. A promising technique to quantitatively measure subtle changes in expression patterns, including changes invisible to the human eye, is surface electromyography (sEMG). To achieve high-quality and reliable sEMG signals, unilateral placement of bipolar electrodes is required in relation to the motor endplates (MEP). We aimed to localize the nerve entry points (NEPs; where the nerve branch first pierced the muscle belly) and the direction of the terminal nerve endings to e...
Effects of intra-articular anesthesia of the tarsometatarsal joint on skin sensation of the distal limb in horses. To determine with mechanical nociceptive threshold (MNT) testing whether distal limb skin sensation is affected by intra-articular anesthesia of the tarsometatarsal joint (TMTJ). Unassigned: This was a prospective cohort study. Ten client-owned horses that had intra-articular TMTJ anesthesia were included in the study. The MNT was measured at 6 sites on the distal limb at 3 time points: before anesthesia (T0) and at 10 min (T10) and 30 min (T30) post-injection. Linear mixed-model analyses were done, with the significance level set at P < 0.05. Unassigned: There was an increase in MNT (P = 0...
An Explorative Anatomical Study on Inter-Individual Variation of the Tibial Nerve and Landmarks for Perineural Anesthesia in Horses. Perineural anesthesia of the tibial nerve can be performed ultrasound-guided or blindly, with the latter still being commonly used in equine practice due to practical constraints, despite its lower accuracy and hence, common failure to achieve desensitization. This may be associated with anatomical variations or inadequate landmarks for injection. To examine the course of the tibial nerve, document potential anatomical variations, and determine optimal landmarks for perineural injection, dissection was conducted along the medial aspect of the tibia in 10 paired cadaver hindlimbs. No anatomical...
Time budgets and weight shifting as indicators of pain in hospitalized horses. Pain assessment in horses presents a significant challenge due to their nonverbal nature and their tendency to conceal signs of discomfort in the presence of potential threats, including humans. Therefore, this study aimed to identify pain-associated behaviors amenable to automated AI-based detection in video recordings. Additionally, it sought to determine correlations between pain intensity and behavioral and postural parameters by analyzing factors such as time budgets, weight shifting, and unstable resting. The ultimate goal is to facilitate the development of AI-based quantitative tools f...
Unusual left colon displacement and clockwise torsion in a 10-month-old Arab filly: A case report. In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10-month-old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention. A 10-month-old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the ...
Management of paracondylar process fracture in three horses. Fractures of the paracondylar process of the occipital bone may cause headshaking, neck pain and neurologic deficits. The condition is being recognised more frequently with increasing availability of computed tomography. However, to date only limited information is available as to presentation, treatment, surgical approach and outcome. Objective: To describe the clinical signs, imaging findings, treatment, surgical approach and outcome in three horses diagnosed with paracondylar process fracture. Methods: Retrospective case series. Methods: Clinical records and diagnostic images of affected ca...
